The Role of Dairy in the Nutrition Management for PCOS

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Are you totally confused about dairy and if it’s good or bad for PCOS? Do an internet search for dairy and you will be sure to come up with conflicting view points in women with PCOS. In this article, we review the most recent research on the impact of dairy, if any, in women with PCOS. Surprise: You may be able to eat your cheese after all.

Acne and the Connection Between Dairy, Androgens and Insulin

Got acne? You may want cut back on milk. This, according to new research published in the Journal of the Academy of Nutrition and Dietetics, showing a positive link between dairy consumption and acne (1).

In their review of 27 studies, researchers concluded that frequent dairy intake as well as a high glycemic load diet (GL) contributes to acne. As the figure below shows (1), there are several ways dairy influences acne development:

1. Dairy ingestion can lead to increased insulin levels leading to increased cellular growth and acne.
2. Dairy products are carbohydrates which stimulate insulin growth factor 1 (IGF-1), resulting in high insulin levels. “Both skim and whole milk (but not cheese products) have a 3 to 6 fold higher glycemic-load compared with other carb foods”. High insulin levels lead to increased androgens creating more sebum production.
3. Milk contains growth-stimulating hormones, including IGF-1 and dihydrotestosterone (DHT), which increases androgens resulting in higher sebum production and acne.

 Acne-and-diet-image-from-JA

 

1.

What’s interesting is that this review showed fat-free and low-fat milk had the most impact on acne development whereas full fat milk didn’t have as strong effect. Nor did cheese.

Individuals who suffer from a type of acne known as hidradenitis suppurativa (HS), which causes painful and large boils under the skin, have been shown to have symptoms improve with a dairy free and low glycemic-load diet (11).

PCOS and Dairy

Studies investigating a link between PCOS and dairy are extremely limited. There are only 2 in fact and none of them are randomized controlled studies or involve a good number of women. Here’s what the available studies show:

In a cross-sectional design study involving 400 Iranian women with PCOS, researchers found a higher consumption of low- and free-fat milk among women with PCOS who self-reported their intake.

A small study (24 women) found that a low starch/low dairy diet resulted in weight loss, improved insulin sensitivity and reduced testosterone in women with PCOS. This diet was very low in calories, eliminated all starches, and included 1 ounce of cheese daily.

A randomized controlled trial did show that the DASH eating pattern resulted in the improvement of insulin resistance, serum hs-CRP levels, and abdominal fat accumulation in overweight women with PCOS. The DASH diet is designed to be rich in fruits, vegetables, whole grains, and low-fat dairy products and low in saturated fats, cholesterol, refined grains, and sweets.

These few studies show that women with PCOS can eat moderate amounts of dairy and still see improvements in metabolic and reproductive aspects when accompanied by other nutrition modifications like a low GL diet.

Fertility and Dairy

Dairy intake, specifically full-fat dairy products, has been shown to have a positive impact on fertility.  In their prospective cohort study,Chavarro et al. found that high intake of low-fat dairy products may lead to an increase in the women’s risk of ovulation-related infertility, whereas incorporating more high-fat dairy foods may decrease the risk for infertility.

How Much and What Type of Dairy Is Ok?

Hate to give up your cheese entirely? You may not need to. No randomized controlled trials have examined the relationship between milk, cheese or dairy consumption and acne. Most of the studies conducted have relied on self-reported dairy intake and focus on milk, not cheese or other dairy sources (2-6). The evidence so far points to fat-free and low fat dairy as the most influential factors in women with PCOS.

Compared with low-fat dairy products, whole milk and fat-rich dairy products have a higher estrogen concentrations and lower levels of androgens. Estrogen can decrease levels of IGF-I. Skim and whole milk (but not cheese products), have a three- to six-fold higher GL response (11). Cheese has been reported to be less insulinemic than other dairy products (12).

There aren’t any formal guidelines as to how much dairy consumption to have or if it’s necessary to completely avoid dairy if you have acne or PCOS. In one study, the risk of acne increased when 3 or more servings of milk were consumed (6). Because of the direct influence on androgens and insulin, it is advisable for women with PCOS (who have acne or not) to limit their dairy intake to 2 or fewer servings each day and go for the full-fat versions.

A serving of dairy is:

1 cup milk or yogurt, or
1.5 ounces hard cheese

We recommend organic sources of dairy including grass-fed butter and cheeses..

Non-Dairy Calcium Sources

American women need 1,000 mg of calcium daily. There are ways to get calcium other than from dairy. Milk alternatives such as almond, hemp, rice and coconut milk can easily be used in place of cow’s milk (but usually lack the protein content of cow’s milk). Many vegetables (kale, broccoli, bok choy, for example) provide a good source of calcium as does fish (5 ounces of salmon contain more calcium than a glass of milk), seeds (chia, sesame and flax) and quinoa.

