Polycystic ovary syndrome (PCOS) can feel like a huge burden on your body and psyche. It makes it hard to maintain a healthy weight, can come with male-pattern body and facial hair, and can bring what you thought was pubescent acne well into adulthood. If you’ve been struggling with symptoms like these for a while, you might be wondering if there’s any hope that you’ll ever get past it.
The answer is a resounding yes. A huge piece of the PCOS puzzle is chronic inflammation (which is a starting point for the list of potential symptoms). All of the symptoms you’re experiencing are, in one way or another, related to inflammation.And an improved diet can play a massive role in reducing or removing inflammation from your body. So it follows that changing your diet to address PCOS could help alleviate symptoms. Of course, we understand that changing your diet is easier said than done. If “eating healthy” were easy, everyone would do it. But what you might not realize is that even some “healthy” foods might not be right for your individual body at this moment, especially if you’re constantly dealing with inflammation.
Let’s go over some of the best, science-backed strategies for building an effective PCOS diet, other lifestyle changes you can make to help ease the symptoms, and PCOS symptoms and potential health risks.
PCOS Diagnosis, Symptoms, and Associated Health Risks
Unfortunately, because PCOS is a collection of symptoms that may not be obviously related, it can be difficult to diagnose. A teenager with acne may see a dermatologist, and the dermatologist might not think to ask about her period or notice a deeper-than-average voice, for example. Many women report seeing doctors and specialists for two years or more before getting a PCOS diagnosis .
- Chronic irregular periods, including infrequent periods (oligomenorrhea) or total absence of a menstrual cycle/ovulation (amenorrhea)
- Hyperandrogenism: excess of the male hormones testosterone and/or aldosterone (androgens), which results in:
- Male-pattern facial/body hair growth (hirsutism)
- Female-pattern hair loss
- Muscle bulk
- Deep voice
- Many small cysts on the ovaries
PCOS is unfortunately associated with a number of other health concerns. Although the cause and effect piece is still being explored, a common thread among all of these physical conditions is chronic inflammation. These issues include [1, 2, 4]:
- Metabolic syndrome
- Obesity, especially middle body weight (in 80% of patients)
- “Lean PCOS” (not obese or overweight) also exists in about 20% of patients
- Blood sugar level imbalances
- Type 2 diabetes
- Risk for heart disease (including high blood pressure and cholesterol)
- Obstructive sleep apnea
- Endometrial cancer
- Nonalcoholic fatty liver disease
Importantly, there’s also mental health risk associated with PCOS. There’s a fourfold increased risk for moderate to severe depression and a sevenfold increased risk for moderate to severe anxiety [1, 2].
Societal standards of beauty impose pressure on women in general. The added body weight, body/facial hair, and acne struggles probably don’t help women with PCOS gain self-esteem, especially if the onset is in their teens.
The good news is that diet and lifestyle changes can help reduce these health risks. By making some key changes, you can significantly improve your symptoms and imbalances associated with PCOS. It’s one step at a time, so take a deep breath, and start small.
PCOS Diet: Science-Backed Strategies
Changing your diet can lead to significant improvements in PCOS symptoms and hormonal balance. There are overarching PCOS diet guidelines and strategies that may apply only to you due to additional food sensitivities.
In general, low-calorie and low-carb diets (especially when combined with lifestyle changes like exercise) have been shown to be effective PCOS diets. That’s because they help lower insulin resistance (especially the low-carb ones), reduce BMI (body mass index), waist circumference, and C-reactive protein (an inflammatory marker), and improve waist-to-hip ratio [5, 6]. A systematic review from 2013 also showed that a low-calorie diet and exercise reduced fasting blood glucose and fasting blood insulin with results comparable to the prescription drug Metformin (a type 2 diabetes medication often prescribed to PCOS patients) .
That being said, quality counts. A blanket reduction in calories without improved nutrition won’t do the trick when it comes to addressing a primary factor in PCOS: chronic inflammation. So, a healthy diet is key. Furthermore, not all women with PCOS are overweight or obese, so a reduction in calories might not be the solution for them.
Replace Inflammatory Foods with Nutritious Foods
Since we know that inflammation is at the root of a number of PCOS symptoms (including severe PMS and cramps), dietary changes that reduce it are the first line of defense. Replacing inflammatory foods with more nutritious, anti-inflammatory foods will go a long way in reducing inflammation and PCOS symptoms through the diet [8, 9].
The most common inflammatory foods include:
- Processed foods/junk food
- Processed carbohydrates (white flour, crackers, bread pasta, etc)
- Industrially processed oils like canola oil and other seed oils
- Conventional red meat and dairy
As you avoid inflammatory foods, you’ll want to focus on eating more:
- Whole fruits and vegetables, especially leafy greens and colorful berries
- Whole grains (brown rice, quinoa, millet, amaranth, teff)
- Legumes (beans, lentils, peanuts)
- Nuts and seeds
- Lean protein (fresh fish, meat, and poultry)
- Healthy fats (monounsaturated fats like olive oil and avocado oil, Omega 3 fatty acids, coconut, and MCT oil) 
In essence, the Mediterranean diet and the Paleo diet are both great places to start. Both of these diets focus on whole, anti-inflammatory foods. If you find that grains and legumes irritate your gut, then start with Paleo.
These also tend to be naturally lower-calorie than the standard American diet so can aid in weight loss as well. We’ll get more into weight loss in a later section. For now, let’s focus on increasing nutrient density and reducing inflammation.
