What is the best diet for PCOS?
PCOS Nutrition is a hot topic among women with PCOS and practitioners alike. There can be a lot of confusion surrounding this topic and this post aims to clear some of that up.
In this article you will learn:
why there is no one-size-fits-all diet for PCOS
why I do not recommend restrictive weight loss diets
what foods should be avoided when you have PCOS
the best foods to eat for your PCOS
how to build a PCOS-friendly meal that supports your health and fertility goals
One-size-fits-all diets don’t exist
Because PCOS can have a variety of root causes and no two women are the same, there isn’t one diet or way of eating that works best for everyone. Genetics, environment, and lifestyle factors can all influence PCOS and your nutritional needs.
Some common root causes of PCOS could include one or more of the following:
insulin resistance
inflammation
gut imbalances
stress
thyroid issues
hormonal imbalances
A woman with insulin resistant PCOS who is carrying extra weight has much different nutritional needs than a woman with lean PCOS and hypothyroidism. So when I see blanket recommendations like “go keto!” or “avoid gluten and dairy!”, I get a little troubled because this sort of advice can often do more harm than good. (This also applies to nutritional supplements!)
I want to give you a real-life example of what this might look like:
Sara is a healthy body weight but has irregular menstrual cycles and acne. Her doctor recently diagnosed her with PCOS.
After receiving her diagnosis she went home to google “PCOS diet” and noticed that a low-carb diet was most often recommended. Sara cut out most carbs and over the next few weeks she actually started to feel worse. She became more fatigued, irritable, and her acne worsened. This is because in Sara’s case, a low carb diet actually stressed her body out more! Through additional testing she learned that she does not have insulin resistance but does have high levels of DHEA, an androgen produced by the adrenal glands, indicating that she has adrenal (aka stress-induced) PCOS.
More stress = more PCOS symptoms. Sara needs a diet that includes more carbohydrate to support her adrenals while incorporating lifestyle strategies to manage her stress.
In order to find a way of eating that will help you reverse your symptoms and get you feeling your best, you need to find out what YOUR underlying root causes are. You can do this through both conventional blood work and functional lab testing.
Nutrition, supplement, and lifestyle recommendations will vary depending on your root causes and nutritional needs.
Why I don’t recommend restrictive diets
It’s estimated that at least 75% of women with PCOS have insulin resistance to some degree. Because insulin resistance is closely tied to weight issues and can lead to long term health complications, many well-meaning doctors encourage weight loss and send the patient on their way with no real plan for how to achieve it other than telling them to eat less and exercise more.
I often hear women say that their doctor suggested they follow a 1200 calorie diet in order to lose weight. This is a VERY low number of calories for a woman of reproductive age and is simply not sustainable. It is going to be very hard to get a regular period and get pregnant when you are keeping your daily calories that low.
Not only that, when you are dealing with the hormonal imbalances that come with PCOS, the calories in < calories out approach to weight loss does not work. Both insulin resistance and low calorie diets can cause erratic blood sugars which lead to strong cravings and feeling like you have no willpower, perpetuating the restrict-binge cycle.
This is a very important because women with PCOS are at a much greater risk of developing disordered eating tendencies and eating disorders.
Because of this increased risk and the fact that weight issues are a symptom of underlying imbalances, I always address individual root causes and prescribe the least restrictive diet as possible with my clients while still getting them results.
Foods to avoid when you have PCOS
Would you be surprised to hear me say “NONE”?
There are definitely foods that should be limited and eaten sparingly, but PCOS is a life-long condition and it’s just not realistic to say you should not eat “xyz” food ever again.
I do recommend limiting processed foods and trying to eat a whole-food diet as much as possible. I know that we are all busy and it’s just not possible to cook all of your meals from scratch!
Remember that connection and socializing are just as important to your well-being as what you eat. You want to be able to enjoy your favorite restaurant or go to a happy hour with friends without feeling like it’s going to derail you.
Here are some foods I do suggest limiting, as they tend to be more inflammatory and inflammation can be a big driver of PCOS:
margarine and vegetable/seed oils
sugar, high fructose corn syrup, & artificial sweeteners
soda and fruit juices
refined and processed carbohydrates
1-2 alcoholic drinks per week
Unless you have an allergy or known food sensitivity or intolerance, all foods can fit. It can be useful to keep a food journal to increase your awareness of how you feel after eating certain foods. This can help you to make better decisions when it comes to what you choose to eat most of the time.
The best foods to eat for PCOS
What can you add in to your diet to make it even healthier and more supportive of your PCOS?
The #1 priority in your diet should be adequate protein. Protein is the most satiating macronutrient and will help to keep blood sugars balanced. The most bioavailable protein sources come from animal products like beef, poultry, fatty fish, eggs and greek yogurt. Tofu, beans, edamame, hemp seeds and lentils are good plant-based sources.
Fruits and vegetables are a great source of fiber and micronutrients. They are also full of antioxidants that will help decrease oxidative stress and inflammation. Berries, avocado, cooked leafy greens and cruciferous vegetables are among my top picks. The more color variety you have in your diet, the more nutritious it is.
Nuts and seeds will also provide you with fiber and are very high in important minerals like zinc and magnesium. Ground flaxseed in particular is one I recommend eating daily to help improve insulin levels, reduce inflammation, and support healthy hormone levels.
Building a PCOS-friendly meal
A balanced meal for PCOS includes all of the macronutrients: protein, carbohydrate, & fat. As I mentioned above protein intake should be a priority as it will help to keep you full for several hours and keep blood sugars from going too high and too low. Aim for 20-30 grams of protein per meal.
Next, I recommend filling half of your plate with non-starchy vegetables. This is a great way to get more fiber in for satiety as well as hormone and gut health. Veggies are a source of antioxidants to lower inflammation and improve egg quality.
Healthy fats include those from nuts & seeds, avocado, full-fat dairy, ghee, coconut oil, and olive oil. Fats are very important for hormone production and vitamin absorption. It will also make your food taste so much better. Oftentimes foods that are labeled low fat are full of added sugars. Do not be afraid of fat!
Finally, carbs can come from starchy foods like potatoes, rice and pasta, or fruit (which is also full of micronutrients, fiber, and antioxidants). The amount of carb you can tolerate per meal will depend on several factors including your degree of insulin resistance and activity levels.
This is a framework I use with my clients to help them build complete meals that check all the boxes:
Nutrition is just one piece of managing your PCOS but it’s a foundational one that shouldn’t be neglected. As you can see, you have a lot more freedom with your PCOS diet than you may have been told!
Finding a practitioner who can help you investigate your root causes will allow you to get a personalized nutrition & lifestyle plan that doesn’t leave you feeling deprived and a supplement protocol that is specific to you. Where will you be in a year if you don’t have this plan in place?
Click HERE to complete an application for a free 30 minute introductory call to discuss your goals and how my root cause approach can help you reach your health goals.
Kate Netz, RDN, LD
Functional Dietitian
All information in this post is for educational purposes only and does not replace medical advice or diagnosis.
