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Polycystic Ovary Syndrome (PCOS) is an endocrine disorder that affects about 7% of women — and likely more since it often goes undiagnosed. It’s such a complex, nuanced topic that we’re all still wrapping our heads around but one thing is for certain here – women with PCOS are much more likely to be deficient in critical nutrients. Even if you’re eating a diverse diet and trying to get as much color on your plate as possible, you may still be missing out on certain micronutrients for various reasons. So let’s dive into some widely researched nutrients that, when lacking, can contribute to characteristic PCOS markers and symptoms. 

Carnitine 

This amino acid plays an essential role in energy production, oxidative stress, and glucose metabolism. It does this by transporting fatty acids into your mitochondria where they can be used as fuel for the rest of your body. You’ll see carnitine in two different isomers (aka forms), L-carnitine and D-carnitine, but L-carnitine is the one we will focus on since it’s the one used in energy metabolism. 

While there are many reasons someone may be deficient in carnitine (liver disorders, meds, genetic disorders, etc), it’s particularly common in people who don’t eat animal products (since it’s found in meat) as well as women with PCOS. Research from the past several years suggests that low L-carnitine levels may be associated with high androgen levels and/or insulin resistance in women with PCOS (1). Supplementing with L-carnitine increases sex hormone binding globulin (SHBG) which is a protein that binds to testosterone in your blood and reduces androgen levels (as well as the unwanted symptoms associated with them). Additionally, taking L-carnitine has been shown to decrease insulin levels, LDL (“bad” cholesterol) levels, and BMI  in women with PCOS while increasing their HDL (“good” cholesterol) levels (3). Some research also suggests that L-carnitine supplementation promotes regular menstrual cycles, increased ovulation rate, and, as a result, fertility (4). 

Foods rich in carnitine are: beef (by far the highest), pork, poultry, fish, dairy products and avocado.

Vitamin D

We all know that a vitamin D deficiency seriously impacts anybody, but it’s particularly detrimental in women with PCOS. A vitamin D deficiency can cause insulin resistance, weight gain, and higher risk for diabetes and heart disease, which are all correlated with PCOS.

In regards to fertility, vitamin D is essential for proper maturation and development of eggs in your ovaries. So without adequate vitamin D, your ovaries have trouble producing fertile eggs and you may struggle to get pregnant. Supplementing with vitamin D has been shown to aid in the creation of healthy follicles, which in turn improve ovulation and fertility (6). This is huge for women with PCOS! On the metabolism side of things, vitamin D helps insulin to break down glucose in your body. Therefore, a lack of vitamin D can lead to insulin sensitivity and other metabolic conditions. 

Foods rich in vitamin D are: salmon, cod liver oil, tuna, swordfish, sardines, beef liver and egg yolk. You’ll sometimes see orange juice, cereals or dairy products fortified with vitamin D these days since so many of us are deficient. 

Omega 3’s

These long-chain polyunsaturated fatty acids (PUFAs) are found in wild-caught fatty fish like salmon, mackerel and sardines. Research shows that omega 3s can reduce testosterone levels in women with PCOS by increasing sex hormone binding globulin (SHBG) levels – remember that these are proteins that snatch up excess testosterone floating around in your blood (7). More generally speaking, we know that omega 3s can help reduce systemic inflammation in your body and since PCOS is considered an inflammatory condition, omega 3s may help reduce PCOS specific inflammation and improve insulin sensitivity. 

Foods rich in omega 3s are: salmon, mackerel, cod liver oil, salmon fish oil, herring, tuna, sardines, anchovies, flaxseeds, walnuts, chia seeds, natto (Japanese fermented soybeans) and egg yolks.

Vitamin E

This fat-soluble vitamin acts as a powerful antioxidant in your body by hunting down and attacking free radicals that cause oxidative damage to your cells. New research shows that vitamin E’s antioxidant properties can potentially increase the thickness of the uterine lining in women with unexplained fertility (8). 

When combined with other nutrient supplements, vitamin E is particularly effective in treating PCOS. One study demonstrated that taking vitamin E with Coq10 improves SHBG levels in women with PCOS, which in turn lowered their free testosterone levels (9). Additionally, combining vitamin E with omega 3 supplementation improved insulin resistance and androgen levels in women with PCOS (10). 