Bottom Line

Much more research, especially randomized controlled trials, need to be done on the role of dairy in women with PCOS. If you do have acne or want to see if dairy has an effect on you, you may first want to start with eliminating dairy entirely and slowly reintroduce it in small amounts after 2 weeks to see if it has an effect. Some women with PCOS (and those without it too) can’t tolerate any dairy or they will break out in acne. Others can tolerate it just fine. Be sure to get your calcium and vitamin D from other sources if you do cut back on dairy. 

Have you cut back on dairy and seen an improvement in acne or other PCOS symptoms? Let us know!

References
1. Acne: The Role of Medical Nutrition Therapy,” Jennifer Burris, MS, RD, CDE, CNSC, CSSD; William Rietkerk, MD, MBA; Kathleen Woolf, PhD, RD, FACSM. Journal of the Academy of Nutrition and Dietetics, Volume 113/Issue 3 (March 2013).
2. Danby FW . Nutrition and acne . Clin Dermatol . 2010;28(6):598–604

3. Smith TM , Gilliland K , Clawson GA , Thiboutot D . IGF-1 induces SREBP-1 expression and lipogenesis in SEB-1 sebocytes via activation of the phosphoinositide 3-kinase/Akt pathway . J Invest Dermatol . 2008;128(5):1286–1293.

4. Abedamowo CA , Spiegelman D , Danby FW , Frazier AL , Willett WC , Holmes MD . High school dietary dairy intake and teenage acne . J Am Acad Dermatol . 2005;52(2):207–214.

5. Abedamowo CA , Spiegelman D , Berkey CS , et al. Milk consumption and acne in adolescent girls . Dermatol Online J . 2006;12(4):1.

6. Di Landro A , Cazzaniga S , Parazzini F , et al. Family history, body mass index, selected dietary factors, menstrual history, and risk of moderate to severe acne in adolescents and young adults . J Am Acad Dermatol . 2012;67(6):1129–1135.

7. Office of Dietary Supplements: http://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/

8. Rajaeieh G1, Marasi M2, Shahshahan Z3, Hassanbeigi F2, Safavi SM1. The Relationship between Intake of Dairy Products and Polycystic Ovary Syndrome in Women Who Referred to Isfahan University of Medical Science Clinics in 2013.Int J Prev Med. 2014 Jun;5(6):687-94.

9. Chavarro JE, Rich-Edwards JW, Rosner B, Willett WC. A prospective study of dairy foods intake and anovulatory infertility.Hum Reprod. 2007 May; 22(5):1340-7.

10. Jennifer L. Phy,1,* Ali M. Pohlmeier,2,3 Jamie A. Cooper,2 Phillip Watkins,4 Julian Spallholz,2 Kitty S. Harris,5 Abbey B. Berenson,3 and Mallory Boylan2. Low Starch/Low Dairy Diet Results in Successful Treatment of Obesity and Co-Morbidities Linked to Polycystic Ovary Syndrome (PCOS). J Obes Weight Loss Ther. 2015 Apr; 5(2): 259.

11.Danby FW1. Diet in the prevention of hidradenitis suppurativa (acne inversa).J Am Acad Dermatol. 2015 Nov;73(5 Suppl 1):S52-4.

12. Hoyt G, Hickey MS, Cordain L. Dissociation of the glycaemic and insulinaemic responses to whole and skimmed milk. Br J Nutr. 2005;
93(2):175-177.

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Comments (15)
  • Chantelle

    November 30, 2014 at 7:58 pm

    I have sucessfully introduced a low gi diet as well as eliminating dairy. It was only a matter of days before I noticed a transformation to my skin. I have been eating this way for two months now and I am virtually spotless. I have suffered with acne relentlessly between the ages of 13 – 34. It has been horrific. I have mild hirsutism and don’t consider that part of pcos significant, however I have noticed a slower rate of growth. My daily diet also includes – a massive mug of spearmint tea (made from dried spearmint leaves) – sesame seeds daily (either in tahini, halva or raw form) – greens (kale, spinach, watercress) -a vit d3 supplement – a zinc supplement – nuts and seeds (particularly sunflower and pumkin) I do not drink alcohol or caffine. I drink a couple of tablespoons of apple cider vinegar on occasions when I may be about to eat something higher carb. So that is my experience of what you need to do to stop acne caused by insulin resistance / pcos. No doubt some people will think its not worth it, but after a while the foods you eat just becomes a habit and you don’t even miss the white bread or the glass of wine.

  • Marie

    January 18, 2015 at 7:58 pm

    Eliminating dairy has entirely cleared up my acne in conjunction with other dietary changes and supplements. There is a clear link between dairy and acne in my personal case of pcos.

