The Best Diet for PCOS: Splitting Fact From Fiction

Last updated on May 25th, 2019 at 1:47 am

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[Last updated 9th January, 2019]

PCOS is one of the most common hormonal disorders in the developed world.

In fact, it’s thought to affect almost 7% of pre-menopausal women in the US (1).

But there is surprisingly limited information on how to treat it naturally.

This article explores the best diet for PCOS, as based on scientific evidence.

What is PCOS (Polycystic Ovary Syndrome)?

PCOS (Polycystic ovary syndrome) is a condition characterised by hormonal imbalances in women.

Specifically, it’s an imbalance in the amount of male hormones (or androgens) produced by the ovaries.

This short Youtube video illustrates the condition well.

The term polycystic ovary means, “to have multiple cysts in the ovaries.” However, the development of cysts isn’t actually necessary for the diagnosis of PCOS.

what is PCOS

Source: Mayoclinic

Unfortunately there is no known cure yet, and the cause is unknown. However, genetic predisposition coupled with inadequate diet is thought to be a major driver (2).

Summary: PCOS is characterised by an imbalance of male hormones in women. It is likely a genetic condition triggered by diet.

PCOS Symptoms

PCOS symptoms and weight gainExcessive androgen secretion appears to be responsible for most PCOS symptoms.

Most will experience one or more of the following symptoms:

  • Irregular or absence of menstrual periods
  • Excess body or facial hair, indicative of increased androgen levels
  • Cysts on one or both ovaries
  • Uncontrollable weight gain
  • Infertility
  • Sleep apnoea
  • Insulin resistance and associated metabolic problems.

Summary: PCOS has a cluster of symptoms related to increased male hormone levels.

PCOS and Diet: Insulin and Weight Loss are Key

The most effective eating pattern for PCOS is one that promotes weight loss and reduces levels of the hormone insulin (3, 4).

This is because PCOS coupled with weight gain drives insulin resistance. That’s why PCOS dramatically increases risk of type 2 diabetes and other metabolic health conditions (5, 6).

Additionally, high insulin levels appear to upset regulation of the sex hormones. This worsens PCOS in a viscous cycle (7, 8).

PCOS INSULIN RESISTANCE CYCLE

Whichever diet or eating pattern helps you to successfully lose weight and lower insulin will have the best possible outcomes.

Assuming you have been unsuccessful following a low-fat diet (which can work), here are several alternatives:

Low Carb Diets

Low carb diet for PCOSA low carb diet is an eating pattern where carbs make up roughly 30% or less of your energy intake.

By comparison, the average American diet is around 60% carbs or more than 300 grams per day.

Reducing carbs tends to equal a higher protein intake, shown to keep you feeling full for longer and reduce total calories consumed through the day (9, 10).

That’s why low carb diets can work well for fat loss when not counting calories.

Strategies to reduce appetite are even more important for PCOS patients, as studies indicate their levels of the “hunger hormone” ghrelin are dysregulated (11).

Low carb diets are also very useful for treating insulin resistance and type 2 diabetes. But note those taking metformin will need to speak with their doctor first.

Ketogenic Diet

A ketogenic diet is a very low carb, high fat eating pattern (as opposed to higher protein).

Consistently eating this way produces ketones, which serve as the main energy supply for your body instead of carbs. This makes it especially useful for reducing insulin levels and weight loss.

In a small study of 5 women with PCOS, a ketogenic diet reduced body weight by an average of 12% after 24 weeks. There was also significant improvements in PCOS hormones, and a 54% reduction in fasting insulin levels (12).

It’s promising, but incredibly difficult to stick with long-term.

Very Low Calorie Diets (VLCD) and Diet Pills

A very low-calorie diet is an intake of 800 calories per day or less.

One study showed that it causes significant weight loss in women with and without PCOS after 12 weeks (13).

Problem is that VLCDs are designed for rapid weight loss in the short term, and are not sustainable.

Additionally, weight loss from severe calorie restriction severely harms your metabolism, ironically making you regain weight more easily.

One study has also shown that a diet pill called helped women with PCOS lose weight over a 24 week period (14).

However, similarly to VLCDs, a diet pill is not a sustainable solution. Unfortunately there are no short-cuts.

