This post was updated on October 7th, 2019
With medical science and the internet being what they are today, you’d think it’d be easy to find out what the best diet for PCOS is. But when I first looked for answers all those years back, I found so much conflicting information that it became completely overwhelming. It was worse than the time I googled “what should I buy my mother in-law for Christmas”.
Should I be eating a plant based diet, or am I supposed to go keto? But how can a ketogenic diet be better when everyone tells me I need to avoid fat? And how the heck am I supposed to “just lose weight” when every diet I’ve tried in the past eventually made me heavier?
After years of research and having to learn everything the hard way, the goal of this article is to make the process as easy and simple as possible for you.
The following 13 steps are the governing principles that helped me beat PCOS and fall pregnant naturally. They come from a critical review of the scientific literature, and are supported by the real life experiences of the tens of thousands of women that have taken part in my free 30 Day PCOS Diet Challenge.
To accompany this article, I’ve also created a PCOS Diet Cheat Sheet that lists over 180 PCOS friendly foods and drinks as well as helpful nutritional notes to make things easy for you. This comprehensive document packs a lot of information onto a single page and is 100% compatible with all refrigerator doors.
If you’re looking for evidence based answers to what you should be eating, then look no further. This article will tell you exactly how to do a PCOS diet correctly, in 13 practical steps.
The Link Between Diet And Your PCOS Symptoms
To understand how these 13 food principles work, there are just two things you need to know about PCOS.
While medical journals routinely state that the exact cause of PCOS is yet to be identified, from a practical, what-can-I-do-about-it perspective we know it’s two main mechanisms: high androgen levels (testosterone being the most famous androgen), and chronic low grade inflammation.
It doesn’t matter if you have lean type PCOS and you’re relatively slim, or your PCOS is expressed with the more classical phenotype where you gain weight easily, these two things are responsible for all those awful symptoms we have to deal with every day.
Once you understand these two main mechanisms, the 13 steps outlined below make a lot more sense. It also becomes apparent why the same PCOS diet plan that works for women wanting to lose weight, also works just as well for someone with lean type PCOS that is struggling to fall pregnant.
Two previous participants from my free 30 Day PCOS Diet Challenge illustrate this point perfectly. While Kendall and Hanna started with vastly different health goals, these two women both achieved remarkable outcomes by following the exact same dietary principles. Kendall joined the Challenge weighing 260 lbs with a goal to lose 90 lbs. By choosing foods like those included in this PCOS Diet Cheat Sheet she was able to blast past this goal, losing 100 lbs within a few short years.
Hanna by comparison was not overly concerned about her weight when she joined my free Challenge, but couldn’t fall pregnant because she never got her period. Within months of making the dietary changes described below, Hanna managed to restart her natural cycle and fell pregnant naturally. She’s now a very busy mom to gorgeous little toddler.
Making dietary changes can be about as fun as having your bikini line waxed after six months in the wilderness, but if you’re anything like me, then understanding the WHY behind what you’re doing makes it a lot easier to get motivated.
This is a big reason why women who do my free Challenge achieve such consistently impressive results. By not just providing PCOS friendly recipes and saying “here, eat this”, but instead also sharing the information behind why you’d want to make these food choices, women find the motivation to stick with the changes long term.
My intention with this article is to use the same educational approach to set you up for sustainable success. As you’re about to learn, despite the epigenetic and environmental causes of this disorder, it’s what you eat that drives all of your symptoms. The flip side of course is that we can turn these same mechanisms around and use better food choices to create a long-term solution.
Let me explain how this kitchen jiu-jitsu works…
How The Right PCOS Diet Plan Can Improve Androgen Levels
Androgens like testosterone are the puppeteers responsible for the majority of our PCOS symptoms. The higher our androgen levels, the worse our presenting symptoms are (Georgopoulos et al. 201452).
They interact with all our other hormones to impact our fertility, to cause unfair weight gain, to promote adult acne, and to give us not enough hair in the right places, while providing extra in the wrong places. High androgen levels are pretty much the bane of our existence.
Androgen levels work in unison with your insulin levels. When insulin goes up, so too does testosterone (Sharp et al. 199151).
Insulin also happens to be the hormone that makes our bodies store body fat, which is why a lot of women with PCOS find it nearly impossible to lose weight, while others often accumulate excess stomach fat despite being otherwise thin.
