The Role of Dairy in the Nutrition Management of PCOS
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.
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.
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!
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;