The PCOS Diet: Best Foods for Managing PCOS

What Is PCOS?

Polycystic ovarian syndrome (PCOS) affects 1 in 10 women of reproductive age. (1)

It is the leading cause of infertility and, if left untreated, may lead to type 2 diabetes and cardiovascular risk. (2)

While PCOS may present differently for each person, symptoms most often include the following hormonal imbalances:

• Elevated luteinizing hormone (LH): LH helps control your menstrual cycle and stimulates the release of a mature egg from the ovaries. High levels of LH may affect ovulation. (3)

• Lower follicle-stimulating hormone (FSH): FSH controls the menstrual cycle and stimulates the growth of eggs in the ovaries. Lower levels of FSH may lead to irregular periods and difficulty getting pregnant. (4)

• Raised testosterone levels: Testosterone is a sex hormone. Elevated levels may affect menstrual regularity and increase body weight, acne, and excess body and facial hair.(5)

• Insulin resistance: Insulin is a hormone released by your pancreas that helps to control blood sugar. Insulin resistance means your body can make insulin but cannot use it effectively, increasing the risk of type 2 diabetes. (6)

Research indicates that insulin resistance may contribute to or worsen symptoms of PCOS and may play a role in increasing testosterone levels. (7)

Helping restore hormone balance and addressing insulin sensitivity are important goals for managing PCOS.

Although PCOS cannot be cured entirely, research indicates that diet may help manage symptoms. (8)

Choose Complex Carbohydrates

According to research, about 65%–70% of women with PCOS exhibit insulin resistance, which influences blood sugar. (9)

Increased insulin levels may induce excess testosterone production and increase levels of luteinizing hormone. (9)

The good news is that your blood sugar is highly responsive to lifestyle changes.

The first step is understanding that simple carbohydrates, such as sugar and processed foods, are the primary nutrients that directly raise your blood sugar.

It is also important to manage the amount of carbohydrates you consume in one meal to improve insulin response and blood sugar levels.

Specific carbohydrate needs will vary based on the individual, but you can use the “plate method” as general guidance.

On a 9-inch plate, fill half of it with non-starchy vegetables, a quarter of it with protein-rich foods, and the other quarter with carbohydrate-rich foods. (10)

Research supports the effectiveness of limiting the intake of high-sugar carbohydrates to manage PCOS.

One small study involving 24 women who followed a low starch diet for eight weeks experienced weight loss, improved insulin sensitivity, and decreased testosterone levels.

Women in this study excluded all grains, beans, and dairy products besides 1 ounce of cheese daily. They focused on low-sugar fruits, such as berries, oranges, apples, and plums, and included lean proteins and healthy fats with plenty of vegetables. (7)

While this study is helpful in understanding the effect of carbohydrates in PCOS, you do not need to eliminate all grains and legumes to help manage blood sugar and improve your symptoms.

Instead, focus on the right amounts of whole, high fiber foods, and limit processed and refined grains. Also, include plenty of non-starchy vegetables.

Some ideas include:

• Quinoa
• Barley
• Oat Bran
• Oats
• Millet
• Lentils
• Peas
• Beans
• Zucchini
• Leafy greens
• Sweet potato
• Avocado
• Broccoli
• Cauliflower

Additionally, fiber is essential in managing your body's response to carbohydrates. It is a non-digestible carbohydrate and helps control the amount of sugar released into the bloodstream. (11)

Fiber also helps you feel full faster, which can deter overeating. (12)

Finally, research has shown that combining fiber-rich carbohydrates with a protein-rich food can further reduce the impact of sugar. (13)

Examples of this include:

• An apple with peanut butter.
• Whole grain bread with turkey and cheese.
• Carrots and hummus.
• Cottage cheese and berries.
• Sweet potato with grilled chicken and green beans.

Go for Omega-3 Fatty Acids

Research has found that insulin resistance is present in about 75%–95% of individuals with PCOS. (14)

Additionally, studies have discovered a chronic presence of low-level inflammation as a symptom of PCOS, possibly relating to insulin resistance. (15)

Therefore, improving insulin sensitivity and inflammation levels are essential goals for PCOS management.

