The best diet for PCOS

Polycystic ovary syndrome (PCOS) is a condition that affects 6% to 12% of American women of reproductive age. It causes a hormonal imbalance—usually an increase in androgen (male hormones)—that results in symptoms like irregular periods, lack of ovulation, acne, thinning hair, excess growth of hair on the face and body, and even infertility. The condition is associated with weight gain and insulin resistance. 

Diet and lifestyle changes can help manage body weight and reduce insulin resistance, which may alleviate other symptoms. But with so many diet plans readily available, which should you choose if you have PCOS?

What is the best diet for PCOS?

The best diet for PCOS depends on the symptoms a person is experiencing. Ideally, eating habits that help to decrease insulin resistance, regulate blood sugar, minimize risk for associated conditions, and manage weight (if needed) should be practiced. 

“The best diet is one that is maintainable and realistic for the long run, isn’t restrictive, makes your body feel good, and that pairs carbohydrate, fat, protein, and fiber foods well to maintain a stable blood sugar throughout the day,” says Felice Ramallo, RD, lead dietitian at Allara.

PCOS increases the risk of developing the following conditions, especially in women who are overweight:

• Diabetes
• Gestational diabetes
• Heart disease
• Stroke
• High blood pressure (hypertension)
• Sleep apnea

Some diet plans can help prevent these health conditions and alleviate other symptoms. The Mediterranean diet (MD) and the DASH diet have been shown to improve PCOS symptoms. These diets are fairly similar to the Dietary Guidelines for Americans.

Some people with PCOS may wish to explore a vegan diet, but “there are too few studies to draw conclusions about a vegan diet and PCOS,” Ramallo says. “However, it is generally recognized as a health-promoting dietary pattern. It could very easily be combined with a Mediterranean diet or DASH-style eating pattern, which we know have numerous benefits for the condition.”

Ramallo generally advises against the paleo diet and the keto diet for PCOS. There’s a lack of evidence that either diet works for PCOS, and both are difficult to adhere to.

Strict adherence to one specific diet plan is not as crucial as making healthy lifestyle choices become habitual. Many people with PCOS find that choosing healthy foods that they enjoy and engaging in regular physical activity are enough to help manage their PCOS symptoms and feel better overall.

Some diet guidelines may be more effective for specific symptoms (for example, low glycemic index diets help with insulin resistance). You may find one diet works best for you, or you may find it more effective to combine guidance from several diets to create a plan more tailored to your personal needs.

RELATED: How to reverse prediabetes with diet and other treatments

Can PCOS go away with weight loss?

“For most people, PCOS does not go away with weight loss,” says Heather Huddleston, MD, director of the PCOS clinic at UCSF and a medical adviser for Allara. “However, some people with PCOS will find that their symptoms are aggravated by weight gain and may improve slightly with weight loss.”

Some people with PCOS who are overweight may find their menstrual cycles come a bit more regularly when they reach a healthy weight but then become less regular if they gain weight.

For people with PCOS who are not overweight, losing weight is not advised. It will not change menstrual cycles or other symptoms.

8 foods to eat if you have PCOS

The foods that are healthy for people with PCOS are healthy for most people. Eating these foods can help balance insulin levels, alleviate some PCOS symptoms such as irregular menstrual cycles, and, in some cases, help with weight loss.

1. Fruits and vegetables

The Harvard School of Public Health states that a PCOS diet that includes lots of vegetables and fruits can help or prevent some of the health conditions associated with PCOS. They can lower blood pressure, reduce the risk of heart disease and stroke, and promote better blood sugar levels. They have a low glycemic load, which prevents blood glucose spikes that can increase hunger. Vegetables that can contain excessive starches, such as potatoes or sweet potatoes, should be limited. Fruits with high glycemic index such as watermelon should be limited. Some great fruits and vegetables to start with are:

• Spinach
• Kale
• Broccoli
• Garlic
• Apples
• Blueberries
• Bananas

Choosing a variety, or a rainbow, of fruits and vegetables is also important. 

