The Best Diet for PCOS (According to a Dietitian)

Polycystic Ovarian Syndrome, or PCOS, is becoming more prevalent and because of this, many people are seeking out the best diet for PCOS.

As a Registered Dietitian, I see a lot of information and advice on my internet surrounding PCOS. While some of this advice is great, unfortunately there is a lot of misinformation out there.

In this article, I will break down what the most up to date research says about PCOS, diet and exercise so you can make more informed decisions about your health.

Before we jump in, I just want to mention that this article is purely for educational purposes. Please make sure you are working with a healthcare team including a doctor and registered dietitian to get personalized advice.

What is PCOS?

PCOS is short for Polycystic Ovarian Syndrome, which is the most common cause of infertility in women, affecting anywhere from 6-12% of reproductive aged women in the United States.

Along with affecting fertility, women with PCOS often have insulin resistance, which increases their risk for type II diabetes.

Women with PCOS can often experience irregular periods, acne, hair loss on their head and hair growth on their face and body. 

This is due to hormonal imbalances that affect the ovaries. The ovaries produce the egg that is released during ovulation. If you have PCOS, the egg may not develop properly or may not be released. 

PCOS may lead to infertility or the development of cysts in the ovaries.

What is the cause of PCOS?

The cause of PCOS is unknown, but experts believe that genetics play a role, along with high androgen levels, being overweight or obese and insulin resistance.

Right now we simply need more research to know what causes PCOS. While family history, weight and activity level seem to be associated with PCOS, that doesn’t mean they are the direct cause.

Can PCOS be reversed?

Unfortunately, there is no cure for PCOS. That being said, symptoms of PCOS can be managed through medication and lifestyle changes.

Treatment is based on an individual’s symptoms, but there are some universal lifestyle changes that can help anyone with PCOS, as I’ll discuss later in the article.

What foods should you avoid if you have PCOS?

There are no foods that you need to completely avoid if you have PCOS. 

Unfortunately there is a lot of misinformation out there regarding diet and PCOS. One of the most common ones I hear is that you need to avoid gluten and dairy if you have PCOS.

This is far from the truth. In fact, whole wheat and dairy products can be beneficial for your overall health and for PCOS specifically.

Looking at the current research, there is no evidence to suggest cutting out these foods can help with PCOS. 

That being said, if you are consuming gluten in the form of refined grains (white bread and pasta, baked goods, desserts), then it’s probably shift your intake towards more whole grains (whole wheat bread and pasta, brown rice).

We’ll discuss what the ideal diet for PCOS might look like later in this article.

How to lose weight if you have PCOS

Weight loss can be difficult if you have PCOS due to hormonal imbalances. But, when you get down to it, weight loss will occur when you are in a caloric deficit.

So what is a caloric deficit? Well, you are in a caloric deficit when you are consuming less calories than you expend daily. It seems simple, but in reality it’s incredibly difficult to implement.

If you have PCOS, you likely have strong cravings due to insulin resistance. This can make staying in a caloric deficit difficult. Along with this, our bodies strongly adapt to caloric restriction and will start expending less calories daily.

This is why you can’t trust those “calories burned per day” calculators online. They are typically inaccurate, especially if you have a history of calorie restriction and dieting.

Along with this, even when we try our best to calculate out every calorie consumed daily, we frequently underestimate how much we are consuming. 

It’s going to take some trial and error but it’s 100% possible to lose weight with PCOS. Here are a few tips to get you started:

• Focus on nutrient dense foods like fruits, vegetables, whole grains, lean protein and dairy products.
• Consume energy dense foods like desserts, chips, candy, pastries and sugary beverages in moderation.
• Start an exercise routine you enjoy and consistently stick to.
• Be mindful of portion sizes. Make half of your plate fruits and vegetables.

If you need additional guidance, please speak to a registered dietitian to get personalized weight loss advice.

Which diets are good for PCOS?

There are so many fad diets out there claiming they can help treat or even “cure” many chronic diseases, even PCOS.

Unfortunately, many of these claims aren’t backed by the research. In the next few sections we’ll go over a few popular diets to see how effective they are at treating PCOS.

Intermittent fasting

There is some evidence to suggest time restricted feeding (a form of intermittent fasting) can be beneficial for PCOS. 

That being said, the benefits are likely from caloric restriction and weight loss as opposed to the fasting itself, especially since we know weight loss is beneficial for PCOS.

We simply need more research to know if intermittent fasting is a good diet for PCOS. If it helps you maintain a caloric deficit, then it’s probably beneficial. But if you notice you eat just as much while intermittent fasting and find it difficult, it’s probably not the best option for you.

Keto diet

Similar to intermittent fasting, there is some evidence to suggest the ketogenic diet can be beneficial for PCOS.

But, in these studies the participants did experience weight loss, which is likely why they experienced benefits. 

