What to Eat with Polycystic Ovary Syndrome (PCOS)

Polycystic Ovary Syndrome (PCOS) occurs when a woman’s ovaries produce a greater than average amount of male sex hormones (androgens). When this occurs, many small cysts develop on the ovaries, and the menstrual cycle becomes altered, often causing infertility. Women with PCOS frequently become insulin resistant and glucose intolerant, putting them at high risk of developing type 2 diabetes.

Obese women and women with a family history of the condition are most likely to develop the condition. Symptoms of PCOS include irregular menstrual cycles and very light periods, excess body and facial hair, abdominal fat, acne and oily skin, either baldness or thinning hair on the head, and the development of skin tags on the neck and armpits. Dark or thick patches of skin may appear on the back of the neck, in the armpits, and the fold under the breasts (via Johns Hopkins). 

Mayo Clinic adds that women with PCOS often develop generalized low-grade inflammation, which adds to the risk of heart and vascular troubles that these women already carry. PCOS can play a part in the development of fatty liver disease, high blood lipids, and sleep apnea. Women with PCOS who get pregnant are more likely to develop gestational diabetes or high blood pressure during pregnancy and carry a risk of miscarriage or premature birth. PCOS takes an emotional toll and women with the condition are more likely than other women to struggle with depression, anxiety, and eating disorders. The increased risk of endometrial cancer that these women carry can cause a great deal of anxiety.

The good news is that lifestyle changes, including a healthy, low-calorie diet, moderate exercise, and relaxation exercises can go a long way towards treating the symptoms of PCOS. Medical treatment generally includes hormonal therapies. Metformin, the most commonly prescribed oral medication for type 2 diabetes is often used to treat insulin resistance. 

Avoid Candies and Baked Goods If You Have PCOS

Because half of the women with PCOS struggle with their weight, it’s important for them to consume a low-calorie, high-nutrient diet. Research published in The American Journal of Clinical Nutrition proved that the low-glycemic index (low-GI) diet was more beneficial to women with PCOS than a low-fat diet. Although the women who ate a low-GI diet lost only 4-5% of their body weight, they experienced an incredible 3-fold improvement in insulin sensitivity. They also reported improved menstrual regularity and better quality of life. Those women with the highest insulin response after eating a meal lost more weight on the low-GI diet compared to a traditional healthy diet. The low-GI diet also caused levels of inflammatory proteins in the blood to decline.

The Glycemic Index is a measurement of the expected blood glucose rise after eating food. Food can be low, medium, or high GI, and the lower they are on the scale, the less of an effect they are expected to have on blood glucose (via Healthline). The measure isn’t as precise as some people would like, however. Consider that a ripe banana has a higher GI than a slightly underripe one and that al dente pasta has a lower GI than pasta that has been cooked until it’s very soft. Besides improving blood glucose, a low GI diet might be beneficial for weight management and reducing elevated blood lipids. Baked goods (such as cake and muffins) and candy and snack foods (like chips or pretzels) have high GI scores and are best avoided by women coping with PCOS.

Choose Cruciferous Vegetables

There are (at least) three reasons why women with PCOS should add cruciferous vegetables such as broccoli, cauliflower, and brussels sprouts to their diet: fiber, magnesium, and the estrogen-lowering abilities of indole-3-carbinols. Fiber lowers the risks of both insulin resistance and cholesterol while reducing levels of androgens, which are to blame for many of the symptoms experienced by women with PCOS. 

Researchers believe that low magnesium levels in the body may play a role in developing and worsening insulin resistance. After all, magnesium plays a pivotal role in glucose metabolism. In one study, the results of four epidemiological analytic studies and three experimental trials confirmed that it is likely that there is a relationship between serum magnesium levels and insulin resistance in women with PCOS. However, it wasn’t clear whether supplementation of the mineral improved matters. Unfortunately, it appears that women with PCOS are more likely to under consume magnesium-containing foods and to subsequently develop a deficiency than women without PCOS. 