Summary: The best diet for PCOS should promote weight loss and reduce insulin levels. A low carb diet is the best solution if low fat has not worked for you, with a ketogenic diet the more extreme option. VLCD and diet pills will not work long-term.

PCOS and Dairy Foods

Dairy milk and PCOSAside from overall eating patterns, there are some common food concerns of PCOS patients that should be clarified.

One of the main issues is dairy consumption.

Some observational studies have linked dairy intake with increased risk of PCOS, especially low-fat dairy products (15, 16).

In contrast, full-fat dairy has been linked to a reduced risk of infertility, which suggests a protective effect on PCOS (17).

It’s really unclear at this stage, and we cannot draw any conclusions from observational studies. It may be that those who drink more dairy also eat more junk food, which is why that trend was observed.

If low-fat dairy is indeed bad for PCOS, and full fat dairy is not, it’s likely because low-fat dairy and other “diet” products have significantly more sugar (18).

In any case, dairy-free is certainly worth a try if other changes have not helped. With a wholesome diet, dairy is not essential for the average person (there are always exceptions of course, such as gastric bypass patients and other specific medical conditions).

Summary: Some studies have linked dairy consumption with an increased risk of PCOS, particularly low-fat dairy. However there is no conclusive evidence yet.

PCOS and Soy

PCOS and soy foodsSoy products are made from soybeans, the protein-rich seeds of the soy plant.

Soybeans are rich in phytoestrogens, a compound so similar to the human estrogen hormone that it can disrupt its function (19).

The effects of soy on hormone-sensitive conditions like endometrial and ovarian cancer are uncertain, which also leaves a question mark for those with PCOS.

Both observational studies and clinical trials have found those with a high soy intake have no greater risk of endometrial cancer, which is encouraging (20, 21).

There was also a clinical trial that showed phytoestrogen supplementation for 3 months had no negative effects, and may even have benefits for PCOS patients (22).

There isn’t much evidence to go by, but it seems moderate soy consumption is likely safe in a diet for PCOS. In saying that, it seems an unnecessary risk to eat a lot or increase your intake.

Summary: Regular soy consumption is likely safe for PCOS patients, but the research is not thorough.

Increase Folate or Folic Acid Consumption

Folate and folic acid for PCOSFolate and folic acid are both a form of vitamin B9.

Vitamin B9 is essential to reduce the build up of a compound in the blood called homocysteine.

High levels are thought to be an independent risk factor for heart disease and stroke (23, 24, 25).

Unfortunately, those with PCOS tend to have high homocysteine and therefore an increased risk of cardiovascular health problems (26, 27).

The most efficient way to reduce homocysteine levels is by increasing folate or folic acid intake. Folate comes from whole foods, while folic acid is the synthetic version in supplements (which some people cannot metabolise) (28, 29).

Top folate sources per 100-gram serve are:

  • Beans and lentils (~50% RDA)
  • Raw spinach (49% RDA)
  • Asparagus (37% RDA)
  • Romaine (Cos) lettuce (34% RDA)
  • Broccoli (27% RDA)
  • Avocado (20% RDA)
  • Oranges/Mangoes (~10% RDA)

Summary: PCOS patients tend to have high homocysteine levels, which appears to increase heart disease risk. Consuming more folate is the most effective way to remedy this.

Limit Junk Food and Added Sugars

It goes without saying that junk food is a nightmare for treating PCOS.

That includes candy, muesli bars, milk chocolate, potato chips, ice cream, fruit juice, soft drinks and similar products.

They’re typically high in calories and added sugars, which can raise insulin levels and disrupt other hormones.

Not only does regular consumption of these foods lead to weight gain, but is likely a driving factor for ovulation problems and infertility (30).

Summary: Foods high in added sugars should be strictly limited, especially if you have PCOS.

Take an Inositol supplement

Inositol is a type of carbohydrate that is found in a wide range of food sources such as fruits, beans, grains and nuts, and also occurs naturally in the human body.

Myo-inositol (MI) and D-chiro-inositol (DCI) are the two main types of inositols that have been studied for their benefits on women with PCOS.

Some of these benefits include:

  • Improved blood glucose (sugar) control
  • Reduced insulin resistance
  • Reduced androgens (male hormones)
  • More regular menstrual cycles
  • Improved fertility
  • Weight loss
  • Improved blood lipid (fat) profiles (31, 32, 33, 34, 35, 36).

