Polycystic ovarian syndrome (PCOS) is a condition that can benefit greatly from diet and lifestyle therapies. In this article we’ll discuss the best diet for PCOS, which should be part of a comprehensive treatment approach to this complex condition.
Often, once diagnosed with PCOS the initial treatment options include hormonal birth control, Metformin, and perhaps Spironolactone. While all of these can be beneficial for some women, they aren’t often enough in the management of PCOS symptoms.
The Best Diet for PCOS
If you’ve taken to Google, you’ll find a long list of diets for PCOS. There are so many claims that individual diet plans are the cure to PCOS and aided in weight loss that it gets confusing.
Firstly, there is no cure for PCOS. You can put your symptoms into remission and manage it well, but at this time, we don’t have a cure for PCOS.
Secondly, it is important to recognize that PCOS can present differently and behave differently for each individual. What is true for one person may not be true for another.
That being said, there are some commonalities to approaching a diet that are universally true for all of us. As we discuss specific foods, just know that you may tolerate them in different portions than someone else or not at all.
PCOS has a metabolic component and is not just about sex hormones. While testosterone is elevated, it is important to understand this is often due to the stimulation of the ovaries by insulin. Elevated levels of insulin cause the ovaries of those with PCOS to produce more testosterone.
What’s even more confusing is that your fasting glucose and hemoglobin A1C, both markers of blood sugar control, can be normal, but you can have spikes (even if transient) in insulin leading to hormone issues. This is why many diets for PCOS focus on blood sugar regulation and insulin control.
In addition, there is also an inflammatory aspect of PCOS that can lend itself to worsening of metabolic issues and increase the risk of cardiovascular disease. It is because of this that I recommend focusing on a diet that promotes lower inflammation levels in the body.
As we walk through this, please continue to ask, “is this true for me” as you read.
In short, the best diet for PCOS is the one that:
- Works for you
- Doesn’t stress you out or create an unhealthy relationship with food
- Feels sustainable
- Helps you achieve your goals—symptom management, weight loss, improved insulin, lower inflammation, better cardiometabolic markers, etc.
The Best Foods for PCOS
There are some simple considerations when thinking about the best and worst foods for PCOS: Focus on nutrient-dense foods. Eat lots of vegetables. Reduce or eliminate inflammatory foods and drinks.
The Best Foods for PCOS Include:
- Grass-fed meat and pasture-raised poultry
- Cold Water Fish
- Healthy fats
- Seeds and nuts
Grass-Fed Meat and Pasture-Raised Poultry
Commercially-raised meat and poultry have a higher omega-6 to omega-3 ratio than grass-fed or pastured meats and poultry. Now, I know omega-6 fatty acids get a bad rap, but we do need them! However, most of us get way too many omega-6s and way too few omega-3s, which could lead to inflammation.
Ideally, our diets should contain approximately one to four times more omega-6s than omega-3s. In grass-fed beef, the ratio is around 2:1. In commercially raised beef, the ratio is about 9:1. Since omega-6 fatty acids can be inflammatory in excess, eating conventionally raised meat can cause inflammation, which may exacerbate PCOS symptoms.
If you’re going to eat meat, try to select the highest quality as often as possible. You may not have access to this readily, which may mean you want to focus on more plants in your diet.
Cold Water Fish
Cold water fish like salmon are a great source of omega-3s. They’re also a great source of vitamin D (which many of us lack) and protein. Salmon is probably the best-known fatty fish, but others include mackerel, tuna, anchovies, sardines, and trout (to name just a few).
Omega-3 fatty acids provide anti-inflammatory benefits and can aid in insulin sensitivity.
In one animal study it was found that pairing omega-3 fatty acids with a low carbohydrate diet helped in the control of PCOS symptoms, including reducing testosterone.
Unfortunately, the larger fish (usually predators, like tuna) contain higher mercury levels. So eat them in moderation, or swap for smaller fish (like sardines), which are often lower in mercury.
Another way to balance your omega-3 to omega-6 ratio is to take an omega-3 supplement. You can learn more about omega-3 fatty acids here.
Fat has been demonized for several years, but human beings need healthy fats. Keep in mind that not all fats are created equal. Healthy fats include monounsaturated fats, polyunsaturated fats, and essential fatty acids. The fat you want to avoid at all costs? Trans fats.
Fat helps with stabilizing blood sugar, keeping your feeling full longer, and may even aid in weight loss.
In one small study comparing low fat vs. high fat diets in women with PCOS it was found that after 8 weeks the higher fat diet resulted in great weight loss. The low fat diet resulted in a loss of lean body mass or muscle. It is important to note that this diet was not a ketogenic diet, as the high fat diet still had substantial calories coming from carbohydrates.
A few examples of healthy fats include:
- Fatty fish
- Pastured meat
- Avocados and avocado oil (cold-pressed, unrefined)
- Coconut oil (cold-pressed, unrefined)
- Olive oil (cold-pressed, unrefined)
Trans fats very rarely occur in nature, and if you want to avoid them, look for the word “hydrogenated” on labels. Fried foods at restaurants are also usually cooked in hydrogenated oils (such as vegetable oil and canola oil), so keep that in mind when eating out.
Contrary to popular belief, fruit is not bad for PCOS. Fruits contain several vitamins, antioxidants, minerals, and fiber, all of which support better health. For women with PCOS that are working on optimizing insulin levels, it may be best to opt for fruit lower in sugar, such as berries. But trust that the occasional banana isn’t going to wreck your hormones.
Filling your plate with plenty of vegetables is a great way to care for your gut and support estrogen metabolism. An ideal goal is six to nine servings of vegetables a day. I know that may sound like a lot of vegetables! But it doesn’t have to happen overnight..