Diets high in saturated fat and trans-fat may decrease insulin sensitivity and increase the risk of type 2 diabetes. (16)

Instead, diets rich in omega-3 fatty acids have shown a positive impact on improving insulin sensitivity and metabolic function. (17)

Furthermore, research supports the role of omega-3 fatty acids in decreasing inflammation. (18)

You can get an adequate amount of omega-3 fatty acids through your diet.

Good sources include:

• Seafood  such as salmon, mackerel, tuna, sardines, herring
• Nuts and seeds including flaxseeds, chia seeds, walnuts, hemp seeds
• Oils such as flaxseed oil and fish oil
• Fortified foods such as eggs, milk, or juices

Fuel Up on Anti-inflammatory Foods

Research has found that women with PCOS were more susceptible to stress. (19)

As a result, PCOS may increase cardiovascular risk, such as impaired endothelial functioning. (20)

Endothelial dysfunction is when the endothelial layer, the inner lining of the small arteries around the heart, fails to perform its essential functions.

Research illustrates a diet high in anti-inflammatory foods may help stress-associated cardiovascular risk and insulin resistance. (18)

Anti-inflammatory foods contain substances called antioxidants.

Antioxidants help to combat free radicals in the body.

Free radicals are molecules that can lead to cell damage and cause inflammation and stress throughout the body.

A diet high in anti-inflammatory foods should include the following:

• Fatty fish such as tuna and salmon
• Fruit such as blueberries, blackberries, strawberries, and cherries
• Vegetables including kale, spinach, and broccoli
• Beans and legumes
• Nuts and seeds
• Olives and olive oil
• Spices such as turmeric, garlic, and ginger

Finally, limiting overly processed and high sugar foods will help to decrease inflammation throughout the body. (21)

Address Vitamin D Deficiency

Studies have shown that vitamin D plays an essential role in metabolic pathways, and a deficiency in the vitamin may contribute to the development of insulin resistance. (22)

A 2012 study found that around 85% of women with PCOS had low levels of vitamin D. (23)

Additionally, there is evidence that vitamin D supplementation may improve menstrual regularity and insulin sensitivity in women with PCOS. (23)

While our body creates vitamin D from absorbing direct sunlight, you can increase your vitamin D through supplementation and fortified foods.

Some food sources of vitamin D include:

• Salmon
• Tuna canned in olive oil
• Mushrooms
• Fortified eggs, specifically the yolk
• Fortified orange juice
• Fortified milk and dairy products
• Fortified cereals

If you are interested in supplementing with vitamin D, it is best to request blood work from your medical provider to take the most appropriate dose.

Ensure Adequate Mineral Intake

Research has found a correlation between women with reduced magnesium levels and high testosterone levels and insulin resistance. (24, 22)

Additionally, there is a similar link between decreased selenium levels and elevated testosterone, most commonly seen in women with PCOS. (22)

Knowing that selenium and magnesium may impact testosterone levels and insulin's action in the body, it is worth taking extra care to include these in your diet.

Foods rich in magnesium include:

• Enriched whole-grains
• Dark leafy greens such as kale, spinach, and collard greens
• Nuts and seeds including pumpkin seeds, almonds, and cashews
• Beans and legumes

Foods rich in selenium include:

• Brazil nuts
• Tuna
• Halibut
• Turkey
• Chicken

Pump Up the Protein

A six-month study evaluating the effects of a high protein diet in PCOS management found an improvement in glucose metabolism. (25)

Additionally, studies have shown that protein stimulates the action of glucagon, a hormone that counteracts the action of insulin. (26)

Eating an appropriate amount of protein can help balance glucagon and insulin levels in the blood, which may protect the body against insulin resistance.

To ensure adequate protein in your daily diet, include a protein source with every meal and snack, such as:

• Lean meats including beef, lamb, veal, pork
• Poultry such as chicken and turkey
• Fish and seafood such as fish, prawns, crab, lobster, oysters, scallops, clams
• Eggs
• Dairy products such as milk, unsweetened yogurt (especially Greek yogurt), cottage cheese
• Nuts and seeds including peanut butter, almond butter, almonds, cashews, and hemp seeds
• Beans and legumes such as lentils, black beans, kidney beans, edamame, and green peas
• Tofu

Supplements to Consider

As noted, a significant component in PCOS management is addressing insulin resistance.

Therefore, many women with PCOS are prescribed Metformin, a medication intended for diabetes and blood sugar management.