A higher supplemented dose of 2-4 grams of inositol per day for a minimum of 6 months may help to achieve the benefits outlined above, therefore improving the symptoms of PCOS (31, 34).

It is certainly worth considering if you are struggling to improve symptoms despite major diet changes and lifestyle improvements.

Summary: Supplementing with 2-4 grams of inositol per day appears to be a promising way to help many symptoms associated with PCOS.

Get Enough Sunlight and Take a Vitamin D Supplement

Vitamin D, also known as the ‘sunshine vitamin’ is mainly made by the body after adequate sun exposure.

It is also found in small amounts from food, including fish, eggs, some fortified milks and margarines.

Unfortunately, 67-85% of women with PCOS are Vitamin D deficient (less than 20nmol/L) (37).

This is a concern, because a low Vitamin D levels in the blood may worsen the symptoms of PCOS, including:

  • Insulin resistance
  • Ovulation problems and menstrual cycle regularity
  • Infertility
  • High androgen levels
  • Overweight and obesity
  • Increased risk of cardiovascular diseases (37, 38, 39).

Depending on your starting levels of Vitamin D, supplementation of 600IU-2000IU of Vitamin D per day is suggested to increase levels back to at least 75nmol/L (37, 39, 40).

A much higher dose may be needed in severe Vitamin D deficiency (41, 42, 43).

Summary: Most women with PCOS are deficient in Vitamin D. Using a supplement to raise Vitamin D levels in the blood may help to improve PCOS symptoms.

Consider L-Carnitine Supplementation

L-Carnitine is a naturally occurring amino acid derivative that plays a role in energy production and glucose metabolism (44).

It is known that obese individuals in general and with PCOS have low blood levels of L-Carnitine. However, low levels have also been found in lean PCOS patients (44, 45).

Regardless of weight, half of women with PCOS have problems metabolising glucose and have insulin resistance (46).

This is a concern, because it increases the risk of other health conditions long term, such as cardiovascular disease and diabetes.

Fortunately, a recent study found that supplementation of up to 250mg of L-Carnitine per day for 12 weeks was a successful additional treatment to manage insulin resistance or obesity in women who have PCOS (45).

So this is certainly something to consider if you are having trouble with symptoms, even after making diet changes.

Summary: Women with PCOS have low levels of L-Carnitine, which can make glucose metabolism and insulin resistance worse. Including a L-Carnitine supplement of 250mg per day for 12 weeks can help to improve these problems and help with weight loss.

Sample Diet Plan For PCOS

Diet plan for PCOSThis is a sample meal plan or diet for PCOS.

It is lower carb (30-50%) and based on the above recommendations:

Monday
  • Breakfast: Eggs and spinach.
  • Lunch: Tuna salad with olive oil, and a handful of nuts.
  • Dinner: Ground beef + lentils with veggies and full fat Greek yoghurt.
Tuesday
  • Breakfast: Small bowl of oats.
  • Lunch: Leftovers from previous night.
  • Dinner: Chicken stir-fry with broccoli and asparagus.
Wednesday
  • Breakfast: Full-fat Greek yoghurt and berries.
  • Lunch: Leftover stir-fry from previous dinner.
  • Dinner: Cheesy potato, cauliflower and broccoli bake (gratin).
Thursday
  • Breakfast: Eggs and spinach.
  • Lunch: Leftovers from previous dinner + 1 orange.
  • Dinner: Salmon with broccoli and asparagus in cream.
Friday
  • Breakfast: Small bowl of oats.
  • Lunch: Tuna salad with olive oil, and a handful of nuts.
  • Dinner: Steak and roast veggies.
Saturday
  • Breakfast: Full-fat Greek yoghurt and berries.
  • Lunch: Chicken avocado salad with olive oil and 1 apple.
  • Dinner: Dining out.
Sunday
  • Breakfast: Sausages and egg with avocado.
  • Lunch: Cucumber and carrot sticks with quark, and a handful of nuts.
  • Dinner: Tempeh stir-fry with lentils, cashew nuts and green leafy veggies.

Get in the habit of drinking plenty of water and really cutting down on snacking.

