Glycemic Index & Glycemic Load
What to Know to Help Regulate PCOS & Improve Your Menstrual Health with Nutrition
A new diagnosis of PCOS, and all of the diet and lifestyle recommendations that come with it, can feel incredibly overwhelming. Not to mention the amount of information from doctors, influencers, and well meaning “experts” can further add to the confusion.
If you’re a millennial, you will probably remember hearing about glycemic load (GL) and glycemic index (GI) in the early to mid-2000s as the “next big thing” when it came to weight and diabetes management. While here at BNT we are never going to encourage “fad diets,” knowing a bit more about the glycemic index and glycemic load of the foods you eat can actually be a not-so-secret superpower to help you manage your PCOS through nutrition, improve ovulation and your cycle health, and, if it is your goal, increase your chances of getting pregnant!
Glycemic Index & Glycemic Load: Definitions First
The glycemic index (GI) ranks carbohydrate-containing foods on a scale of 0-100 based on how quickly they will raise your blood sugar levels after eating, with straight glucose as the benchmark (100).
Glycemic Load (GL) is a measure of how much a typical serving of food raises blood sugar, considering both the quality - via its glycemic index - and quantity of carbohydrates.
Can we have an example of why it matters to think about both? Of course!
Watermelon is considered a high glycemic index food because it could increase blood sugar quickly, however at typical portions, the total carbohydrate amount, fiber, and water content actually results in only a small increase in blood sugar, resulting in it being a low glycemic load food.
(See the references and resources at the bottom for a comprehensive list of the glycemic index and load of many foods.)
Why Does This Matter for Those with PCOS?
Somewhere between 50 and 70% of women with PCOS are insulin resistant(1). But Cameron, what does it mean to be insulin resistant?? Insulin is a hormone produced by the pancreas that is responsible for getting glucose (sugar) out of your blood stream and into your cells to use. In many people with PCOS, your body’s cells have a “resistant” response to insulin, leading to both sustained high blood sugar, and the pancreas has to send out more and more insulin to manage the high blood sugar, leading to hyperinsulinemia. Over time, this state of chronic high blood sugar and high insulin and can put someone at increased risk to developing many issues including but not limited to(2):
Excess androgen hormone production
Chronic inflammation
Development of type 2 diabetes
High blood pressure
Ovulatory dysfunction
Menstrual irregularities and infertility
Cardiovascular Disease
Increased risk of preeclampsia and gestational diabetes
You can see that PCOS is not just about your ovaries or your cycle health, but has vast implications for your health as a whole. This is why paying attention to the type of carbs you eat can help lead to steadier blood sugar levels, which means your pancreas has to secrete insulin less to process the food you eat.
Why Not Just Eat Super Low Carb?
Most importantly, the BNT dietitians are NOT in the business of stealing joy and making someone miserable by having to eat a very restrictive diet, which is how most of our clients feel about low carb diets. AND, from an evidence based perspective, attempting to achieve a very low carb diet can often lead to a diet that doesn’t have enough energy and nutrition to support healthy cycles or a pregnancy.
Remember, the body views reproduction as a relatively low priority in the context of survival, and if it perceives your diet as starvation, you may see menstrual irregularities, thyroid dysfunction, and impacts on mood(3).
What Matters More, Portion Size or Pairing? And Can We Get Some Examples?
If you are already a Bloom & Grow client, you know that I don’t “prescribe” portions, since everyone is different and appetite and needs vary throughout someone’s cycle. The goal of eating with the glycemic index and glycemic load of foods in mind is to help your body process carbs in a way that supports managing your PCOS.
This can look like overtly choosing low GI/GL foods, like quinoa, beans, brown rice, and whole wheat pastas and breads, but you can also hack your meals by PAIRING foods to help lower the glycemic response of your favorite high GI foods, including dessert(4,5)! Like I said earlier, we are not in the business of stealing joy, but empowering you to enjoy the food you love while managing PCOS as a chronic health condition.
Balance, not perfection is the name of the game here. Some easy pairings you can incorporate:
Having fruit with nuts or nut butter
Having your morning toast with scrambled eggs and cheese
Adding avocado and grilled chicken to a grain bowl
Having your dessert right after a balanced meal, instead of by itself hours later
One of the easiest and most underrated interventions for PCOS is to make sure that breakfast…
1) happens (I know, it can be a tough ask for some) and
2) is a meal that is lower GI/GL with fiber and higher in protein.
Studies have shown this dietary approach can:
help with overall satiety throughout the day (yahoo for feeling less ravenous at that afternoon slump!)
improve blood sugar regulation
lower circulating insulin levels
lower markers of insulin resistance and hormone dysfunction
and improve ovulatory function in as little as 90 days(6).
Here are some great examples of a protein- and fiber-forward breakfast that will help you hit the target of a low GI/GL meal:
Smoothies from our “Secrets to Spinning a Super Smoothie” e-book
Frittata made with veggies and cheese with a small side salad and toast (french bistro vibes anyone?)
Pepper, onion, sweet potato, and sausage hash
Avocado toast with hard boiled eggs
Ready to Seek Additional Support?
Whether you’ve already received a diagnosis of PCOS or think you might have it (some flags to watch for: irregular cycles, or no ovulation if you are tracking, high androgens, male pattern hair growth on face/chin, chest, and body, insulin resistance often seen with a rising A1c lab value, you experience fatigue, cravings, or persistent hormonal symptoms, or have unexplained weight gain), Cameron and the team and BNT are here and ready to support you in developing a long term PCOS nutrition plan that works for you!
References and Resources
Teede, H. J., et al. International evidence-based guideline for the assessment and management of PCOS. Human Reproduction, 33(9),2018: 1602–1618.
Kelly, C.J.G., et al. The long term health consequences of polycystic ovary syndrome. BJOG: An International Journal of Obstetrics and Gynaecology 107(11)2000: 1327–1338.
Podfigurna A, Meczekalski B. Functional Hypothalamic Amenorrhea: A Stress-Based Disease. Endocrines. 2021; 2(3):203-211. https://doi.org/10.3390/endocrines2030020
Basturk B, Koc Ozerson Z, Yuksel A. Evaluation of the Effect of Macronutrients Combination on Blood Sugar Levels in Healthy Individuals. Iran J Public Health. 2021 Feb;50(2):280-287. doi: 10.18502/ijph.v50i2.5340. PMID: 33747991; PMCID: PMC7956086.
Huicui M, Matthan NR, Ausman LM, Lichtenstein AH. Effect of macronutrients and fiber on postprandial glycemic responses and meal glycemic index and glycemic load value determinations. Am J Clin Nutr. Published online February 15, 2017. doi:10.3945/ajcn.116.144162
Jakubowicz, D., et al. Effects of caloric intake timing on insulin resistance and hyperandrogenism in lean women with polycystic ovary syndrome. Clinical Science 125(9) (2013): 423–432.
Cameron Sisler, MS, RD, LDN is a registered dietitian who has spent six years working in higher levels of care, helping clients navigate the complex journey of eating disorder recovery. She is also St. Louis’s leading expert on fertility nutrition, and has used science-backed nutrition and lifestyle guidance to help many people achieve their dream of conceiving. Cameron loves cooking and developing new recipes, and uses her skills in the kitchen to help clients find nutritional solutions that fit their taste preference and lifestyle.