The Best Types of Foods to Eat and Avoid When You Have PCOS
With Polycystic Ovary Syndrome or PCOS, as it's commonly known, diet is a key part of a treatment plan. When you're following a PCOS diet, try to incorporate more of these expert-recommended food groups while avoiding others to improve symptoms of PCOS and maintain or reach a healthy weight.
What is PCOS?
PCOS is a condition in which women have an imbalance of reproductive hormones; often, the ovaries produce an excess of the male hormone, testosterone, and a lack of the female hormone, estrogen. The body doesn't go through regular ovulation as a result, so the eggs that are not properly released each month often swell and cluster around the ovaries, forming cysts.
Because the body's estrogen receptors don't work properly, its whole metabolic system may be thrown off, which can affect anything from the way it processes insulin to the good bacteria in the gut microbiome, explains Felice Gersh, MD, author of PCOS SOS: A Gynecologist's Lifeline to Naturally Restore Your Rhythms, Hormones, and Happiness.
The condition officially affects 10 percent of American women (and often their fertility), according to the U.S. Department of Health and Human Services, but doctors suspect that it's more like 25 percent, as many cases go undiagnosed or dismissed.
Symptoms of PCOS
To be officially diagnosed as PCOS, women will likely have at least two of the following three symptoms, according to Dr. Gersh: high levels of the androgen, or male hormone, testosterone (which often leads to the trademark symptoms of excess body hair, or Hirsutism, and cystic acne), irregular or painful menstrual cycles, or tiny cysts, that often only show up via ultrasound. Ironically, having the actual ovarian cysts is not always a key symptom of the condition.
In addition, 80 percent of PCOS patients tend to be overweight and have excess belly fat, explains Dr. Gersh—this weight loss resistance stems from the patients' hormonal imbalance, which leads to difficulty processing insulin. Because of their weight, PCOS patients often have higher rates of sleep apnea, joint pain, and infertility as well.
Traditional Treatment Options
Hormonal birth control is one of the most common treatment options, aiming to regulate the hormonal imbalance at the root of PCOS. Other prescription drugs, like Metformin, which may help the body process insulin and lose weight, or Spironolactone, which may reduce excess hair growth due to testosterone, are also often used to treat PCOS.
However, all nutritional and medical experts seem to agree that healthy lifestyle changes; specifically, improving diet and exercising, can significantly impact the treatment path in a positive way.
How Changes to Your Diet and Lifestyle Can Help PCOS
Maintaining a balanced diet and therefore a healthy weight can be key in managing PCOS symptoms, by improving the way the body processes glucose, and potentially improving fertility, according to experts. Plus, PCOS patients often have chronic low-grade inflammation, Dr. Gersh explains, and much of that inflammation exists in the gut lining. Eating better, in general, may help your gut issues and other uncomfortable manifestations of PCOS heal from the inside out. Here are some food groups you should increase and limit, respectively, to manage PCOS symptoms and maintain or reach a healthy weight.
Foods You Should Eat on a PCOS Diet
The following healthy foods can lower inflammation, keep blood sugar levels in check, and help you maintain a healthy weight to mitigate the side effects of gut issues and other uncomfortable manifestations of PCOS.
Eat This: Fiber
"A high-fiber diet offers many benefits to women with PCOS, such as lower insulin levels, and antioxidants which fight to lower inflammation, and better gut bacteria," says Angela Grassi, MS, RD, LDN, founder of The PCOS Nutrition Center. (Many high-fiber foods contain prebiotics, which feed probiotics and help to nourish your gut microbiome.)
Examples of high-fiber foods for a PCOS diet include:
- Seeds (chia, flax, sunflower seeds)
- Legumes (black beans, lentils, chickpeas)
- Berries (raspberries, blackberries, blueberries)
- Whole Grains (bulgur, quinoa, brown rice, whole oats)
Eat This: Lean protein
Eating more lean protein (as opposed to meat that's higher in saturated fat, like red meat and cured meats) may help weight loss, as well as keeping you fuller for longer. "When it comes to protein sources, I recommend include 2 to 3 servings of fish per week (avoiding fish with high amounts of mercury), chicken (grilled or baked), and plant-based sources of protein," says James Nodler, MD, site director at CCRM Houston.
Examples of foods high in lean protein for a PCOS diet include:
- Fish (salmon, shrimp, tuna, cod)
- Lean poultry (skinless chicken and turkey)
- Plant protein sources (beans, peas, tofu, tempeh)
Eat This: Antioxidant-heavy foods
"Because women with PCOS have been shown to have low-grade inflammation, elevated inflammatory signals can raise insulin, contributing to worsening of PCOS symptoms," Grassi says. "The best inflammation-fighting antioxidant-filled foods include fruits, vegetables, whole grains, and unsaturated fats."
Examples of antioxidant-rich foods for a PCOS diet include:
- Fruits (strawberries, blueberries, raspberries )
- Vegetables (spinach, artichokes, kale)
- Whole Grains (whole oats, whole wheat, quinoa, brown rice)
- Unsaturated fats (nuts like pecans, nut butters, olive oil, avocado)
Eat This: Foods with organic whole soy
Recent research published in the journal Nutrients suggests that the isoflavones in soy may increase the chances of getting pregnant. "Organic whole soy has been shown to improve fertility in PCOS women," Dr. Gersh echoes, "But it must be organically produced and not highly processed," she adds.
