If you have been diagnosed with Polycystic Ovarian Syndrome (PCOS), there can be a lot of fear and uncertainty of what that can mean for you. Or maybe you’ve been written off by your medical provider and are told to come back when you want to get pregnant, but that doesn’t sit right with you. Whatever the circumstance, if you have PCOS, you aren’t alone and there are things you can do to improve your health and wellbeing. Learning more about nutrition for PCOS is a great place to start.

What is PCOS? 

PCOS is an endocrine condition (meaning hormonal) and diagnosis requires two of three criteria to be met: anovulation, elevated androgens, and the “string of pearls” follicles on the ovaries.

PCOS Symptoms:

Early symptoms:

• Few or no menstrual periods. This can range from less than nine menstrual cycles in a year (more than 35 days between cycles) to no menstrual periods. Some women have regular periods but are not ovulating every month. This means that their ovaries are not releasing an egg each month.
• Heavy, irregular vaginal bleeding. About 30% of women with PCOS have this symptom.
• Hair loss from the scalp and hair growth on the face, chest, back, stomach, thumbs, or toes. About 70% of women in the United States with PCOS complain of these hair problems caused by high androgen levels.
• Acne and oily skin, caused by high androgen levels.
• Depression or mood swings. Hormonal changes are a known cause of emotional symptoms.

Gradual symptoms:

• Weight gain (more around the abdomen than the hips).
• Male-pattern baldness or thinning hair.
• Repeat miscarriages
• Infertility.
• Symptoms of too much insulin and insulin resistance, which can include upper body weight gain and skin changes, such as skin tags or dark, velvety skin patches under the arm, on the neck, or in the groin and genital area.
• Breathing problems while sleeping. 
• Pain in the lower abdomen and pelvis.
• High blood pressure may be more common in women with PCOS

Insulin Resistance 

A symptom that we, as nutrition professionals, often help manage is insulin resistance, a common occurrence in those with PCOS. Insulin is a hormone produced by the pancreas when we eat (particularly carbohydrate foods). Our blood sugar rises, and the insulin acts as a key to allow the glucose to enter the cells to be used (or stored) for energy. With insulin resistance, the cells do not respond to insulin appropriately. The body must produce more insulin to force the glucose into the cells. 

This elevated insulin level can exacerbate symptoms like elevated androgens (testosterone) and irregular ovulation. A big component to treating insulin resistance can be nutrition changes. Because insulin is a hormone produced when we eat, we can make changes to what and how we eat to impact the body’s insulin response.

The Role of Nutrition for PCOS Management

How diet affects PCOS symptoms

When we eat, particularly carbohydrates, the body recognizes this and starts producing insulin in response. The insulin signals to the cells to let in the glucose (sugar). With insulin resistance, the body doesn’t respond appropriately, thus leading to the pancreas producing more insulin. Excess insulin can cause higher testosterone and irregular ovulation. 

The goal is not to eliminate carbohydrates but to be aware of how much and what type of carbohydrate you choose, as well as balancing it with protein, fat, and fiber for a better blood sugar and insulin response.

Higher fiber carbohydrates include whole wheat breads and pastas, starchy vegetables, beans and peas, bean-based products like chickpea pasta, quinoa, kamut, farro, and oats.

Not every carbohydrate needs to be a high fiber, whole grain carbohydrate. We can add fiber through veggies, nuts, and seeds. And not every carbohydrate needs to be gluten free for that matter. Gluten free has become a fad for PCOS with very little grounds to support it.

We can pair that carbohydrate with protein (animal or plant based), fat, and fiber to slow down how quickly that carbohydrate is broken down. That helps keep blood sugar more stable and requires less of an insulin response.

Meal Planning for PCOS

Foods to Include and Avoid

When it comes to nutrition for PCOS, the best diet for PCOS would include high fiber foods, lean sources of protein, anti-inflammatory foods (think colorful fruits and veggies), and omega- 3 fatty acids. Eating foods in combination is particularly helpful in managing your insulin and blood sugar responses. Combine high fiber carbohydrates with protein and colorful fruits and veggies. Include fatty fish, avocado, nuts, and seeds for healthy fats. 

