While many people with PCOS tend to have overweight or obese, it’s possible to have PCOS and a healthy body mass index, or BMI (less than 25). This has been described as “lean PCOS.”
But “lean” doesn’t mean better: In fact, having lean PCOS can make it harder to get a diagnosis, even though it causes many of the same long-term health complications as other types of PCOS.
Symptoms of lean PCOS
The symptoms of lean PCOS tend to be similar to symptoms of non-lean PCOS:
- Menstrual issues such as irregular or heavy periods, or no periods at all
- Acne
- Excess growth of dark, coarse hairs on areas like the face, thighs, and chest
- Infertility due to not ovulating
- Insulin resistance, which can lead to abnormal blood sugars and diabetes.
How can it be Diagnosed?
There are different ways to diagnose PCOS.
- The diagnosis is based on having high androgen levels in the blood.
- Menstrual Irregularities.
- Opting for an ultrasound after consulting a specialist: the result showing many cysts on the ovaries (polycystic ovaries) should be considered as part of the diagnosis, but this needs to be handled by an expert.
- Hormonal disorders, like an underactive thyroid (hypothyroidism) or Cushing’s disease, can show up similarly to PCOS.
- A blood test like fasting Insulin, Glucose, and HOMA Index will point to insulin resistance in lean women with PCOS.
Meal planning for lean PCOS
Planning a meal is essential for women with lean PCOS because it can help manage symptoms of lean PCOS. Here are some Smart tips
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.
Eating low Glycemic index (GI) foods
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
Besides including low GI foods, one also needs to consider the overall glycemic load, GL, of a meal to avoid sudden spikes in blood sugar.
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. That is to best use GL control portions of carbohydrate-rich foods, such as brown rice or sweet potato. Pair them with foods containing protein and fat such as fish or chicken. Add a salad to complete your meal.
Women with PCOS should make use of both GI and GL to manage insulin resistance.
Simple Rules to follow are
- You should know the GI of the foods you’re eating. Click here for more. 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.
- Include protein-rich foods at each meal to temper the rise of blood glucose.
- Include healthy 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 flaxseed 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. Women with PCOS are recommended 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.
Manage Plate portions
Opt for cooking with unsaturated fat such as olive oil and follow the plate portion rule method. In this method, 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 Women with lean PCOS
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 with. An excellent strength-training workout includes the 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 bodyweight 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 10th 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 the help of a personal trainer. And, 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 include a one-minute high-intensity interval followed by 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, or 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 Modifications 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 exercises to improve insulin resistance and lower body fat percentage.