Foods rich in vitamin E are: wheat germ, sunflower seeds, almonds, peanuts, leafy greens, pumpkin, red bell pepper, asparagus, mangoes, and avocado.

Vitamin A

Also known as retinol, vitamin A is another important fat-soluble vitamin for women with PCOS. One research study took a retinol derivative and applied it to the cells of women with PCOS, noticing that it increased levels of dehydroepiandrosterone (DHEA), the steroid hormone precursor to both estrogen and testosterone. The retinol derivative also increased the accumulation of cytochrome P450 17α hydrxylase (CYP17), an important enzyme involved in androgen production and your body’s own synthesis of retinol (11).

Foods rich in vitamin A are: beef liver, leafy greens, tomatoes, red bell pepper, cantaloupe, fish oils, milk and eggs.

Probiotics

Turns out that most women with PCOS have some sort of gut dysbiosis, often paired with leaky gut and/or inflammation of your gut lining. Interestingly, women with a lower diversity in their gut microflora have higher androgen levels, total testosterone levels, and hirsutism (male/excess hair growth patterns) (12). 

As we mentioned before, PCOS is a chronic state of inflammation and it’s clear that gut dysbiosis and inflammation go hand in hand. Some scientists postulate that an imbalance of gut bacteria increases the amount of colonic bacteria circulating in your body, which sparks a chronic inflammatory response. This process impacts insulin receptors and biochemical pathways involved in PCOS. So by supplementing with a high-quality probiotic, some researchers believe that PCOS markers and symptoms will improve (13). Lastly, a diet rich in probiotics can actually delay the onset of glucose intolerance, high blood sugar (hyperglycemia), and high insulin (hyperinsulinemia) – all metabolic conditions associated with PCOS (14). 

Foods rich in probiotics are: kefir, sauerkraut, yogurt, kombucha, natto, raw cheese and milk, raw apple cider vinegar, brine-cured olives, tempeh, miso, cultured buttermilk, and kimchi.

Chromium

This trace mineral boosts insulin function in your body which we now know is critical in women with PCOS! In particular, chromium helps lower blood sugar and insulin levels. One study showed that supplementing with chromium (in the form of chromium picolinate) decreased fasting blood sugar and insulin levels, therefore increasing insulin sensitivity in women with PCOS (15). 

These impressive results rival those of metformin, the highly prescribed drug used in the treatment of PCOS. Also, high blood sugar levels directly relate to weight gain and hormonal imbalances so managing your blood sugar levels with chromium could drastically impact the commonly reported PCOS symptoms of weight gain and high androgens. 

Foods rich in chromium are: grape juice, whole wheat flour, ham, brewer’s yeast, orange juice, beef, tomato juice, apples and green beans.

Magnesium

We probably don’t have to tell you this by now, but magnesium is a critical mineral for overall health. It plays a central role in over 600 reactions in your body, from muscle function to cellular metabolism. Women with PCOS are typically deficient in magnesium and this is even more likely if you’ve ever taken birth control pills since they leach magnesium from your body. In order for you to break down sugar and use insulin properly, you absolutely need magnesium. One study found that taking 300 mg of magnesium each day improved fasting blood sugar and insulin levels, suggesting that magnesium supplementation can help improve insulin resistance. 

In that same vein, metabolic syndrome is a cluster of conditions that drastically increase your risk of heart disease, stroke and diabetes. Some of the symptoms associated with metabolic syndrome are: excess fat around your waist, high blood pressure, low HDL (“good”) cholesterol, high triglyceride levels, and high fasting blood sugar levels. Fortunately, magnesium has been shown to help women diagnosed with metabolic syndrome, which is a leading cause of PCOS (17). Remember when you’re selecting a magnesium supplement to opt for highly absorbable forms! Look for chelated forms where magnesium is bound to an organic compound that helps it across your gut lining, like magnesium glycinate, citrate, chloride and aspartate. 

Foods rich in magnesium are: pumpkin seeds, almonds, peanuts, soybeans, leafy green, white potatoes (with skin), brown rice, oatmeal, salmon, beef, poultry, bananas, raisins, dark chocolate, milk and yogurt. 

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