The PCOS Diet: Why Food Matters and How to Use it to Your Advantage

While there’s a clear relationship between diet, nutrition, and PCOS, most doctors aren’t talking about it enough, or at all with patients, beyond women with PCOS being told all too often, and sometimes in a shaming, blaming way, to just  “lose the weight” – as if that were the only answer – and as if it were just that simple to do! Most women with PCOS who do struggle with their weight have tried any number of diets – often overly restrictive ones that backfire despite their best efforts, and feel that ‘failure’ to lose weight is a result of a problem with their willpower, when in fact this and other food-related challenges are now known to be a symptom of PCOS – not a cause. 

Further, PCOS doesn’t just affect women who are overweight. In fact, PCOS affects women of all sizes, many of whom struggle for years with not only menstrual cycle symptoms, acne, hair loss, and unwanted hair growth, but also with depression, anxiety, and food-related symptoms, including cravings and binge eating – now a recognized PCOS symptom related to metabolic dysfunction, as I’m going to explain. 

The result of all of this is often a fraught relationship with food, and a lot of confusion, overwhelm, and disempowerment when it comes to feeling in charge of your body, eating, and weight. 

In this article I’m going to show you how you can use food to take charge of your symptoms, how you feel, and your weight, too if that’s one of your symptoms. We’ll focus on the relationship between diet and PCOS, and food solutions for PCOS – what to eat and what to avoid. While food is just one of the root causes of PCOS, it’s intimately connected to each of the others and is truly the foundation of treating PCOS naturally. You can make a huge difference in the severity of your PCOS, and sometimes even reverse your diagnosis, by getting to the roots of imbalance in this complex hormonal and metabolic condition. 

The PCOS Diet: Why Food Matters 

First things first: I want to acknowledge that the word diet itself can be such a trigger. What I’m referring to here is not a diet in the traditional weight loss, restrictive eating sense, but a way of eating to support your optimal health with PCOS. There’s not one single diet for PCOS, but there are food and nutritional strategies that can can make a tremendous difference – and rolled into one plan these comprise what, in my medical practice, I call “the PCOS Diet.” 

While we tend to think of PCOS primarily as a women’s hormone condition, it’s more than that – it’s a complex condition involving both female hormones – including testosterone which we often think of as a male hormone, and notably, metabolic hormones, including insulin, leptin, and ghrelin. A phenomenon called Insulin resistance is at the heart of the imbalances, and this, and its relationship to inflammation and appetite dysregulation, is what makes food such a powerful tool in PCOS treatment. 

Insulin Resistance and Inflammation

Insulin, a hormone produced in the pancreas, regulates the metabolism of carbohydrates, fats and protein by promoting the absorption of glucose from your blood into liver, fat and skeletal muscle cells. Insulin resistance is when your cells stop responding optimally – or sensitively- to insulin in your bloodstream, causing high blood sugar levels that over time can put you at risk for chronic conditions, especially, diabetes.

Insulin resistance is a key feature of PCOS – as many as 70% of women with PCOS demonstrate measurable insulin resistance beyond that which would be expected by their body weight or degree, and it may be occurring at a more subtle level, usually undetected based on conventional lab values, in far more women than this with PCOS. 

Insulin resistance causes the ovaries to produce excess testosterone, impairing ovulation and leading to the classic androgenic symptoms of PCOS: hair loss, unwanted hair, and cystic acne. It also drives inflammation which drives depression and fatigue, and also puts women with PCOS at much greater lifetime risk of the metabolic consequences of PCOS. And it impairs your relationship with food.

Appetite Dysregulation and Weight Struggles

Insulin resistance goes hand-in-glove with dysregulation of other hormones that affect metabolism, weight, appetite and satiety, and inflammation. Women with PCOS have been shown to have impaired secretion of a hormone called leptin, which controls appetite and satiety – in short, it tells our brains when we are full and should stop eating. In PCOS, leptin signaling goes awry, and rather than eating creating satiety signals in the brain, women with PCOS might be getting the message that they're hungry, even when they've eaten. High calorie, high carbohydrate foods exacerbate this phenomenon because they cause areas of the brain to become hyperactive, making you crave even more carbohydrates and sugar – sometimes intensely so. The high levels of leptin associated with PCOS help to explain the years of battling weight, frustrations with diets that just haven’t worked, and are a recently discovered cause of binge eating disorder in PCOS.

