By: Theresa Ngozi Agbonome, MD, MPH – California State University, San Bernardino, USA
For the millions of women who suffer from polycystic ovary syndrome (PCOS), diet is the word that is repeated again and again and again as they learn to manage their symptoms such as irregular periods, weight changes and hormonal imbalances. However, a new paper from California State University, San Bernardino puts a question that’s rarely at the forefront: what happens when it just is not possible to eat well?
The one thing Dr. Agbonome hasn’t forgotten in developing her research agenda is that dietary intervention is a difficult plan to execute for a woman with PCOS if she has no consistent and convenient access to healthy food.
More Than a Willpower Problem: PCOS is a condition that affects about one in ten women of reproductive age and can impact nearly every aspect of a woman’s life, including menstrual cycles, fertility, weight, skin and mood. The role of nutrition in treatment has always been a significant part of the discussion, and diets such as the Mediterranean diet have been seen to have potential benefits in relieving symptoms and improving metabolic health.
Yet Dr. Agbonome’s paper challenges a silent assumption that lurks in many of these recommendations that nutrition is primarily a matter of information and motivation. In fact, a host of factors beyond an individual’s reach controls whether they can afford and cook healthy foods consistently: the price of foods, the availability of a real supermarket, the reliability of the food supply from week to week, and the stress of everyday life.
The paper calls for the study of these environmental and economic issues to be taken as seriously as the study of nutrition itself, drawing on existing research in Iran, such as the study on food security among Iranian women with PCOS and food habits among adolescent girls with PCOS.
This is still a Roadmap and not yet a Result: This paper is about both the nature and the limits of the paper. It does not report any new data or suggest a definitive correlation between access to food and improvement of symptoms. Rather, it’s a comprehensive study design, a blueprint of what researchers have to do in order to further investigate that relationship, down to the specifics of which surveys to use, which symptoms to monitor and which statistical tools would determine if it’s a true relationship, or a coincidence.
The proposed approach would be to compare women’s access to affordable, nearby, reliable healthy food with other indicators of their PCOS symptoms (such as menstrual regularity, hormone-related symptoms, metabolic markers), and also consider other factors that might influence them (such as income, physical activity, stress and sleep). The latter part is important: Even if future studies establish a strong correlation, it wouldn’t prove that improved access to food reduces symptoms, the paper says. It’s accompanied by way too many other factors.
The importance of this framing: It’s not a find, it’s a reframing that is special about this proposition. For many people, the management of PCOS continues to revolve around personal choices: what the woman eats, how she trains. Dr. Agbonome’s work is part of a growing body of ideas that see food access as a structural problem, rather than a willpower problem, much more akin to healthcare access than willpower.
Should this connection be substantiated in future research using this design, its implications go beyond the doctor’s office. The paper envisions a food counseling approach that is mindful of actual constraints, community initiatives that increase access to food in food-insecure settings, and public health policy that considers food security as a component of reproductive and metabolic health, rather than a standalone issue.
The Takeaway: The message is not that diet is not important, but rather that this isn’t the whole conversation anymore. It’s not always a fault of the individual if they are unable to eat in the right way, but rather an indicator of what is available, affordable, and convenient in their day-to-day life. This paper doesn’t solve the problem, but it provides a solid justification for asking the question by researchers and clinicians.