Because the majority of people with PCOS experience insulin resistance, meal planning for insulin resistance can be helpful. These meals often contain whole grains and are higher in fiber and protein.

When it comes to avoiding foods for PCOS, we truly believe that all foods can fit. You may want to be cautious with high sugar foods, and if your cholesterol levels are a concern, you want to pay attention to your saturated fat intake. But moreso, focus on what you can add into your diet, not what you think you need to eliminate.

What to Eat for PCOS

Breakfast

Breakfast can be a challenging meal to get enough protein because so many typical breakfast options are carbohydrate based (waffles, pancakes, toast, cereal, etc). Any of these options can be included with breakfast, but make sure to pair it with protein. You can also experiment with the higher fiber version of any of those foods. Here are a few examples:

• Kodiak waffles with peanut butter and scrambled eggs
• High fiber cereal with milk and turkey sausage 
• “Carb smart” tortillas with eggs, black beans, cheese, and salsa 
• Whole grain bread with avocado, smoked salmon, and desired toppings 

Lunch and Dinner 

These meals tend to be a little easier to get more protein. To make sure you have lunches for the week, you can either cook extra portions at dinner and eat leftovers, or plan/prep in advance to make easy lunch options available.

Choose a high fiber carbohydrate if possible (or add fiber in other ways!) and pair it with protein, fat, and veggies. Here are a few examples: 

• Chickpea pasta mac and cheese with broccoli and chicken sausage 
• Turkey and bean chili with cornbread
• Refried bean and avocado quesadillas 
• “Egg Roll in a Bowl” over rice (you can try Right Rice for more fiber) 
• Naan pizza with a side salad 

Snacks

Our general rule of thumb for snacks for PCOS is to pair a carbohydrate food with protein or fat. Carbs give us energy and are enjoyable and satisfying, and protein/fat is going to be more satiating and keep your blood sugar stable. Here are some examples: 

• Veggies + hummus + triscuits 
• Protein bars like Kind Protein bars or Clif Whey Protein bars 
• Apple slices + peanut butter
• Greek yogurt + berries

Supplements for PCOS

When it comes to supplements, we urge you to discuss with your treatment team before starting anything. There are so many supplements out there but they may not be right for you or they may not be in the correct dose. 

A few supplements that we often utilize in practice are:

• Inositol 
• Vitamin D
• Vitamin B12
• N-acetylcysteine (NAC) 
• Berberine 
• Magnesium 

PCOS and Fertility 

So many times, PCOS is boiled down to only an issue when you “want to have a baby.” While it is so much more than that, if you are trying to conceive, we know the mental load and emotional toll it can have on you. 

You may need medical intervention or fertility treatments to get pregnant. However, there are some nutrition-related changes you can make to see if it helps regulate your period and set your body up for more success.

Address your blood sugars. Even if your A1C is completely normal, you may still be experiencing insulin resistance. Aim for more balanced meals and snacks and eat consistently throughout the day.

When it comes to food for fertility, increase the variety in your diet. Add things like citrus fruits, dark leafy greens for folate, berries for antioxidants and fiber, full fat dairy, and omega 3 rich fish. Also make sure you are eating enough! Undereating and even fasting for too long can impact your menstrual cycle.

When itf comes to supplements, start a prenatal if you are trying to conceive. Ask your doctor to check for micronutrient deficiencies. You may also want to consider supplements for insulin resistance, egg quality, and improving androgens.

PCOS Nutrition Goals

There is a lot of information on the internet and a lot of opinions when it comes to PCOS management. Not every recommendation is going to be right for you. Work with a doctor who specializes in PCOS management (likely an endocrinologist or OBGYN), a registered dietitian knowledgeable in PCOS nutrition, and anyone else you need to support you (therapist maybe?).