There are more low-carb recipe examples here.

A Better Diet For PCOS Is Only The Beginning…

As you can see there are several important dietary considerations for PCOS.

This includes shifting your eating pattern and considering certain supplements.

Treatment also involves reducing chronic stress, increasing physical activity levels and getting adequate sleep.

All these factors greatly influence our hormones, and in the end PCOS is a hormonal problem.

Be sure to discuss any diet changes with your doctor, especially if you use metformin and are considering a low-carb diet for improving insulin levels.

About Joe Leech, Dietitian (MSc Nutrition & Dietetics)

Joe Leech is a university-qualified dietitian from Australia.

He graduated with a Bachelor's degree in exercise science, followed by a Master's degree in Nutrition and Dietetics in 2011.

Learn more about him on the About page

34 responses to “The Best Diet for PCOS: Splitting Fact From Fiction”

  1. This is the first genuinely helpful site I’ve found (that isn’t victim focused either!) and I can’t thank you enough. My daughter’s Endocrinologist is super helpful, as is the Dietician, but as a scientist myself I need data to form a fuller understanding. I was shocked how truly unaware our GP was about PCOS, which is quite odd for her TBH. Anyway, thank you so much….everything I’ve read on your site is excellent!

    On another note, if you’ve done anything about Bipolar Disorder and PTSD and that would be brilliant and helpful too!

  2. Hey Joe, very glad to see an Aussie Dietitian building a global profile. re PCOS article. Your comment that in a well planned diet dairy is not essential probably could do with more explaining. The reason i say this is that I work with Bariatric clients and have started linking to your posts.
    My audience would be very interested in the PCOS post but this is one target group that could get it very wrong from over simplification (5-10 times more at risk of osteoporosis). Bypass patients need around 1500mg calcium per day. Sleeve 1200mg. Not easy from non-dairy sources and i prefer they source whole foods not supplements. Ok your post is not about dairy! Nor targeting my audience (I am a Dietitian).
    Speaking my mind as I just missed out on linking to a great summary on PCOS due to this one sentence!!
    Ps. You come across fine on video!

    Please feel free to delete this post after reading. Just take it as nit-picking feed back re. my particular angle.

  3. Hi Joe,
    Thanks for the very helpful information. I have a concern – I’m on metformin to control insulin and am going to move on to a low carb lean protein and healthy fat diet along with a 6 day-a-week cardio/weigh training regime. My concern is if I could become hypoglycaemic since I’m on a 2000mg a day metformin dose. My GP said there is no chance of that happening – but I’m not confident of his answer.
    Thanks,
    Winnie

    • There is certainly the likelihood of your blood sugars naturally dropping. If you are eating enough fat on the diet this should not be cause for concern but be aware of your exercise regime as your body takes time to adjust to the lower availability and intake of carbohydrates reduces. There are studies to suggest a small amount of carbohydrate replenishment directly after strenuous exercise can assist specifically in terms of your concerns. It would be a worthwhile consideration for you to self-monitor your bg levels and discuss lowering your metformin dose over time with your GP. Be tracking your mood, energy, hunger and macro intake as you transition to the new diet. Lastly, why ‘lean’ protein? You ought to embrace properly reared grass-fed forms of red meat, chicken, fish and so on. None of this 90% chicken slice rubbish, and avoid any processed meats in general.
      I’m not a Doctor! But I am a 31 year old female with PCOS, who had hypoglycaemia, and who was on Metformin, but these days is currently on the HFLC diet, and with a steady menstrual cycle, no blood sugar issues and feeling great.

  4. Grateful to read this post! Great info.

    I’m trying to right my own ship and have kept things somewhat under control for year. But a year of shoulder surgery recovery and stress have resulted in working hard to get back muscle and take off about 5lbs (which feels like 15 when you have PCOS).

    Do you have a recommendation for safe macro percentages for PCOS for an endurance athlete? Long distance running and CrossFitter. Any input is greatly appreciated! Thank you!

  5. Hello, I am finding myself so depress, nothing seems to make me happy. I have a 7year and husband. You would like i would be happy and content with life but I am unhappy. I feel disgusting with myself. I have try to diet eat healthy. I have notice for the past couple of week i am loosing my hair.