2. Nuts and seeds

These are a great source of protein, healthy fats such as omega-3s, and anti-inflammatory agents. This is helpful for people with PCOS as they often have a type of low-grade inflammation that causes their ovaries to produce androgen. This can lead to heart and blood vessel problems. Some nuts and seeds to try include:

• Almonds
• Walnuts
• Cashews
• Sesame
• Sunflower
• Pumpkin
• Flax (use pre-ground or grind your own rather than using whole flax seeds)
• Chia

Nuts and seeds work well on their own as a snack, incorporated into meals such as a topper for oatmeal, sprinkled into salads, or blended into smoothies. 

3. Fish that are high in omega-3s

This important healthy fat is beneficial for people with PCOS as it can help with insulin resistance and cholesterol levels. Omega-3s can be found in many types of fish, including:

• Salmon
• Mackerel
• Shrimp
• Herring
• Oysters
• Sardines
• Anchovies
• Caviar

4. Whole grains

Whole grains are a great source of protein and provide more fiber than refined grains. High-fiber foods are important for people with PCOS because they help prevent blood sugar spikes, which cause more insulin to be released into the bloodstream. High insulin levels in people with insulin sensitivity can cause problems such as difficulty losing weight. Some examples of healthy whole grains include:

• Whole oats
• Whole wheat
• Whole grain rye
• Millet
• Quinoa
• Popcorn
• Whole-grain bread
• Whole-wheat pasta

Whole grains also help you feel full longer, making you less likely to overeat. 

5. Lean and plant-based proteins

Proteins are also helpful in helping you feel satisfied, as well as promoting healthy muscle building and reducing blood sugar spikes—but not all proteins are equal. For meat-based protein, go for poultry, fish, and other non-red meats more often. Lean protein is better than fatty meat because it provides the same amount of protein with fewer calories. You can also get adequate amounts of protein without eating meat. Some great plant-based proteins include:

• Tofu
• Chickpeas
• Lentils
• Hempseed
• Quinoa
• Soybeans

When it comes to protein, you probably don’t need as much as you think. A serving of protein is about the size of a deck of cards. 

6. Full fat dairy and alternatives

Ramallo recommends full-fat dairy over low or no-fat dairy products for people with PCOS, as this may help improve fertility. Some examples of recommended dairy products include:

• Whole milk
• Cheese
• Plain greek yogurt 

If you don’t eat dairy, alternatives are available such as fortified soy milk, oat milk, or almond milk.

7. Spices

A diet that includes anti-inflammatory foods may help people with PCOS lose weight and minimize inflammation. Some spices that are thought to have anti-inflammatory properties include:

• Cinnamon
• Ginger
• Turmeric
• Cayenne
• Garlic

8. Healthy fats

Fats are important to a healthy diet. Because many vitamins are fat-soluble, fats help facilitate vitamin absorption. They also help prevent or lessen blood sugar spikes, which are harmful to people with PCOS. It is important to choose healthy fats over saturated or trans fats, such as hydrogenated oils, and to consume them in moderation—especially for people with PCOS who are at risk of heart disease. Look for:

• Extra virgin olive oil
• Avocado oil
• Walnut oil
• Flaxseed oil

3 foods to avoid if you have PCOS

There are no bad foods, according to Ramallo. People with PCOS shouldn’t feel they need to completely cut out any one item unless they are sensitive, intolerant, or allergic to it (except for zero- or low-calorie sweeteners, which she recommends against as they have been shown to increase sugar cravings and are linked to weight gain.)

Rather, people with PCOS should look at the overall picture of their diet and focus on creating a balanced diet of healthy foods they choose.

Some foods can affect people with PCOS by raising insulin levels or creating blood sugar spikes. These foods, while allowed, should be limited.