When you dig into a dish of roasted Brussels sprouts or broccoli salad, your stomach acid goes to work on a compound called indole-3-carbinol in those crunchy vegetables. During this process, a new substance called DIM is formed. DIM production is why researchers think cruciferous vegetables might help reduce the risk of hormone-dependent cancers. According to a study published in Nutrition Reviews, DIM and its precursor indole-3-carbinols have been widely studied for their potential to reduce breast cancer risk through various mechanisms, including both estrogen metabolism and cell cycle modulation.  

Avoid White Bread and Pasta

Research has determined that women with PCOS likely do not eat more calories or do less physical activity than other women in the U.S. However, they tend to eat diets that are deficient in fiber. This is a problem because low-fiber diets can increase androgen levels, which are already elevated in women with PCOS. In one study, women who ate more fiber had lower glucose levels two hours later. They also had improved fasting insulin, blood triglyceride, and cholesterol levels. The authors of the study published in Food Science & Nutrition concluded that “women with PCOS and obesity were not in a caloric surplus state. However, dietary components, specifically low fiber, low magnesium, low vitamin A, and high glycemic load may contribute to IR/HI (insulin resistance/high insulin) and obesity.” 

Good sources of fiber include certain breakfast cereals (such as bran flakes), fruit, vegetables, nuts, and whole-wheat bread. Everyday Health recommends adding green peas, artichokes, avocado, edamame, pears, and oatmeal to your menu if you’re looking to boost your fiber intake.

Choose Leafy Green Vegetables

Green leafy vegetables, including spinach, kale, and collard greens, among others, are considered some of the most anti-inflammatory foods available to us (via US News). Inflammation is widely regarded as the root causes of heart disease, type 2 diabetes, and many other common health conditions. Research, including a study published in Therapeutic Advances in Reproductive Health, show that women with PCOS are more likely to have elevated markers of inflammation, such as C-reactive protein (CRP) and white blood cells. 

Although it’s ability to stifle inflammation is enough to make that spinach salad worth your time, these nutritional gems are also full of magnesium, a mineral that not only aids immunity and bone health but may also improve heart health, lower blood lipid levels, reduce insulin resistance, and aid in the fight against the depression that plagues many women dealing with PCOS. A study in Diabetes Care in 2014 found that eating magnesium-rich foods every day might reduce the risk of type 2 diabetes by nearly a third. 

Avoid Soft Drinks

The same Iranian study referenced above uncovered a high preference for soft drinks among young ladies with PCOS, especially as a component of fast-food meals. This is especially scary considering that even diet soda dramatically alters how your body processes glucose. In fact, according to research published in the European Journal of Endocrinology, drinking more than two soft drinks a day, diet or regular, can double the risk of type 2 diabetes and Latent Autoimmune Diabetes in Adults (LADA), which is sometimes referred to as type 1.5 diabetes. Drinking five or more daily servings causes the risk to skyrocket — by an incredible 3.5 times for LADA and 10.5-fold for type 2 diabetes! 

Women hoping to become pregnant should be especially wary of soft drinks, which appear to decrease the chances of achieving pregnancy within one menstrual cycle. The researchers of the study, published in the journal Epidemiology, concluded that “chemical additives or contaminants in some soft drinks, such as bisphenol A, may have an adverse effect on fertility.” On the other hand, tea drinkers experienced improved fertility in this study. Indeed, caffeine is not believed to be the problem with drinking soda. Rather, according to the authors, even decaffeinated soda is associated with “increased insulin resistance, metabolic syndrome and weight gain, which are related to polycystic ovary syndrome, a leading cause of ovulatory infertility.” 

Choose Berries

Some women with PCOS stay away from fruit, fearing that it contains too much carbohydrate for them. This is a terrible idea because many types of fruit, especially berries, are full of antioxidants and other anti-inflammatory nutrients, as well as fiber (via Bustle). According to a study published in the Archives of Physiology and Biochemistry, women with PCOS are believed to have high levels of oxidative stress and inflammation, which the phytochemicals in berries can help to squelch.

A study published in Food & Function in 2019, found that adding berries to the diet improved insulin resistance and decreased glucose response in metabolically healthy, as well as overweight and obese adults, who already have insulin resistance. The authors of this study concluded that “blueberries, cranberries, strawberries, and raspberries, may exert unique beneficial effects in diabetes management, mainly by improving glycemic and lipid profiles, increasing antioxidant status and decreasing biomarkers of atherosclerosis.” 