So, before I say another word I want to emphasize something: It’s not you! You are not broken. It’s not your fault if you can’t lose weight, if you’re binge eating, don’t know why, and find it hard to stop. The underlying disruptions that are causing PCOS are causing or contributing to these symptoms. And that’s just what they are – symptoms of PCOS as a complex hormonal and metabolic syndrome, not signs of weakness or a statement on your character. But, by resetting this disrupted hormone signaling or nutritionally over-riding it when it’s a genetic predisposition, you can really transform your relationship with food, and you can learn to take back your health with PCOS. 

How the PCOS Diet Works

Numerous studies demonstrate the important influence diet can have on PCOS. In fact, a combination of healthy diet and exercise alone has been found to be more effective than even the most common medication (metformin) used to treat PCOS. The key – supported in numerous studies – lies in reducing insulin resistance. This can be done simply by increasing protein and healthy fats in the diet, and modestly reducing in unhealthy carbohydrates and sugar.

Without even losing weight, this decreases testosterone, improves insulin sensitivity, and reduces inflammation. Reducing testosterone reverses many of the symptoms associated with PCOS including acne, excess hair, male pattern hair loss, and menstrual cycle irregularities, and increases fertility, while reducing insulin and inflammation reduces the medical risks associated with PCOS. 

The PCOS Diet: What to Eat

The PCOS diet starts with a Mediterranean-style diet, which has been shown to steady blood sugar, reverse insulin resistance, and is most effective for weight loss.

Every meal should include:

• Protein: palm size of animal protein (fish, poultry), 2 eggs, or 1/2 cup beans/legumes 
• Healthy fats: 1-2 tbsp olive oil, 1 tbsp ghee or coconut oil, or ½ avocado
• Veggies: 1-2 cups of veggies, or combination of veggies and fruit

Plus every day aim for: 

• 6 to 8 servings of vegetables, and up to 1-2 servings of low glycemic fruit
• ½ cup slow carbs 1 or 2 times daily
• About 1 oz of nuts or seeds (roughly ¼ cup or a small handful) or 1 TBS of nut or seed butter
• 6-8 glasses of water

Below you’ll meet the energy rock stars – protein, fats, and slow-burning carbohydrates (“slow carbs”) – that in the right amounts and at the right times, keep your blood sugar steady, your energy humming, and your hormones happy.

Hormone Healthy Proteins

Improving protein intake throughout the day improves blood sugar levels, lowers testosterone levels, increases satiety, and reduces PCOS symptoms, even without other measures like reducing carbohydrates or increasing exercise. Replacement of carbohydrates with protein improves weight loss and improves glucose metabolism by an effect that seems to be independent of the weight loss and thus seems to offer an improved dietary treatment for PCOS women.

• Include animal protein including poultry, eggs, and fish
• Legumes: Eating legumes two to three times/week has also been shown to improve blood sugar and improve weight without even dieting or increasing exercise – black beans, chickpeas (garbanzo beans), lentils, white beans, tempeh, tofu
• Avoid all processed meats and excessive red meat intake (keep to 1 portion/week, 4-6 oz) – these lead to measurable increases in inflammatory markers in the blood, as well as to harmfully elevating blood sugar and insulin resistance markers. 

Healthy Fats 

Healthy fats help us to feel satisfied and full after meals, maintain steady energy and blood sugar, and squash sugar cravings. Healthful dietary fat intake has also been shown to reduce abdominal fat, improve insulin sensitivity, and reduce testosterone levels along with associated symptoms. Importantly, low omega-3 and high omega-6 levels – which is true for 80% of people – are associated with insulin resistance and PCOS.  EFAs reduce insulin resistance, reduce testosterone levels, and can improve depression, return period cyclicity, support you achieving a healthy weight, and may reduce hirsutism.

• Emphasize olive oil, avocado, nuts and seeds, and occasional ghee and coconut oil
• Eat 4 oz of cold-water fatty fish rich in essential fatty acids 3 times weekly, including salmon, mackerel, anchovies and sardines.
• If you’re not into fish, or are unable to eat it this often, take fish oil or an algae-based omega 3 supplement daily.

Slow Carbs

A reduced carbohydrate diet is important for improving fertility, endocrine/metabolic parameters, weight loss and satiety in women with PCOS. But a word of caution: very low-carb diets aren’t the answer. Small amounts of whole grains and healthful, energy rich root vegetables and squashes can be beneficial even with PCOS. The key is enjoying small portions of these, with reduced frequency. How much? No more than ½ cup cooked grain at a meal or one serving of an ‘energy' veggie How often? Once, or at most, twice daily.

