This post was updated on May 11th, 2023

By Kym Campbell, BSc. | Updated May 11th, 2023

Medically Reviewed by Dr. Sarah Lee, M.D & Dr. Jessica A McCoy, Ph.D

This article describes how best to use a PCOS diet to improve your health and fertility.

To put these good ideas into practice download this accompanying 3-day meal plan PDF and PCOS Diet Cheat Sheet.

If you’d like to try a PCOS diet within a supportive online community, then you can also sign up for my next free 30-Day PCOS Diet Challenge.

Dietary change is one of the best things you can do to take back control of polycystic ovary syndrome (PCOS). It’s both an alternative and a complementary therapy to any other treatment intervention.

What Is PCOS?

PCOS is a collection of symptoms that affects roughly 1 in 10 women of child-bearing age. Common signs and symptoms include having difficulty losing weight, excess stomach fat, irregular periods, infertility, pelvic pain, hirsutism, male pattern baldness, acne, anxiety, and depression.

What Causes PCOS?

PCOS is caused by a combination of genetic and environmental factors [1]. It’s been hypothesized that prenatal insults trigger the development of PCOS. But other factors, especially diet and lifestyle, contribute to its manifestation during puberty [2].

How Diet Can Impact PCOS Symptoms

PCOS is driven by two diet-related mechanisms; inflammation and poor blood sugar regulation. These mechanisms cause the hormonal imbalance that drives the wide range of PCOS symptoms [3-5]. Foods that aren’t well-tolerated affect the intestinal lining. This causes an inflammatory response which then makes all PCOS symptoms worse.

Foods that cause a sharp increase in blood sugar levels are also a problem. These readily available carbohydrate-rich foods need large amounts of insulin to restore homeostasis. When your diet frequently causes elevated insulin levels, insulin resistance can develop. This then impacts fertility, body composition, skin, hair, and mental health.

Managing inflammation and blood sugar regulation is key to controlling PCOS long-term.

Here are a few examples from my free 30-Day PCOS Diet Challenge that illustrate what’s possible.

Foods To Eat

There’s no one-size-fits-all solution that describes the best diet for PCOS. But nutrient-dense whole foods are essential. These foods improve gut health and blood sugar regulation.

Women with PCOS generally see the best outcomes with a low carb, high fat, moderate protein diet. These are the best macros for PCOS. Getting 50% or 60% of calories from whole food sources of fat is a particularly powerful way to drive weight loss and reverse insulin resistance. Assuming adequate protein intake, around 20-30% of energy should come from carbohydrate-containing foods. Preferably those with a low glycemic index (GI). Low GI carbohydrate-containing foods tend to be high in dietary fiber. This is because fiber slows the rate at which blood sugar levels rise. This is one of the main reasons why high-fiber foods are generally considered “good for us”.

Probiotic and prebiotic foods are other key ingredients for maintaining good gut health. Probiotics contain live cultures of “good” gut bacteria. Prebiotic foods, by comparison, provide the nutrients needed for a healthy gut microbiome.

Non-starchy vegetables should form the largest part of a PCOS-friendly meal. Non-starchy vegetables improve gut health and aid in better blood sugar regulation. They also provide many vitamins, minerals, and unique phytonutrients.

The following are common examples of PCOS-friendly foods to eat. For a more comprehensive list, download my PCOS Diet Cheat Sheet here.

Foods To Avoid

Knowing which foods to avoid with PCOS is also a matter of reducing inflammation and improving blood sugar regulation.

Reducing consumption of sugar and readily-digested (high GI) carbohydrates improves blood sugar regulation. To minimize inflammation, it’s best to avoid any food that causes gut discomfort. Gluten and PCOS, for example, share a close association. Dairy is another common problem food within the PCOS population.

Many women see significant health improvements after eliminating gluten from their diet. This may be because they suffer from non-celiac gluten sensitivity. This is a condition that can’t be diagnosed by normal celiac blood tests or even an intestinal biopsy.

When it comes to PCOS and dairy, it’s not just a matter of lactose intolerance. Many women with PCOS have a sensitivity to the protein’s casein and whey without being aware of it. Like gluten sensitivity, an undiagnosed dairy intolerance can damage the intestinal wall lining. This drives inflammation, and worsens the effects of PCOS.

Processed foods are also best avoided. These foods often contain industrial “vegetable” oils and food additives that cause inflammation.

The following are common examples of foods to avoid for women with PCOS. For a more comprehensive list, download my Foods to Avoid list here.