    I need someone to talk with someone who will understand me…

  6. Wow! I was diagnosed with PCOS in 1966 and not one doctor has addressed it or my symptoms all these years (other than to have to prove infertility twice in order to adopt.) In 1982 a pituitary adenoma was diagnosed resulting in a very high prolactin level. Off and on use of a special drug to reduce the size of the tumor resulted in empty sella syndrome. I’ve had a partial thyroidectomy and gallbladder removal. My endocrine system is a mess! So, now I’m 71, morbidly obese with hypertension, heart failure and pre-diabetes (6.5) and taking We’ll but rin for depression. ENOUGH! My cervical specialist suggested I look into a whole foods plant-based diet hoping I can avoid surgery. I’ve not had meat, dairy, processed foods or sugar for over two months (1200 calories). It just occurred to me today that.my PCOS might affect my weight loss (so far only water loss, not fat). Your thoughts?

    • Hi Sabina, I’d recommend reviewing your overall calorie intake, as this is the ultimate factor in weight loss/gain, not just carb intake. You need to be eating less calories than you expend in order to lose weight.

    • I have PCOS too. I was recently diagnosed after I complained to my OBGYN about irregular periods. The year prior, I gained a lot of weight and also began to break out in acne. I’d thought it was caused by stress from work. All 3 symptoms are PCOS-related. My OBGYN told me to simply diet and exercise. I started running and watching what I ate but lost only 5 pounds in 2 months. What changed everything for me was consulting a nutritionist who also has PCOS. She educated me about the foods to avoid (in a nutshell, those with PCOS should limit sugar, dairy, and soy). Without making any other changes, she asked me to avoid dairy and soy for 2 weeks. This required a lot of label reading, as dairy is in so many products under so many different names (google this and you’ll be surprised). After 2 weeks, my skin cleared up and I lost additional weight. She advised me on the type of exercises to engage in (for example, people with PCOS benefit more from weights than from running) and had me limit my sugar intake to the recommended daily amount not to exceed 25 grams. The weight seriously melted away after this, my periods regulated, and my acne disappeared. Without the nutritionist’s guidance, I’d be lost and still perplexed about my condition, it’s symptoms, and relation to the types of exercises and diet to assist with it. I HIGHLY recommend anyone with PCOS to meet with a nutritionist, preferably one with PCOS herself. It’s a very common condition yet there are so few people out there who are well educated on it. Due to its commonality, however, you should be able to find someone out there who can help. I found mine locally through the internet.

  7. Thank you for making sense of things. I have PCOS and type 2. It was highly suggested to me to try the keto diet. I hated it. So much mixed information. I had to stop the diet because it made me so moody (I have bipolar) so this was a first sign that this diet was not for me. In my own researching I still found low carb to be beneficial for those with pcos etc. I have currently given up but I am wanting more information before I jump into anything again. I also want to be able to get off my metformin as it really messes up my GI. Any additional advice would be welcomed.

  8. Hello! What is the recommended carb, protein and fat intake? I was on keto diet for 9 months. I had a weight loss of 60-65 pounds but then I finally got pregnant after 6 years of trying. I can not lose weight and it feels like it’s increasing drastically. Thank you

  9. Thank you so much for this FACT based article! Being newly diagnosed I have come across some truly helpful information through the internet, and some not so helpful. It seems a lot of women with PCOS have made it their business (quite literally) to push their agenda and “plan” on you, and it gets quite confusing to know which direction to go. For example dairy and soy are forbidden to most of these women, yet when we look at the facts, as you have done, the data shows us otherwise. Sorry for rambling, but I appreciate this post and the stress it eases for someone like me!

  10. I’m glad you mentioned the keto diet and said it’s promising, but I have to disagree with the statement that the ketogenic diet is “incredibly difficult” to stick to. I’ve been eating keto for going on two years and not only have I gotten my PCOS under control, but the food is great! I love eating eggs, meat, veggies, nuts, berries, and full fat dairy. It’s so satisfying! It also makes sense that it should work long term for PCOS because less carbs = less insulin. I know I would not feel good or have as much energy as I do if I ate oats for breakfast or lentils at dinner. High fat is where it’s at. 😉

    • Hi Kaylyn, it’s great that you find keto easy to stick to! I think, generally speaking, for the majority of people, it can be difficult to stick to, but of course there are also people who thrive on it. Sounds like you’re one of them. Good to hear you’ve managed to get your PCOS under control!