For some, medication leads to stomach discomfort and other unwanted side effects.

While it is necessary to work with your medical practitioner, there may be more natural supplements you can try to support your insulin and hormones.

Inositol

Research has found that inositols act as a second messenger for insulin, and deficiency may contribute to the various features of PCOS. (27)

The two most researched forms of inositols include myo-inositol and d-chiro-inositol. Both have been shown to improve PCOS symptoms. (27)

Furthermore, research has found that supplementation with 4000 mg, or 4 grams, of myo-inositol per day improved egg quality and fertilization rates in individuals with PCOS.

Women in this study also supplemented 400 micrograms of folic acid. (28)

Finally, a meta-analysis comparing Metformin to inositol found that both treatments effectively lowered glucose, fasting insulin, and estrogen. (29)

Inositol was more effective at reducing testosterone and demonstrated better pregnancy rates. (29)

NAC (N-Acetyl-Cysteine)

NAC is an amino acid that helps the body make antioxidants.

Research has shown that Metformin and NAC appear to have comparable effects on testosterone levels, insulin, and menstrual irregularity in women with PCOS. (30)

Dosages range from 1.8–3 grams per day. However, it is best to work with your practitioner to identify what is best for you.

Sample Week Meal Plan

Here is a sample one-week menu plan that includes foods to best support your PCOS.

Monday

• Breakfast: Scrambled eggs with spinach, tomatoes, and mushrooms, and sprouted wheat bread topped with avocado.
• Lunch: Greek salad topped with grilled salmon and a side of mixed berries.
• Snack: Veggies and hummus.
• Dinner: Roasted chicken and veggies with a baked sweet potato.

Tuesday

• Breakfast: Chia seed pudding (chia seeds mixed with yogurt or almond milk) topped with pecans and banana slices.
• Lunch: Roasted chicken, spinach, tomato, hummus, and avocado in a whole grain wrap.
• Snack: Apple slices and unsweetened almond butter for dipping.
• Dinner: Quinoa and black bean stuffed bell peppers.

Wednesday

• Breakfast: Greek omelet.
• Lunch: Open-faced veggie tuna salad sandwich on whole-grain bread, or leftovers from last night’s dinner.
• Snack: A handful of lightly roasted nuts such as cashews, almonds, pecans, Brazil nuts.
• Dinner: Grilled shrimp and veggie skewers with roasted potatoes.

Thursday

• Breakfast: Whole grain toast topped with avocado, sautéed spinach, and an over-easy egg.
• Lunch: Arugula salad with leftover shrimp, goat cheese, tomatoes, avocado, and olive oil dressing.
• Snack: 1/2 cup full fat, unsweetened Greek or coconut yogurt topped with fresh fruit and a light drizzle of honey.
• Dinner: Pan-seared fish with roasted asparagus and butternut squash.

Friday

• Breakfast: Smoothie with banana, avocado, flax meal, spinach, and blueberries. Protein optional.
• Lunch: Quinoa and chickpea tabbouleh.
• Snack: Hardboiled egg with avocado mashed and spread on toasted whole-grain bread.
• Dinner: Turkey burger and a green salad.

Saturday

• Breakfast: Protein banana pancakes.
• Lunch: Lentil soup with a side salad.
• Snack: Handful of roasted nuts and one piece of dark chocolate.
• Dinner: Grass-fed beef Bolognese over spaghetti squash or lentil pasta.

Sunday

• Breakfast: Cottage cheese or a dairy-free option, like cashew yogurt, topped with fresh berries, almond slivers, and a drizzle of maple syrup.
• Lunch: Egg and vegetable scramble with a side of toasted grain bread.
• Snack: Olives and hummus with fresh vegetables.
• Dinner: Chicken and veggie kebobs with Cous Cous.

The Bottom Line

With a healthy and balanced diet, you can see improvement in PCOS symptoms.

A well-balanced PCOS diet includes the following:

• High fiber, low sugar carbohydrates.
• Adequate omega-3 fatty acids.
• Optimal intake of anti-inflammatory foods.
• Sufficient vitamin D.
• Enough mineral intake, specifically magnesium and selenium.
• Proper intake of protein.
• Supplementation if needed.

To make these changes more attainable, consider working with a Registered Dietitian specializing in PCOS to find an eating style and supplementation that works best for you.