Examples of foods containing organic whole soy for a PCOS diet include:
Eat This: Foods compliant with the Mediterranean Diet
"I tend to recommend the Mediterranean diet to my patients, many of whom are predisposed to heart disease, and prediabetic due to difficulty processing insulin," says Amy Plano, RD, founder of The PCOS Dietitian blog. "This diet focuses on lean protein, higher quality fats, and complex carbs rather than simple carbs," she adds, all of which are positive for heart disease and diabetes prevention.
Examples of Mediterranean Diet foods for a PCOS diet include:
- All fruits and vegetables
- Seafood (shrimp, salmon, tuna, sea bass)
- Whole Grains (brown rice, quinoa, couscous)
- Healthy Fats (olive oil, plain, unsalted nuts, avocado)
Eat This: Foods compliant with the DASH Diet
The DASH diet, originally designed for controlling high blood pressure, can also be beneficial to patients with PCOS in managing lower levels of insulin. It mainly focuses on healthy carbs, like fruits, vegetables, and whole grains. "Due to the presence of fiber, whole grains minimize spikes in your blood sugar and insulin levels. Individuals who are insulin sensitive are able to better manage their weight and experience a reduced risk of diabetes, heart disease, and stroke," Plano says. "Plus, lower levels of insulin are also consistent with menstrual regularity," she adds.
Examples of DASH Diet foods for a PCOS diet include:
- All fruits and vegetables
- Whole Grains (brown rice, quinoa, whole wheat)
- Poultry and fish (chicken, turkey, salmon)
- Legumes (peanuts, chickpeas, peas)
- Nuts and seeds (walnuts, pecans, flaxseeds, sunflower seeds)
Foods To Avoid on a PCOS Diet
When you're eating to alleviate PCOS symptoms, you'll want to avoid the following foods that can spike blood sugar, increase inflammation, and cause weight gain.
Limit: Refined carbs
Women with PCOS do not typically process carbohydrates correctly (because of their high levels of insulin, in most cases), Dr Nodler explains, which is why refined carbs are on the list of foods to avoid with PCOS. "Limiting carbohydrates, especially refined, nutrient-void carbohydrates, can lead to weight loss, which in turn decreases androgen levels responsible for acne, abnormal hair growth, and anovulation, or an irregular menstrual cycle," he says.
Examples of carbohydrates to avoid on a PCOS diet include:
- White bread
- Pizza dough
- Regular pasta
- White rice
Limit: Sugary beverages
Though you may think juice and smoothies are healthy, some pre-bottled options can contain close to 30 grams of sugar and will spike your blood sugar, a problem if you have high insulin levels to begin with. "It's best to stay away from concentrated sweets and sugars, like fruit juice—instead, choose natural sugars like fruits," Plano says. "These are higher quality carbohydrates, and therefore are higher in fiber."
Examples of sugary beverages to avoid on a PCOS diet include:
- Fruit juice
- Bottled smoothies
- Cold-pressed juices
RELATED: The easy guide to cutting back on sugar is finally here.
Limit: Sugary, processed foods
Along with sugary beverages, sugary foods are not much better for the PCOS diet. "Really all processed foods, many containing harmful chemicals, not only are poor for weight loss but can also destroy the gut microbiome. Instead of packaged foods, choose farm-to-table, whole foods," Dr. Gersh suggests.
Examples of processed foods to limit on a PCOS diet include:
- Cakes, candy, cookies, and other sweets
- Sweetened cereals
- Yogurts with added sugar
- Ice cream with excess added sugar or sugar substitutes
Limit: Saturated and trans fats
Saturated fats, found in foods like overly processed meats, aren't beneficial for weight loss or a healthy balanced diet. Additionally, these high-fat foods can also be problematic for PCOS patients. It's much better to focus on healthy fats, as in the Mediterranean diet (and you can have as much whole grain avocado toast as you want). "Women with PCOS should avoid saturated and trans fats which can be pro-inflammatory, especially in the gut," Dr. Nodler says.
Examples of fats to avoid on a PCOS diet include:
- Saturated fats (red and processed meats like fast food hamburgers)
- Trans fats (doughnuts, French fries, frozen pizza)
Limit: Dairy, in some cases
According to research published in the International Journal of Preventive Medicine, reducing dairy intake could potentially help certain women with PCOS lose weight and help some of their hormonal PCOS symptoms. Some patients (perhaps if they have gut issues linked to a dairy intolerance) can benefit from starting out with cutting back on dairy or even a vegan diet. But other patients, Plano explains, if they have no sensitivity or intolerance to dairy, have no reason to eliminate it from their diet—especially if they need the calcium and Vitamin D. Plano suggests sticking to healthy options like plain Greek yogurt as opposed to sugary options like a candy-topped yogurt.
Examples of dairy products to limit on a PCOS diet include:
- Artificial or heavily processed cheeses
- Yogurts with added sugar
- Ice creams with sugar alcohols or tons of added sugar
"Women with PCOS have high rates of fatty liver, which is only diagnosed with an ultrasound. Also, alcohol is a direct toxin to the liver and gut microbiome," Dr. Gersh says. A European Journal of Endocrinology study states that lifestyle changes, particularly maintaining a balanced diet, is the best way to manage fatty liver in conjunction with PCOS. A glass of red wine with dinner won't be harmful at all, but it's best to limit excess alcohol intake and especially inflammatory, sugary mixed drinks.
Examples of alcohol to avoid on a PCOS diet include:
- Cocktails made with sugary mixers like juice or bottled mixers
- Canned cocktails