  11. Thank you so much for this great article!
    I’m 40 and was diagnosed with PCOS when I was 25 even though I had regular periods, my hormones were normal (and have been ever since), was not obese. At the same time I was diagnosed with Hashimoto (anibodies present, treated with hormone replacement therapy).

    The only thing that has been seriously bothering me is unwanted facial hair.
    I was always able to control my weight, water retention and even have some control over skin problems and hair-loss.

    I redid recently the usual bunch of hormonal tests (on the 3rd and 7th day of my period) + cortisol + OGGT and insulin levels. Everything is normal!

    I’m at my wits end. Facial hirsutism seems to be worsening for no apparent reason. I have read about androgen sensitivity in women with PCOS. Do you have any information on how to deal with
    that?

    I don’t want to take (not that desperate yet) any medication for hirsutism, because I have a family history of cardio-vascular disease (my parents and their siblings died before they were 50).

    Thank you!

  12. It was really helpful for me to know something new about my disease.Thank you very much. I am creating a web site this days about PCOS in russian language(I am russian).I have found so much information which i hardly can find in my language 😀 Can i use something from your site too? 😉 Btw There is written that PCOS affect pre-menopausal women but i think its more common for younger girls. I got my PCOS in school due to high pressure. I see that uk, usa have their centres which can help women with PCOS. Here in Russia is not like that the only cure they know is women harmones which are actually dont work if you dont take them. I ask myself is it a cure? tablets which dont help you. I dont think so. I have read somewhere that acupuncture can help to treat PCOS. Next year as I save enough money I will try it. I want to take herbs as well. Hope it will help. If it will help I will post it here if you dont mind 😉

    • Hello my name is Sarah I was diagnosed with PCOS when I was 27.I’m now 51 first off there is no cure for PCOS and no diet will reverse it, and it’s not a disease it’s a syndrome a disease something that is contagious a syndrome is something that affects most everything in your body.
      But there is way to manage it finding the right diet is the first step, then a exercise program, and a good doctor who knows about PCOS and who can take care of you.
      Most importantly never give up .

  13. I have been suffering from PCOC for sothe long now I knew I have them 7 years ago. Knowing this explain the stupid things that used to happen to me. Now I’m on merina Iud and it’s driving me crazy but I am fed up of the weight loss issue. I can’t keep the result that I GRT afteryou each diet but it’s frustrating as I started a nes work and i have been crazy busy so I couldn’t keep my health lifestyle and once I became normal as eating like normal people not much just average I gained almost all that I have lost which was 20 kilos. I am so depressed and really helpless.

  14. Hi Joe, Great article on PCOS. I have been following a PCOS for 3 years. However, I find I continuously need to readjust. Most plans are hard to maintain when cooking for more than one or they’re just way too boring. How much exercise do you recommend a week? Do you have any favorite books or places to find more sample plans?

  15. To everyone out there wanting to start a keto diet for PCOS, I highly recommend to watch Rawbeautykristi’s (YouTube) video on her keto journey and how it has helped her pcos, and actually reversed it and her risk of diabetes. I as well am doing the ketogenic diet for my PCOS and have done an incredible amount of research prior to starting. This article really makes me feel as though I have made the right decision for my body! Also, something that is really helping me is the Senza app, which helps to track all of my macros (carbs, calories, protein and fat) to make sure that I am getting the right amount daily for what I need to lose weight. It really helps you ease into the diet by taking it step by step, even including where to start with grocery shopping as well!! Hope this helps. 🙂

  16. Terrible article. Are you kidding me? Animal proteins?! Those will shoot testosterone levels through the roof. They are very anabolic and androgenic in nature with high leucine and BCAA levels.

  17. My sister was diagnosed with an ovarian cyst 6.7 Cms of size and she was in much pain. The doctors advised her to have surgery but it is something that she was not in favour of and she cannot afford the costs.This natural remedy ( pcos.natural-approach.org ) was of big help to us and her pain has reduced very much after a week.

  18. Food has no effect on your “ability” to have PCOS. PCOS is a genetic hormonal imbalance of the endocrine system. However, I am definitely going to try this diet

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