1. Simple carbohydrates/refined sugars

Baked goods made with simple carbs (such as most cookies, cakes, pastries, etc.), soft drinks, many juices, white bread/rice/pasta, and similar foods are high in the glycemic index, meaning they are absorbed into cells quickly, causing excess insulin to circulate. This causes a blood sugar spike and contributes to insulin resistance. If consuming these foods, Ramallo recommends eating them with or near a meal and combining them with healthy fats, proteins, and fiber to slow the sugar swings.

2. Processed foods

Heavily processed foods can also contribute to insulin resistance in the same way simple carbohydrates do. They often have added sugar and salt and lack the fiber in the unprocessed foods. For instance, a whole apple contains fiber, slowing down the sugar spike. Applesauce processes a lot of that fiber out, causing the body to absorb the sugar faster. Apple juice is further processed and creates a quick sugar spike. The same is true for many processed foods, such as whole grain al dente pasta versus processed canned noodles.

3. Saturated and trans fats

People with PCOS are at an increased risk of cardiovascular disease. Saturated fat should be used sparingly, and many health experts recommend avoiding trans fats altogether. These fats can be found in processed foods and can make healthy foods less healthy. Eggs and vegetables cooked in butter are less healthy than poached eggs and steamed vegetables, for example.

Is fasting good for PCOS?

“This has not been well-studied, so there is no definitive answer,” says Dr. Huddleston. “Some people find that fasting helps them control their overall food intake, but more studies should be done to understand whether fasting is beneficial for PCOS.”

Fasting may have harmful psychological impacts as well. People at risk for eating disorders should be especially careful. “It fosters a restrictive mindset, which can lead to disordered eating behaviors,” says Ramallo. “We know there are other healthy diets (Mediterranean Diet, DASH) that have a far greater impact, while not damaging one’s relationships with their body, food, and family/social circle.” 

People with diabetes should check with their healthcare provider or endocrinologist before incorporating fasting into their lifestyle to avoid risk for hypoglycemia. 

Other ways to treat PCOS

Anyone who thinks they may have PCOS should visit their healthcare provider to explore a possible diagnosis. “They should also see their physician to help manage irregular menstrual cycles and fertility concerns,” says Dr. Huddleston. “If hair growth, hair loss, or acne are bothersome, physicians can assist in medical treatments. Finally, weight gain or questions about metabolic health should prompt a visit.”

While diet and exercise can play a big part in helping relieve symptoms of PCOS, other measures may need to be taken as well.

Lifestyle changes

Lifestyle practices such as getting enough sleep, eating smaller portions throughout the day instead of spaced-out meals to stabilize blood sugar and insulin levels, and practicing mindfulness and stress reduction can also help. Chronic stress is associated with insulin resistance and may contribute to the development of insulin resistance. Joining a PCOS support group may help with shared resources and emotional support.

Supplements

Supplements may be appropriate for some people with PCOS. For instance, inositol can help regulate insulin, and B vitamins can help fight insulin resistance. Supplements should be used with care and discussed with your healthcare provider. Ramallo offers an extensive guide for supplement use with PCOS here.

Medications

Medications such as oral contraceptive pills and metformin (a drug commonly used to treat Type 2 diabetes but often prescribed for PCOS) may be beneficial for people whose symptoms are not relieved by lifestyle changes or for those still struggling with insulin resistance.

RELATED: Metformin coupons | What is metformin?

While PCOS can cause unpleasant symptoms and increase the risk for other health disorders, it can be managed. The insulin resistance that often accompanies PCOS can often be addressed with dietary and other lifestyle changes.

These changes do not need to be overly restrictive. Focusing on healthy eating often has the effect of naturally decreasing the consumption of foods that are not ideal for people with PCOS. Whether you follow a specific diet, such as the Mediterranean or DASH diets, or create your own meal plan full of mostly PCOS-friendly choices, you may notice a difference in your symptoms and how you feel.