Companion 3-Day PCOS Meal Plan

To help you put a PCOS diet into action, I’ve put together a free 3-Day PCOS Meal Plan which you can download here.

For more PCOS meal plans, and interactive video lessons, you can also sign-up for my next free 30-Day PCOS Diet Challenge. This is a live event that has launched hundreds of thousands of women towards better health and fertility. You can see some of their success stories here.

Companion PCOS Diet Cheat Sheet

This PCOS Diet Cheat Sheet lists over 180 PCOS friendly foods and drinks to make things easy for you. This document packs a lot of information onto a single page and is 100% compatible with all refrigerator doors.

PCOS Diet FAQ

What about fruit? Fruit should be consumed in moderation, preferably in the presence of healthy fat. 1-2 servings per day are best. The adverse effects of sugar in fruit are offset by the benefits of fiber, phytonutrients, vitamins, and minerals.

What about soy? The scientific literature is conflicted when it comes to soy consumption. This trial for example was conducted on patients with subclinical hypothyroidism. They observed a three-fold increased risk for developing overt hypothyroidism with soy consumption levels consistent with a vegetarian diet [6]. When the same researchers repeated a similar experiment several years later they found a different result. High soy consumption did not significantly alter thyroid function [7]. Many studies show that soy intake is associated with improved outcomes in diseases. This includes obesity, cardiovascular disease, insulin resistance, and immune disorders [8]. But the clinical significance for women with PCOS remains unclear.

What about alcohol? From a nutritional perspective, alcohol is best avoided. But it may not be as bad as many sources lead you to believe. For a nuanced understanding of this topic, there are five things you need to know about PCOS and alcohol.

What about coffee and caffeine? This is another nuanced topic which I address in detail in my article is coffee bad for PCOS. Pure caffeine, but not caffeinated coffee appears to have an adverse effect on insulin sensitivity [10]. This is consistent with other findings in the literature. It’s understood that over the long-term, coffee (and tea) consumption is positively associated with better health outcomes. This includes type II diabetes [11-13], and heart disease [14, 15]. But it’s also common for women with PCOS to experience symptoms associated with hypothalamic-pituitary-adrenal (HPA) axis dysfunction. For these women, consuming caffeinated beverages (even coffee and tea) is likely to do more harm than good.

What are the best teas for PCOS? According to the literature, the best PCOS teas are marjoram tea and spearmint tea. Green tea may also be helpful, although most studies of green tea use concentrated extracts to demonstrate efficacy.

What about sweeteners? When consumed in moderation, the following sweeteners can be appropriately included in a PCOS diet. Raw unpasteurized honey (that is never heated). Glucose-based sweeteners like brown rice or corn syrup. Allulose, xylitol, erythritol. Other sugar replacement products containing monk fruit or stevia extract. Most other non-nutritive sweeteners are best avoided.

What about salt? The risks of too much dietary salt have been talked about for years. Yet studies have also shown that too little salt can lead to increased cardiovascular disease risks. The sweet spot for good health appears to be between 3,000 and 6,000 mg of sodium per day [16]. This is the equivalent of approximately 1.5 to 3 teaspoons.

Should I be restricting calories? No. Despite the popularity of restricting calories for weight loss, this approach is not recommended for women with PCOS. It’s been well documented in the scientific literature that caloric restriction diets are ineffective over the long term [17]. It’s much better to control macros for PCOS, rather than calories

Does eating more fat make you gain weight? No. In 2010, researchers published a critical assessment of the Dietary Guidelines Advisory Committee (DGAC) report [18]. They concluded that this top US nutritional authority ‘failed to provide sufficient evidence to conclude that decreases in dietary saturated fat, salt, and animal protein lead to positive health outcomes.’ One of the best ways to lose weight with PCOS is to consume more fat.

How is a PCOS diet different from a ketogenic diet? Carbohydrate consumption needs to be restricted to less than 5% of total calories to reach nutritional ketosis. This is significantly lower than the 20 – 30% recommended for a PCOS diet. Because of this wider allowance, a PCOS diet is generally much easier to follow. It’s also better suited to people that have experienced disordered eating in the past. Learn more about the pros and cons of a keto diet for PCOS here.

Does a vegetarian diet fit in with a PCOS diet? Maybe. Many women report an improvement in health after switching to a vegetarian diet. Getting enough protein without also consuming too many carbohydrates can be difficult though. This is especially important for weight loss or the treatment of insulin resistance. The same “clean” diet, with the addition of whole food sources of animal protein, is likely to result in better health outcomes.