  • Sonja

    August 23, 2015 at 7:58 pm

    The reduction of dairy products and also gluten products helped with my acne breakouts almost immediately. I was able to notice a difference with in a week to two of the dairy reduction. I occasionally have cheese but I am consistently regretful of the decision. I am careful to say reduction of dairy because I have refused to omit organic butter from my diet. My hair is still thinning but not at the same rate. The hirsutism has increased but I believe it is due to my Biotin intake increase.

  • YB

    March 29, 2016 at 9:06 am

    Hi Prof. Grossi:

    “What’s interesting is that this review showed fat-free and low-fat milk had the most impact on acne development whereas full fat milk didn’t have as strong effect. Nor did cheese.”

    FYI, when whole milk is processed/centrifuged to reduce milk the effect is an increase in the male hormone, androgen. So whole milk actually has less androgen than low fat milk which explains this effect.

  • Joy

    April 7, 2016 at 3:06 pm

    Going dairy free made an almost immediate difference in my skin. I still have oily skin, but now I have very few breakouts, only around the time of my period. And very few at that!

  • K

    April 28, 2016 at 11:07 pm

    Before being diagnosed with PCOS, I tried an elimination diet, cutting out dairy, gluten, soy, and a few other things for 2-3 weeks. I had mild acne since my teen years, and at the time, was in my early 20s, but after this diet, my skin cleared up. I added back the foods that I eliminated one at a time to see if I had any adverse reactions. A day or two after I added back dairy, I noticed some acne. I tried eliminating it again, then added it back, and the same thing happened. I actually tried this a total of FIVE times to make sure it was the dairy because I didn’t want to give up an entire food group if I didn’t have to. One of these times, I had about 3 servings of dairy in one day, which I think included Greek yogurt, cottage cheese, and whey protein powder. Within 1-2 days, I had the worst breakout of my life with most of my forehead covered in little pimples.

    About 3 years later, I continue to avoid pretty much all dairy. I still get 1-2 occasional pimples on my chin, but also have periods where my skin is clear. I seem to get an extra pimple or two if I accidentally have a small serving of dairy, but this rarely happens. I don’t seem to notice much of an effect if I have butter, possibly because it is mostly fat.

  • Soni

    February 15, 2017 at 11:27 am

    My acne goes away completely after quitting sugar and dairy.In less than three days results start showing.

  • SUMAN PREET KAUR

    May 12, 2017 at 4:33 am

    Hi,

    I have PCOS from last few months. I have already excluded dairy products from my diet but as it is too hot nowadays I sometimes feel like having curd/yogurt. Can I have the same of about on bowl on a daily basis?

  • Angela Grassi

    May 12, 2017 at 8:31 am

    Every woman with PCOS is different. Many women can tolerate small amounts of dairy, say a serving or two, with no problem. As long as you tolerate dairy and haven’t noticed an impact on your symptoms such as acne, enjoy your yogurt 🙂

  • Jeannie

    May 31, 2017 at 11:12 pm

    Excellent article with science based information. Thank you.

  • Aimee

    September 23, 2017 at 8:30 pm

    My acne goes CRAZY along my chin line and my face gets swollen when I have too much dairy. When I cut it out completely, my face stays clear and no swelling. I’ve found lactose free and vegan cheeses that I can have and don’t have any issues with, but I love cheese so it’s difficult to cut out all the time.

  • Fiona

    November 4, 2017 at 6:47 pm

    I often consume milk as my post-workout drink. Since I have PCOS I work out, do strength training, etc and milk is my go-to beverage to build muscle and I don’t have any pimples considering my often intake of dairy. I really feel okay and good about drinking milk. Perhaps it’s case to case basis?

  • Angela Grassi

    November 13, 2017 at 9:35 am

    Fiona, Yes, there is still so much we don’t know about the role of dairy for PCOS women. What we do know is that fat free milk is high in glycemic index and in some people, has the potential to increase acne. If you tolerate milk fine, please enjoy it! It is a great recovery drink for athletes.

  • Kelly Ransdell

    November 14, 2017 at 6:18 pm

    Hi! Does Whey protein have an effect on IGF-1 levels? Or is it something else in dairy?

    Also, I was told by my endocrinologist that I do NOT have the “insulin-related” PCOS—does this mean my diet does not affect my symptoms? Thanks!

  • Angela Grassi

    November 15, 2017 at 9:17 am

    Kelly, Yes, whey protein does seem to affect IGF-1 levels but we do see a difference between fat free and full fat milk. The latter doesn’t have quite as high GI.

    If your docotor says you don’t have insulin resistance, it can still mean that your insulin levels are high, but not high enough to cause resistance.

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