Avoid Processed and Red Meats

The saturated fat in processed and red meats feeds into the nonalcoholic fatty liver disease, insulin resistance, hyperlipidemia, and higher body weight that plague many women with PCOS. In fact, just one meal high in saturated fat can have a lasting effect on the body, according to research published in The Journal of Clinical Investigation. 

Other research published in Diabetes Care, illustrates that saturated fat increases triglycerides storage in the liver, even among young, nonobese adults. In this study, the 38 participants were divided into three groups and consumed roughly 1,000 extra calories each day for three weeks — the excess calories came either from saturated fat, unsaturated fat, or simple sugars. The saturated and unsaturated groups got 60% of their total calories from fat, and the saturated fat group ate twice as much saturated fat as the unsaturated group.  The simple sugar participants ate 2.8 times the amount of carbohydrate than either of the fat group participants.

Although body weight changes were comparable among all three groups, the saturated group had a much higher increase in hepatic (liver) triglycerides versus either the unsaturated fat or carbohydrate group. Serum insulin level also increased significantly in the saturated fat group, and testing showed damage to the gut microbiota. 

Besides red and processed meats, other major sources of saturated fat in the American diet are pizza, cheese and milk, butter, ice cream and other dairy desserts, cookies and cake, and fast food meals (via the Harvard T.H. Chan School of Public Health). 

Choose Whole Grains

In a fascinating study in the International Journal of Reproductive BioMedicine, women who ate more whole grains had a 64% lower risk of PCOS. The authors contend that this is because of the effects that the grains you choose have on hormonal and metabolic health. As discussed above, high glycemic foods have been linked to both infertility and insulin resistance. Barley and bulgur are two examples of whole grains with low GI values (via Diabetes Canada). 

As emphasized in this study, the fiber and magnesium in whole grains should be given some credit for improving glucose metabolism. Regrettably, although Americans should be consuming at least six servings of whole grains each day, they often only consume one. Not liking whole grains isn’t a great excuse for a lack of these healthy carbohydrates in your diet since there are dozens of options available, from oatmeal and popcorn to quinoa and wild rice (via Oldways Whole Grain Council). 

Avoid Fried Foods for a Healthier Heart if You Have PCOS

There is a lot of evidence showing that individuals who eat the most fried food have the highest risk of developing both type 2 diabetes and heart disease. An extensive study, following 100,000 men and women for a quarter-century, uncovered the unsavory fact that consuming fried food at least once a week is enough to increase your risk of these lifestyle-attributed diseases. Those participants who admitted to eating fried foods four to six times a week had a 39% increased risk of developing type 2 diabetes, but those who ate the greasy food at least seven times a week suffered from an enormous 55% increased risk when compared to those who imbibed only once per week. 

According to Leah Cahill, a research fellow in the Department of Nutrition at Harvard School of Public Health, eating fried foods outside of your own home is especially dangerous. This is because, as she explains, “with each reuse, oil becomes more degraded, and more gets absorbed into food, which can contribute to weight gain, higher cholesterol, and higher blood pressure — all risk factors for type 2 diabetes and heart disease” (via Harvard T.H. Chan School of Public Health). 

Choose Beans and Lentils

The authors of a study published in BMC Nutrition point out that pulses (e.g., lentils, chickpeas, split peas, beans) are high in fiber, have a low-glycemic index, are low in fat, and contain high-quality protein. Diets rich in these foods are effective for reducing blood glucose, insulin, and blood pressure. 

In another study, this one published in Nutrients in 2018, the Therapeutic Lifestyle Changes Diet (TLC) with an added emphasis on consumption of pulses, demonstrated improved insulin response, glucose tolerance, blood pressure, cholesterol, triglycerides in a group of 30 women after a 16-week intervention that also included lifestyle counseling and aerobic exercise. The TLC diet, developed by the National Institute of Health’s National Cholesterol Education Program, is quite low in fat and consists of fruits, veggies, whole grains, and lean meats (via US News). 