I recommend starting where you’re at with daily vegetable servings and adding one additional serving a day each week. Overtime you should ideally be eating vegetables at each meal. And listen, you won’t be perfect every day and that’s totally ok.
I make it easy to incorporate more vegetables in this free meal plan and recipe guide.
Vegetables are vital sources of vitamins, minerals, antioxidants, and fiber. Fiber is essential for gut and hormone health. The ideal goal is to aim for 25 grams per day, which is about twice as much as the average person gets in the U.S.
Research has shown that fiber helps women with PCOS achieve a more ideal body composition (lean body mass and adiposity), as well as improved glucose metabolism. It may also help prevent the chronic illnesses associated with PCOS.
Because of the pattern of anovulatory cycles, women with PCOS often exhibit symptoms of estrogen excess in addition to high androgen symptoms. Vegetables, especially cruciferous like broccoli, cabbage, and kale, supply you with nutrients to support estrogen metabolism. In addition, the fiber they provide helps with the elimination of estrogen via the bowels.
Seeds and Nuts
Nuts and seeds contain healthy fats, protein and minerals, which are great for an overall healthy diet. Nuts like cashews, sunflower seeds, and Brazil nuts provide zinc, which supports balanced testosterone levels.
Brazil nuts, almonds, and hazelnuts provide you with magnesium, which is an essential nutrient for PCOS. Studies have shown magnesium can improve blood sugar and insulin levels. In addition, low levels of magnesium are linked to diabetes and cardiovascular disease. Both are conditions women with PCOS are at higher risk for.
Looking for a way to incorporate more seeds into your diet and support your menstrual cycle? Check out our article on Seed Cycling for Hormone Balance.
Foods That Can Make PCOS Worse
We don’t do “bad” foods around here and yet, there are definitely foods that can aggravate PCOS symptoms and make the condition more difficult to manage. That doesn’t mean these foods are “bad,” it just means they might not work for you. The following list is of foods you want to be mindful of in your diet.
While I’m going to give you a list of foods to limit or avoid, I would highly encourage you to focus on foods to bring in that are beneficial for your health and less on what you’re cutting out.
Foods That Can Make PCOS Symptoms Worse Include:
- Refined oils
It may seem obvious that if you struggle with blood sugar dysregulation and insulin resistance that limiting sugar is wise. But for some women with PCOS, sugar can be a culprit in driving acne — a common symptom of PCOS.
When you eat sugar, your body secretes insulin. In an ideal setting insulin knocks on the cell’s door and sugar is invited in. But things get squirrely when you have insulin issues like insulin resistance or PCOS.
Insulin leads to increased oil and testosterone production. It can also lead to increased keratin production, which is a protein that blocks pores.
This is why eliminating sugar from your diet and then bringing it back in can be a good test for how it affects your skin.
Does this mean if you have PCOS you can never eat sugar? No, not at all. But you do need to be mindful of how it impacts your skin, insulin, and testosterone levels.
In this complimentary meal plan and recipe guide I provide you tons of tasty recipes that will leave you satisfied without feeling deprived.
For women with PCOS, gluten or other grains can be problematic for their skin and metabolic health. Is this universally true for everyone with PCOS? No. And as I explain in Beyond the Pill, it is individualized, which is why cutting them out for about 21 days and bringing them back in to see how they affect you can be very telling.
Gluten can may reduce leptin binding by 50%, which is a hormone that tells you that you’re no longer hungry. Pretty important when it comes to weight regulation. This means gluten may lead to leptin resistance, which means your brain doesn’t get the signal to stop eating.
Some grains can trigger an inflammatory response in some people, and women with PCOS usually have varying levels of inflammation. Many of my PCOS patients in my practice have seen a big difference in their symptoms after limiting grains.
While grains can provide nutrients like B vitamins and are an important source of fiber, they may not work for you or at least not all of them. Again, it’s all about what is true for you.
Dairy can raise insulin like growth factor (IGF-1). This in turn leads to high insulin levels, which can stimulate the ovaries to produce more androgens. Those androgens can drive symptoms like cystic acne, oily skin, hair loss on the head, and hair growth on the chin or abdomen. It can also lead to anovulatory (lack of ovulation) cycles.
A study showed that women who adopted a low dairy and low starch diet for eight weeks showed improvement in their PCOS symptoms, such as decreased weight and increased insulin sensitivity.
If you want to better support your hormones, limiting alcohol is a great step. Alcohol can affect our hormones and menstrual cycle, which is problematic enough without adding PCOS into the mix.
Alcohol consumption is associated with an increased risk of fatty liver, cardiovascular disease, menstrual cycle irregularities, depression, and obesity—all of which women with PCOS can be at higher risk for.
One study showed a rise in estrogen levels after just one alcoholic beverage. If estrogen dominance is a problem for you, this is especially important to take note of.
Refined oils (such as vegetable oil, soybean oil, and canola oil), offer a disproportionate amount of omega-6 fatty acids compared to omega-3s. Since the majority of us do not get enough omega-3s, adding even more omega-6s is problematic.
You’ll often find higher amounts of omega-6 promoting oils in processed foods. This is why focusing on a whole foods diet is an easy way to improve your omega-6 intake and support healthy levels of inflammation.
When Omega-6s are in excess, they can cause inflammation. Aim for cold-pressed, unrefined oils such as coconut, olive, and avocado oil. Keep in mind that some oils work better at high temperatures than others.
What’s the Best Diet for PCOS?
The answer is about what is true for you and may take some trial and error to get there. I hope this outline helps guide you in making choices that help you discover what works best for you.
And remember, even with the best diet and lifestyle practices, we sometimes require additional support from supplements or medication. You can read our Best Supplements for PCOS guide if you’re looking for more support in that area.
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