• Healthful Grains: brown rice, millet, oats (rolled and steel-cut), quinoa, wild rice, red, pink, or black rice are all great choices. Buckwheat – technically a seed not a grain – may be especially helpful in improving blood sugar balance and reducing insulin resistance. 
• Starchy “Energy” vegetables: parsnips, potatoes, squash, winter squashes (delicata, pumpkin, acorn, spaghetti, butternut, etc.), sweet potatoes. 

Eat More Plants

This doesn’t mean that you have to be a vegan or vegetarian, in fact, fish and other forms of animal protein are an important part of a PCOS-healthy meal plan. But it does mean increasing your intake of veggies, fruits, nuts, seeds, and plant-based protein sources like legumes as the base of your diet for important anti-inflammatory, gut supportive, blood sugar balancing nutrients – particularly fiber. Studies show a strong connection between low fiber intake and insulin resistance and strong evidence shows us that high dietary fiber intake can improve insulin sensitivity. We also know that fiber is really important for improving satiety when we eat, preventing us from overeating, supporting weight loss, and supporting the health of the gut microbiome. 

• Aim for 8-10 servings of veggies daily with a rainbow of colors to support nutrient diversity
• Especially emphasize greens: bok choy, broccoli, broccoli rabe (rapini), broccoli sprouts, brussels sprouts, cabbage (all varieties), cauliflower, collard greens, kale, napa cabbage 
• While fresh fruit is healthful, with PCOS, keep it to 2 servings daily, and stick to the low glycemic choices like blackberries, blueberries, raspberries, strawberries 

Go Organic 

It’s more than just what you eat – it’s what comes along with your food – including herbicides and pesticides, as well as plastic compounds that leach into our food from packaging and storage containers. For example, studies have shown higher BPA levels in women with PCOS and has been associated with higher markers of inflammation. BPA stimulates androgen production and interferes with testosterone lowering mechanisms – problematic since high testosterone levels is a hallmark of PCOS. Here’s how to cut down on your body burden from food: 

• Eat organic strictly for meats and dairy
• Ideally choose organic fruits and vegetables
• Choose low mercury fish
• Avoid plastic packaging and food storage

Do I Need to Take Supplements?

Nutritional deficiencies are common in PCOS and certain vitamins (i.e, Vitamin D) and minerals (i.e., B-complex, chromium, magnesium) are needed to regulate blood sugar. Insufficiencies in these and other micronutrients and are associated with elevated blood glucose, insulin resistance, PCOS, and diabetes. While food should always be the foundation of your nutrient intake, I recommend all women with PCOS include a daily multivitamin and mineral supplement, vitamin D, and inositol. You can read more about the top supplements I recommend for PCOS here. 

Beyond What You Eat: Timing is Everything

Our bodies are meant to have clear times for eating, and clear times for digestion. Eating for steady blood sugar means meals should be balanced and provide the energy you need to feel satisfied – enough that you’re not on the hunger rollercoaster and craving that morning muffin, bagel, doughnut (you name it!) by 10am…and on and on it goes. Here’s how to support healthy meal timing:

• Eat regularly and make sure all meals and snacks are blood sugar balanced with the foods mentioned above 
• Eat breakfast every day and make sure breakfast includes a good quality protein and fat source
• Don’t go hungry; keep an emergency food stash in your bag, your desk drawer, your glove compartment – wherever you might get hungry
• Keep a food journal. It can be a helpful tool to make food-body connections and recognize satiety, fullness, cravings

What About Intermittent Fasting?

When it comes to women’s hormone balance, evidence shows that overly restrictive intermittent fasting isn’t optimal. In fact, one study showed that blood sugar control actually worsened in women after three weeks of intermittent fasting with meal skipping, which was not the case in men. But when done properly, it can be incredibly effective for reducing insulin resistance and improving blood sugar balance. Just 8–12 weeks of intermittent fasting has been shown to lower insulin levels by 20–31% and blood sugar levels by 3–6% in individuals with pre-diabetes. One study also found that eight weeks of intermittent fasting decreased depression and binge eating behaviors while improving body image in overweight adults. Research has shown metabolic benefits with implementing a shorter eating window and fasting for up to 16 hours overnight.

So it’s absolutely something to consider, but whether or not it’s right for you depends on a number of factors – read this to help you navigate more. At baseline, a 12-hour overnight fast is healthful for most everyone. This simply means not eating between dinnertime, which is ideally 4 hours before you go to sleep, and breakfast the next day, i.e., not eating from 7 pm each evening until 7 am the next morning.