Avoid Large Amounts of Dairy Products

The relationship between milk and dairy products and the development of type 2 diabetes is a tangled web, indeed! It seems likely that milk and dairy stimulate the production and secretion of insulin, but whether this is a good or bad thing for health has been challenging to suss out. 

Perhaps the insulin protects against type 2 diabetes, but, on the other hand, researchers pointed out in a study published in the Journal of Diabetes Research that hyperinsulinemia might have “less-than-desirable long-term effects in healthy individuals, including insulin resistance.” A total of 272 women participated in this study, most of whom were white, middle-aged, and married. Those women who consumed the most dairy had higher levels of insulin resistance, regardless of other factors including age, physical activity, intake of energy or macronutrients, and intake of fiber.

Several other studies have also found links between dairy consumption, higher fasting glucose, and an increased risk of metabolic syndrome. The results are far from conclusive, however. It might not be the dairy itself that increases the risk. The authors astutely point out that “women with higher energy intakes were more likely to have higher consumption of dairy products, participate in greater amounts of physical activity, have higher body weights, and be more insulin resistant than women with lower energy intakes.” 

Choose Nuts

The healthy fats in nuts have proven to improve hormonal balance, insulin response, and lipid levels in women with PCOS. In a study published in the European Journal of Clinical Nutrition, walnuts decreased LDL by 6%, increased insulin response during oral glucose tolerance testing by 26%, and decreased hemoglobin A1c from 5.7% to 5.5%. 

According to the Mayo Clinic, nuts also lower LDL cholesterol and triglycerides in the blood, benefit artery health, decrease inflammation and lessen the chances of blood clot development. 

Even with all of the health benefits imbued by nuts, it is necessary to keep portion control in mind. After all, 24 almonds contain around 160 calories and 14 grams of fat. A serving of nuts is one ounce, equivalent to 12 macadamia nuts, 15 pecan halves, or 14 English walnut halves (via the Cleveland Clinic). 

Avoid Margaritas and Other Sugar-Laden Cocktails

According to Amy Planos, The PCOS Dietitian, it’s especially important for women with PCOS to not drink on an empty stomach so that the alcohol can be absorbed at a slower rate. She also makes the critical point that people with PCOS are often on metformin, which can interact very badly with large amounts of alcohol. Besides increasing the chances that you’ll suffer a bout of low blood sugar (hypoglycemia), this combination could lead to lactic acidosis for people on metformin. Lactic acidosis can be fatal and cause “serious damage to your kidneys, lungs, heart, and blood vessels.”

All alcohol is rich in calories, but those sweet frozen drinks like mudslides, pina Coladas, daiquiris, and margaritas can contain a mind-blowing number. Although hard liquor still contains roughly 70 calories an ounce, most are carb-free. It’s the mixers that will make your blood glucose spike. You may be surprised to learn that some white wines only contain around 125 calories in a reasonable 5-ounce glass. 

Medical News Today clarifies that the liver is a workhorse when it comes to digesting alcohol. When there is a backup of alcohol to process, it becomes sluggish and releases less glucose than usual into the bloodstream. Drinking alcohol will also, over time, make cells less sensitive to insulin and subsequently increase blood glucose.

Choose Fish to Reduce the Inflammation from PCOS

If you have PCOS, it appears that choosing to eat a tuna fish sandwich or grilled salmon filet this afternoon might be one of the best things that you could do for yourself. In a study printed in the Journal of Research in Medical Sciences, six months of omega-3 supplementation improved the waist circumference, HDL and LDL cholesterol, triglycerides, and menstrual regularity of women with PCOS compared to the control group. 

For women trying to conceive, the advice to eat fish might be extra beneficial, and you may even want to invite your partner to dine with you. “Seafood may help in semen quality, ovulation, and other markers,” said Audrey Gaskins, a research associate at Harvard Chan School, when speaking to The New York Times about a study in which he was the lead author (via the Harvard T.H. Chan School of Public Health). 

According to a study published in Circulation Research, fish oil might also help reduce inflammation by raising levels of specialized pro-resolving mediators (SPMs) throughout the body, thereby increasing immunity and decreasing factors that encourage blood clotting. 

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