As you begin to change what you eat, remember, every individual may find slightly different foods work for their PCOS diet. If you find that you generally eat healthy and are at a healthy weight, but you’re still experiencing a lot of symptoms of PCOS, chances are you have a food sensitivity you don’t know about yet.
That’s where elimination diets enter the picture.
Elimination Diets for Addressing Chronic Inflammation
Elimination diets are generally more effective than food sensitivity tests (usually blood tests, sometimes stool tests) because these tests are extremely limited — and sometimes have errors — in their results. Food sensitivities don’t always evoke an IgG antibody response, which is the main metric most of these test kits use to determine food allergies and sensitivities. But you can personally observe and note your changing symptoms as you make shifts in your diet, giving you a more personalized picture of what foods trigger inflammation in you.
I always recommend starting with the least restrictive elimination diet first, then adding in additional restrictions if your symptoms don’t improve. To that end, the first place to start is the Paleo diet. The Paleo diet restricts everything on the “inflammatory foods” list above, then takes it a step further by removing dairy, grains, and legumes. It’s a diet focused on whole fruits and vegetables, healthy fats like coconut oil, avocado oil, and olive oil, as well as unprocessed meat, fish, and poultry. The Paleo diet has also been expressly shown to improve insulin sensitivity in patients with metabolic syndrome, a health condition that sometimes accompanies PCOS.
Read more about how to systematically eliminate potential triggers with this elimination diet plan.
Watch Your Sugar (a Low-Carb Approach)
A PCOS diet should encourage low-glycemic foods and restrict simple carbohydrates.
It’s important to remember that PCOS has a metabolic component that can lead to insulin resistance/metabolic syndrome. Insulin resistance occurs when your body becomes resistant to absorbing insulin back into your cells after a sugary meal.
With insulin resistance, your glucose levels rise, as well as your insulin levels, which comes with a whole cascade of health effects, including middle-body weight gain and difficulty losing weight in general (both symptoms of PCOS). Insulin resistance can progress into pre-diabetes and then full-on type 2 diabetes if no dietary or lifestyle interventions take place.
This means that foods that raise your blood sugar and insulin levels (high on the glycemic index) are more harmful long-term to a PCOS patient than an average woman without the syndrome. So, focusing on low-glycemic foods and avoiding excessive amounts of simple carbohydrates is important in maintaining your health and reducing symptoms . This is why low-carb diets and even the ketogenic diet have been shown to help some women with PCOS mitigate symptoms .
Supplements for PCOS
While dietary changes can make a big impact on your overall experience with PCOS, a few key supplements might help further balance your hormones. These include:
- Herbal blends to balance hormones
- Fish oil
- Mineral supplements
- Spearmint tea
Probiotics specifically address potential gut problems that can exacerbate inflammation and leaky gut syndrome. Research shows that PCOS patients have lower gut microbial diversity than average and are more prone to leaky gut syndrome, both of which can be improved with a good probiotic [13, 14, 15]. In fact, one study showed an explicitly inverse relationship between excess androgens/unwanted body hair and bacterial diversity in the gut .
Exercise and Stress Management
Beyond diet, the two lifestyle changes that are most important in managing PCOS are gentle exercise and stress reduction. I’m emphasizing gentle — no crossfit or endurance challenges right now — because exercise, while a healthy habit, can also cause additional stress to your body, which can make PCOS symptoms worse. Gentle exercise means a light jog or brisk walk, a swim or a bike ride, a fun dance class that gets your heart beating but doesn’t leave you huffing and puffing.
Exercise and stress management can go hand in hand — when you think about it, exercise can actually be your vehicle to stress management, especially if you can zone out and just be in your body without thinking of everything on your to do list. Other ways to manage stress are to enjoy a good book or podcast, guided meditation or a meditation group, breathing exercises, journaling, or a no-pressure artistic endeavor like an adult coloring book.
In both exercise and stress management, the goal is to keep the cortisol low, so as to not begin the hormonal cascade that can exacerbate symptoms.
A Word on Weight Loss and Low-Calorie Dieting
A standard recommendation for a PCOS diet is an overall low-calorie diet plan. When we say “low-calorie,” we mean a healthy reduction of calories, with the help of a dietitian or nutrition professional.
Reducing inflammation in your diet and beginning healthy eating habits can help reduce the overall inflammation in your body, and your body will naturally begin releasing excess middle body fat. If you’re in less pain (due to lowered inflammation), weigh less, and eat a diet that offers balanced nutrition from your improved diet, then maybe gentle exercising will feel less like a chore and more like self-care. That’s the goal. Weight loss can be a happy side effect of positive lifestyle changes rather than the initial focus. And you can be healthy without being lean.
The Bottom Line
The best PCOS diet is nutrient-dense, low-calorie, high in healthy fats, and low in sugary processed foods. You want to focus on whole foods, especially colorful fruits and vegetables, lean meats, and beneficial fats. You may need to dig a bit deeper if you find that your dietary changes don’t give you relief from your symptoms. An elimination diet can help you identify potential irritants in your diet that extend beyond the list of generally inflammatory foods. Adding in a probiotic is a good idea to help reduce inflammation further and increase biodiversity in your gut microbiome.
It’s a good idea to lose weight and exercise more (if you have excess weight to lose), but focusing on your dietary improvements is priority number one. If you need help getting your new diet off the ground, reach out to our clinic to set up a call. We’d love to help you.