Right now there is not enough evidence to suggest the ketogenic diet is beneficial for PCOS without weight loss. Along with this, it’s a notoriously difficult diet to adhere to, and if you can’t maintain the diet, you won’t see benefits.

As mentioned before, if you enjoy eating a ketogenic diet and are experiencing weight loss, then it’s probably beneficial for you. If you don’t like it, aren’t experiencing weight loss and find it difficult to stick to, it’s probably not beneficial for you.pu

Mediterranean diet

There is evidence to suggest the Mediterranean diet can be beneficial for diseases involving insulin resistance such as type II diabetes and PCOS. 

While there still needs to be more research to determine how beneficial the diet is for PCOS, overall it’s one of the most well researched diets and has been shown to have a variety of benefits for many conditions.

The diet puts an emphasis on fruits and vegetables, olive oil, nuts and even red wine. It involves less strict rules compared to other diets and is typically easier to maintain.

While we don’t know for sure if it’s beneficial for PCOS, it’s a great diet for overall health and well being.

Vegan or plant based diet 

There is some limited evidence to suggest a vegan diet is beneficial for weight loss in women with PCOS.

Since we know weight loss can help the symptoms of PCOS, this could be promising. But, again, there isn’t much research to support a vegan or plant based diet being uniquely beneficial for PCOS.

That being said, if you are a vegan for ethical reasons, you can absolutely continue to consume a plant based diet and see benefits as long as you focus on nutrient dense foods.

DASH diet

The DASH (Dietary Approaches to Stop Hypertension) diet is probably the most well researched diet for PCOS. Studies have demonstrated that the DASH diet helps participants lose weight, reduce insulin levels, fat mass, triglycerides and VLDL cholesterol.

As mentioned earlier, these benefits may have just been due to the weight loss the participants experienced. So that is important to keep in mind.

There still needs to be more research on the DASH diet, but so far the research is quite promising.

What is the best diet for PCOS?

There is no one “best” diet for PCOS, but there are a few small tweaks you can make to your current diet to make it more optimal for weight loss and PCOS.

Just as a warning, there are no “shortcuts” or “magic pills” when it comes to PCOS (at least based on what we know now). A healthy diet for PCOS isn’t too different from a healthy diet for the general population.

The main focus is on balance, variety and moderation. That means eating a variety of foods from all the food categories and limiting certain foods that are easy to overeat.

There is no magic to it, and it’s honestly pretty boring. But stay consistent with it and you’ll likely see benefits.

Focusing on variety

Variety is key when it comes to healthy eating in general, but especially for PCOS and insulin resistance. 

When I say variety, I mean a variety of foods from all the food groups. It’s best to include at least one food from each food group in every meal and snack if you can.

Along with this, it’s important to switch up what foods you consume within a food group. This helps to ensure you are getting a variety of nutrients to prevent deficiencies.

There are five food groups you should be basing your meals around:

• Grains: bread, pasta, rice, crackers, noodles, pretzels, tortillas, oatmeal, popcorn
• Protein: lean meats, nuts, seeds, tofu, eggs, seafood
• Fruits: any fruits
• Vegetables: red/orange, dark green, beans, peas, lentils, starchy, other  
• Dairy: milk, cheese, yogurt, kefir, cottage cheese

If you can, try to get one food from each food group into every meal. If this is too difficult for you, try to include at least three. Over the course of the day, aim to include foods from every category into your meals and snacks.

For the grains, try to make most of your grains come from whole grain sources. For example, whole wheat bread, whole wheat pasta, brown rice, whole wheat crackers, whole wheat tortillas, corn tortillas, oats, popcorn and quinoa. 

Consuming whole grains is important because they are high in fiber and nutrients, plus they won’t spike your blood sugar as much as refined grains. 

It’s also important to eat a variety of vegetables. Try to “eat the rainbow” and include different colored vegetables in your diet. Red or orange vegetables contain different nutrients than dark green vegetables, so it’s important to consume both for good health.

For more information about how many servings to consume on each food group, please consult the Dietary Guidelines for Americans. 

Eat more protein

Protein is going to be an incredibly important nutrient for women suffering with PCOS. Consuming protein will help reduce blood sugar spikes and also help maintain lean muscle mass. It can also help keep you full and satisfied, which can aid in weight loss.

Try to consume at least one source of protein at every meal and snack. Here are a few examples of foods rich in protein:

• Poultry: chicken, turkey, cornish hens, duck
• Red meats: beef, pork, lamb, goat, game meat
• Eggs
• Seafood: salmon, tuna, white fish, anchovy, sardines, clams, shellfish, oyster
• Nuts: almonds, peanuts, walnuts, cashews, pistachios, nut butters
• Seeds: flax, chia, sunflower, pumpkin, sesame, hemp, tahini
• Soy products: edamame, tofu, tempeh
• Beans: any beans
• Dairy products: milk, yogurt, cheese, kefir

Protein is usually the most difficult macronutrient to consume for most people and it can also be rather expensive. If you are on a budget, try consuming more eggs, canned fish, soy products, beans and dairy products. These are going to be the cheapest sources of protein.