The PCOS Diet: What to Avoid

I’m not about restriction – in my own life or for my patients. Food is meant to be nutritious, information for your cells, and pleasure for your soul. But there are some common foods in the standard American diet (SAD) that undoubtedly cause or contribute to insulin resistance, inflammation, and harmfully alter our food-brain hormone signaling. These are a no-go for PCOS except on rare occasions – and I’m talking only on a blue moon level here. Cutting them out completely for a short period of time – for 6 to 12 weeks – may make it easier to get started – and can be incredibly eye opening. The goal, of course, is to cut them out completely, which becomes much easier when you start to feel more energetic, sleep better, your moods get better, your skin clearer, and you notice your hormones and metabolism start to come back into balance! 

Sugar and Empty Carbs

There’s no getting around it – sugar diet, processed foods, processed flour products, sodas, and even bottled fruit juices wreak havoc on your blood sugar. Highly refined foods are void of nutrients – from protein, fat, and fiber, to important minerals and vitamins – which can help to improve blood sugar levels and insulin response, while also reducing inflammation. They’re the main dietary culprit contributing to insulin resistance and the cascade of problems that follow. Learning to enjoy more of the nutrient rich foods I emphasize above, making sure you empty your pantry of the no-go foods, replacing them with the YES foods can literally retrain your brain to prefer healthy foods.. Enlisting a buddy or someone for accountability – whether a friend, family member, or health coach, can also help. 

Dairy 

Studies indicate a possible relationship between dairy consumption and PCOS. Individuals with PCOS appear to have more dairy in their diets, especially low- and free-fat milk, which are higher in sugar than their full fat counterparts. Low-fat dairy products may increase the level of insulin like growth factor I (IGF-I), which seems to play a role in PCOS. Further, all dairy, unless organic, hormone, and antibiotic-free, may contribute to an array of hormone imbalances. Many women with PCOS find that elimimating dairy can be beneficial in reducing hormonal symptoms, especially acne. I recommend trying it for 3 to 6 months, and if you feel better without it, keep it out of your diet generally. There are many excellent ways to get adequate calcium in your diet, without dairy products. If you do choose to keep dairy in your diet, or reintroduce it after a trial of removing it, make it organic, full fat, and enjoy it as a complement to your diet, not the main event. 

Alcohol and Caffeine

Alcohol may be particularly problematic for women with PCOS. Even small amounts of alcohol consumption have been associated with Non-Alcoholic Fatty Liver Disease (NAFLD) in women with PCOS. It breaks down into sugar, adding to insulin resistance and has been associated with increased fat stores. 

While I know the love for coffee is real, caffeine can increase our stress hormones, jack our blood sugar, and lead to insulin resistance, all of which can aggravate PCOS. It’s just not worth the quick buzz!

Skip Over-Restricting, Too! 

Restrictive eating is a no-go for PCOS.  Restriction leads to activation of your stress response – which in turn leads to increased cortisol, insulin, and insulin resistance. Over time, this can cause weight gain, and exacerbate inflammation and confused food signaling. Restriction tends to lead to rebound cravings and binging. Also, the more you restrict, the less diversity of nutrients you get from your diet. So eat regularly,  learn how to identify healthy portion sizes, and while you might eliminate certain foods, don’t take an overly restrictive approach to eating. If you need a healthy indulgence now and then to keep you from binging, and to feel like you’re enjoying life’s pleasures, learn about what I call the 95/5 Rule in my new book Hormone Intelligence. 

What to Expect with the PCOS Diet

PCOS is a complex condition. The best approach focuses on addressing each of the root causes, which you can read more about here and in my book, Hormone Intelligence. Food is an important key to healing on your PCOS, and a way to reclaim a healthy relationship to your body. The PCOS diet isn’t a quick fix solution or a magic diet plan. In real health and medicine, those just don’t exist. The magic lies in making this part of lifestyle in which whole, natural foods play an important role in your total well-being. This is what leads to you experiencing symptom improvement, sometimes noticing  small changes in just a few weeks, but knowing it may take closer to 3-6 months for major shifts, depending on the severity and range of your symptoms. Be patient and compassionate with yourself –  especially if you’ve been blaming yourself for food cravings, binging, and weight struggles. You now know these aren’t your fault.  Changing the way you eat isn’t always easy, but with time, you’ll find it’s second nature – and before long, with the changes you’re feeling, you won’t want it any other way.