How many meals a day is best? Two or three. Some people recommend four of five small, regular meals to help manage blood sugar levels. This is not recommended for women with PCOS. Consuming two or three meals that achieve a high degree of satiety is best, both nutritionally and psychologically.

Is snacking okay? Yes. Women with PCOS should follow intuitive eating cues. This means eating when they’re hungry and stopping when they’re full, regardless of other considerations. That said, snacking regularly may show that your main meals are inadequate. Or, other factors, not related to hunger, may need addressing. Find 27 PCOS snacks that are quick, easy, and cheap here.

What about intermittent fasting for PCOS? Intermittent fasting, a.k.a time-restricted eating, is a proven tool for improving metabolic health [19-20]. Studies have shown that for women with PCOS, limiting eating to within eight hours per day can be helpful. Improvements have been observed for body composition and insulin sensitivity. Benefits also extend to menstruation, chronic inflammation, and androgen regulation [21]. Excluding any potential risks for disordered eating, intermittent fasting is a useful way to further improve a PCOS diet.

How is a PCOS diet different from the Mediterranean diet? Like a Mediterranean diet, a PCOS diet is a whole food-based anti-inflammatory diet. There’s a lot of overlap in the recommended foods to eat. A PCOS diet is more inclusive of saturated fats and animal sources of protein. But it’s less inclusive of gluten, dairy, and wine. A PCOS diet is also higher in fat and lower in carbs, than a Mediterranean diet.

How is a PCOS diet different from a DASH diet? Dash stands for Dietary Approaches to Stop Hypertension. This diet was developed in the 1990s with a key focus on reducing saturated fat, sugar, and salt. As a result of more up-to-date science, a PCOS diet does not restrict saturated fat or salt [16, 18].

What are the best PCOS supplements? Dietary supplements are one of my nine recommended PCOS natural treatments. In some cases, they can have pharmaceutical-level effects. Ovasitol and Vitamin D for PCOS stand out as the two most valuable supplements for most women.

Other Evidence-Based Lifestyle Interventions

While diet is one of the best interventions for PCOS, other lifestyle changes are well known to further improve health outcomes.

Exercise

It’s well known that physical exercise improves insulin sensitivity and body composition in women with PCOS [22, 23]. Aerobic exercise reduces inflammation [24], while resistance training improves sex hormone balance [25]. Meta-analysis shows that exercise can also reduce anxiety and depression [26].

Sleep

Poor quality sleep is associated with increased markers of systemic inflammation [27]. It’s also known to affect insulin resistance in women with PCOS [28]. Better quality sleep can improve food choices [29], and reduce the desire for sugary foods [30].

Stress management

Studies show that women with PCOS suffer greater psychological distress than non-PCOS controls [31]. Stress increases inflammation and reduces insulin sensitivity. This makes it a meaningful risk factor in the development of type 2 diabetes [32] and heart disease [33]. In a first-of-its-kind study, US researchers found a link between infertility and stress too. They observed more than a two-fold increased risk of infertility as a consequence of stress [34].

Given these findings, reducing stress is likely to further add value to a PCOS-friendly lifestyle.

The Bottom Line

Living with PCOS presents many challenges, both emotionally and physically. Since diet plays such a key role in this syndrome, there’s a lot you can do to help yourself. This is true whether you’re trying to lose weight, get pregnant, or you just want to feel better.

If you’ve recently been diagnosed, or you’ve been battling your symptoms for decades, there’s reason to remain optimistic. You can take back control of your health and fertility by changing the foods you eat.

My free 30-Day PCOS Diet Challenge and 3-Day Meal Plan are the best ways to get started.

Author

Kym Campbell

Combining rigorous science and clinical advice with a pragmatic approach to habit change, Kym is on a mission to show other women how to take back control of their health and fertility. Read more about Kym and her team here.

Co-Authors

Dr. Jessica A McCoy, Ph.D

This blog post has been critically reviewed to ensure accurate interpretation and presentation of the scientific literature by Dr. Jessica A McCoy, Ph.D. Dr McCoy has a master’s degree in cellular and molecular biology, and a doctorate in reproductive biology and environmental health. She currently serves as a University professor at the College of Charleston, South Carolina.

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Dr. Sarah Lee, M.D

This blog post has also been medically reviewed and approved by Dr. Sarah Lee, M.D. Dr. Lee is a board-certified Physician practicing with Intermountain Healthcare in Utah. She obtained a Bachelor of Science in Biology from the University of Texas at Austin before earning her Doctor of Medicine from UT Health San Antonio.

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References

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