Managing PCOS with Food Intake Patterning

Polycystic Ovary Syndrome (PCOS) is a complex hormonal condition that affects millions of women, often beginning in adolescence and continuing through reproductive years, although it can occur later in the reproductive years as well. Its symptoms include irregular cycles, cystic acne, unwanted hair growth, infertility, and weight gain. Complications of uncontrolled PCOS can include endometrial hyperplasia and endometrial cancer – precancer and cancer of the uterine lining. PCOS also increases the risk of developing Type II Diabetes and Obesity if not already present.

What Causes PCOS?

The underlying cause of PCOS is insulin resistance. Insulin is produced in response to eating, and it helps move glucose from the bloodstream into cells to give them energy to work. Genetic predisposition, environmental factors, and diet influence insulin’s ability to do this. If insulin isn’t working efficiently, the body compensates by producing more of it. Chronically high insulin can stimulate the ovaries to produce more androgens (like testosterone), which can lead to acne and hair growth on the face, breasts, and abdomen. These high androgens also prevent regular ovulation, causing periods to become irregular. The high insulin can also cause weight gain and resistance to weight loss.

Conventional Treatments

While conventional treatments like hormonal birth control protect the endometrium, they don’t address the insulin resistance to decrease risks of diabetes, optimize weight, and improve overall health. Sometimes Metformin can be helpful as it decreases insulin levels, but there are ways to do this naturally. Pharmaceuticals, have side effects and only work as long as you are taking them (a “band-aid” approach). At Alive Integrative Medicine, we support women in implementing a more sustainable, root-cause approach that can improve their overall health.

How to lower insulin levels with food patterning

The good news is that you can decrease insulin levels and improve your body’s sensitivity to insulin without pharmaceuticals!

The fastest way to do this is with specific food patterning, including intermittent fasting.
Insulin levels fall between meals but take longer to fall when there is insulin resistance, so the goal in treatment is to give it a longer amount of time for it to decrease. We naturally fast overnight. Extending this time gives insulin more time to fall. Many people start intermittent fasting by skipping breakfast. This can be a very effective approach as it extends your overnight fast by multiple hours. If you are snacking throughout the day, however, skipping snacks can also make a big difference in insulin levels. My recommendation for food patterning is not to focus on an “eating window” but to focus on food intake at no more than two or three isolated times in the day, about 4-6 hours apart. Meals or snacks less than 4 hours apart cause an additional rise in insulin.

Is this a diet? Do I have to restrict what I eat? Should I count calories?

No. In grouping food together into two or three isolated times in the day, you can improve insulin sensitivity and control PCOS symptoms without any specific restrictions on what you eat. How many times you eat and how close together meals or snacks are has a much bigger effect on insulin than how much you are eating and even what you are eating! That said, there are some tips below for preventing low blood sugar and optimizing health on this plan.

I could never skip breakfast! I need energy for my brain to work!

I hear this a lot. Did you know that our bodies are designed to keep blood sugar super stable when we are fasting? The hardest time for blood sugar to stay stable is after we eat. Many people are amazed that they are more clear-headed and able to focus when they fast than after eating breakfast.

I can’t make it four hours to the next meal without snacking

Even many of today’s “healthy” meals are much more carbohydrate dense than they were long ago. When you eat breads, rice, pasta, potatoes, or tortillas, your body is overwhelmed with the load of carbohydrates and makes an overestimate of how much insulin to produce. This overestimate causes a rebound low blood sugar that gives you a very strong food craving about two hours after eating. This can be avoided by decreasing the carbohydrate load in your meal and pairing it with increased protein and
fat. Depending on what you are eating, sometimes my only recommendation is adding more fat to what you are eating in order to get by without that snack afterwards.

I am hungry

Hunger is a sensation that passes and in history hasn’t always been a cue that gets addressed. Our bodies are designed for times of feast and times of fasting. Hunger is different than low blood sugar, however. If you are shaky, sweaty, and lightheaded, you need to eat. If this is occurring, make sure you are eating three meals a day with plenty of fat and protein and check with your doctor on the possibility of adrenal concerns.

How long do I need to fast?

There is no specific time for intermittent fasting. I like to see at least 13 hours between the last meal of one day and the first meal of the next day if you are eating three meals a day. It will be much longer if you are eating just two meals a day.

Timing is important, but here are some optimal foods to eat for clean nutrition at your meal times

• Focus on whole foods. Minimize processed foods like sweetened drinks and white flour products.
• Optimal Proteins: Pasture-raised eggs, wild-caught salmon, organic chicken, tempeh, grass-fed beef, grass fed dairy products if tolerated
• Healthy fats: Avocado, olives, coconut oil, olive oil, grass fed butter and cream, pasture-raised egg yolks
• Slow-digesting carbohydrates: Quinoa, carrots, squash, steel-cut oats, legumes, wild rice, brown rice
• Non-starchy vegetables: Leafy greens, cauliflower, broccoli, bell peppers, onions, zucchini, cucumbers, tomatoes, bok choy, celery, green beans, artichoke, asparagus, mushrooms

Ready to get started?

You don’t need to navigate PCOS alone. Working with a knowledgeable provider can help you uncover root causes and create a sustainable plan tailored to your unique body.
At Alive Integrative, we take a functional approach to health, offering support in nutrition, lifestyle, gut health, and hormone optimization. Whether you’re newly diagnosed with PCOS or looking for more natural ways to feel better, we’re here to support your healing journey.
Reach out to schedule a consultation and begin building a life that supports your body, your hormones, and your sense of vitality—naturally.

Written by Dr. Claudia Knight, DO
Osteopathic Gynecologist

Dr. Claudia Knight is an osteopathic gynecologist specializing in integrative and functional medicine. With a holistic, patient-centered approach, she treats conditions like PCOS, endometriosis, and menopause by addressing root causes. Bilingual in English and Spanish, Dr. Knight is passionate about inclusive care for diverse communities, including the Latino and LGBTQ+ populations. She offers both routine and advanced gynecologic care, blending conventional and alternative treatments to empower women in their health.