You can also use protein supplements if you really struggle to consume enough protein. There are a variety of protein powders available that you can throw into a smoothie or add to things like pancakes, waffles, cookies, etc. You can also just consume it mixed with water or milk.

Try to aim for 0.8-2.2 grams of protein per kg of body weight daily. This would be between 47-130 grams of protein per day if you are 130 pounds. 

I recommend aiming for the higher end of this range if you can. Slowly work your way up until you’ve reached a good amount that you are able to maintain pretty easily. 

Choose healthy fats

When choosing what fats you consume in foods and what you cook with, it’s best to stick to healthy fats. These fats are called “unsaturated” fats. 

Unsaturated fats are liquid at room temperature. Some oils high in unsaturated fats include olive oil, avocado oil, canola oil and vegetable oils. It’s best to limit saturated fats, which are solid at room temperature like butter or coconut oil. 

That being said, it’s ok to enjoy foods containing butter or red meats occasionally. Just try to get most of your fat from foods high in unsaturated fats.

Here are some foods rich in unsaturated fats. Try to eat more of these:

• Oils: olive, avocado, canola, vegetable  
• Nuts: almonds, peanuts, walnuts, cashews, pistachios, nut butters
• Seeds: flax, chia, sunflower, pumpkin, sesame, hemp, tahini
• Seafood: salmon, tuna, white fish, anchovy, sardines, clams, shellfish, oyster

Here are some foods rich in saturated fats. Try to limit these:

• Butter
• Coconut oil
• Red meats: beef, pork, lamb, goat, game meat
• High fat dairy products: full fat yogurt, whole milk, full fat cheese

If you usually cook with butter or olive oil, try cooking with olive oil instead. If you consume red meat five times a week, try reducing it to two or three.

This being said, there is some data suggesting full fat dairy may be beneficial for women with PCOS. We don’t know why this is the case. It could be due to the nutrient content or the fat’s ability to reduce blood sugar spikes. And there still isn’t enough research to confirm that full fat dairy is better. But if you love whole milk or full fat yogurt, it’s probably okay to continue consuming it.

Foods to consume in moderation

Now that we’ve covered what foods are good to consume for PCOS, let’s discuss what foods you should consume in moderation.

Notice how I didn’t say “eliminate” or “avoid”. This is because there are no foods you need to completely remove from your diet to see benefits. Black and white thinking about food can often lead to disordered eating or binge eating, which we should try to avoid.

I would try to ensure that about 80% of your daily calories are coming from nutrient dense foods and about 20% of your daily calories are coming from energy dense foods.

Energy dense foods include foods high in added sugars and fats. They are high in calories and low in essential nutrients.

These foods would include:

• Desserts: cookies, cake, ice cream, pastries, baked goods, sweet breads
• Fast food: cheeseburgers, pizza, fried chicken, sandwiches with processed meat
• Sugar sweetened beverages: sweet tea, soft drinks, energy drinks, lemonade, fruit punch

As mentioned before, it’s okay to have these foods in your diet in moderation. Don’t feel like you can never consume these foods again. 

If these foods make up a majority of your diet, start by adding in more nutrient dense foods. For example, instead of having five slices of pizza, try two or three slices with a side salad. Or, try switching out a sugar sweetened soda with a diet soda.

Don’t beat yourself up or make it harder than it has to be. Instead, focus on making small changes and shifting your diet towards more nutrient dense foods.

What exercise is best for PCOS?

There isn’t a specific exercise or workout plan that is “best” for PCOS. The main goal should be to stay active and be consistent.

Ideally, you should be getting a mix of aerobic exercise and strength training. And there are a variety of activities you can do to get both of these forms of exercise in.

You should try to aim for 75 minutes of vigorous intensity aerobic activity or 150 minutes of moderate intensity aerobic activity every week.

Here are some examples of vigorous intensity activities:

• Running or jogging
• Walking uphill or hiking
• Fast bicycling
• Aerobics
• Karate, judo, jujitzu, tae kwon do
• Jumping rope
• Stair climber
• Boxing, wrestling
• Sports
• Skiing
• Swimming laps
• Canoeing or rowing
• Heavy gardening or yard work

Here are some examples of moderate intensity activities:

• Leisurely walking
• Leisurely biking
• Yoga or gymnastics
• Dancing
• Golf
• Table tennis
• Volleyball
• Recreational swimming
• Paddle boarding
• Horseback riding
• Skateboarding
• Light gardening or yard work
• Playing with children

You get even more benefits when you increase your activity to 150 minutes vigorous intensity or 300 minutes moderate intensity exercise per week. Plus, you continue to get even more benefits when you excel past this level.

To sum it up, the more exercise you get, the better. And there doesn’t seem to be an upper limit for when exercise becomes harmful. 

That being said, start small and slowly work your way up. You will run into issues if you try to increase the amount of exercise you perform too quickly.