Putting two and two together here, since our insulin levels are controlled by what we eat, if we can implement the right diet for PCOS and eat in a way that keeps our insulin levels lower, our PCOS symptoms can improve.
I’ve been amazed by how quickly this effect can be seen when hearing from women who do my free 30 Day PCOS Diet Challenge. It’s not uncommon for people to see early results within just a few weeks of changing their diet, which is pretty remarkable.
While quick results are always welcome, what’s even more impressive is the long-term benefits of a PCOS diet. After suffering for four years with infertility, Jamie Bietzell joined my free Challenge in November of 2017. She started applying the food principles I describe below and by January of 2018 she was getting a regular cycle for the first time in years. By April she had lost 50 pounds, by June she was pregnant, and by December she was a mom. What’s more Jamie did this all without nutritional supplements or any medications. Just herself, this diet, and a lot of determination.
Inflammation And The Best Diet For PCOS
While I might get lucky once in a while, it’s pretty safe to say that most people who find my blog aren’t that interested in biochemistry. But it’s still very important – especially if you want to understand how food affects PCOS.
In the hopes of finding a happy medium, here’s the less boring, simplified explanation of the PCOS-inflammation connection:
Chronic low-grade inflammation is an inherent part of a PCOS diagnosis which means our immune systems are constantly on amber alert. Together with high androgen levels, insulin resistance, and poor diet, low-grade inflammation is viewed as a key component of the “deadly quartet” of metabolic risk factors associated with PCOS (Barrea et al. 201853). While inflammation is good if you happen to be injured, when it happens all the time it leads to many of the serious long term health risks that are associated with PCOS. Things we don’t want to think about normally like heart disease, liver disease and cancer etc (Orio et al. 200654).
At a more everyday level, inflammation makes a major contribution to many of the daily health issues so common amongst our PCOS community. Things like bloating, sinus congestion, low energy, brain fog, sore joints, insomnia, anxiety and depression.
Given this unfortunate starting point, it makes perfect sense that when choosing what to eat, women with PCOS need to avoid pro-inflammatory foods, and eat more of the things that are rich in natural antioxidants instead.
It’s as simple as that.
As you’ll see throughout the 13 steps below, managing insulin levels and avoiding inflammatory foods are the two foundational ideas behind each of these principles.
So let’s get into it!
1. Avoid Fad Diets
Almost without exception, all of the success stories from my free 30 Day PCOS Diet Challenge come from women that have tried a lot of other diets before finally discovering that a PCOS diet is a unique beast.
While we can draw on the healthy influences of the Mediterranean Diet, Whole30, and Paleo recipes, none of these are perfectly synonymous with the type of diet that works best for PCOS.
Restriction Diets Don’t Work For PCOS
The most important misconception I want you to forget is this seemingly universal belief that you need to restrict your calories if you want to lose weight.
It’s simply not true for women with PCOS and avoiding restriction diets is both one of the most effective, yet radical elements of a sustainable PCOS friendly diet.
If you understand that body fat accumulates because of poor insulin regulation and NOT because of excess energy in your diet, then it should be pretty obvious that restriction dieting is a fool’s errand.
Since PCOS is the cause of weight gain, reducing your calories is a bit like putting your dirty socks in the dishwasher. You’re simply using the wrong tool for the job. Anyone who tells you otherwise is not keeping up with our current understanding of how PCOS works.
My biggest problem with restriction dieting though is the fact that they’ve been shown not to work time and time again, yet they continue to be the only way we’re told we can lose weight.
The most famous study showing the ineffectiveness of restriction diets reviewed 31 long term weight loss studies and found that between one to two thirds of dieters regained more weight after they finished their diet than what they lost while on it (Mann et al. 20071). Based on the hundreds of people I hear from at the start of my free 30 Day PCOS Diet Challenge, I’d say the percentage is closer to 99%!
So I’ll say it again: The best diet for PCOS does not require caloric restriction. Traditional dieting techniques don’t work over the long term.
Why I Don’t Recommend A Ketogenic Diet For Women With PCOS
While it’d be unfair to call it a “fad,” the ketogenic diet seems to be a popular diet for women with PCOS that I don’t think is optimal. This approach can certainly be effective, but I don’t think it’s the best diet for PCOS.
Ketogenic diets require that you consume very small amounts of carbohydrates – like 20 grams per day small. When you do this for several days, there’s not enough glucose in your system to keep you functioning so your metabolism switches to consuming fats instead. This metabolic state mimics starvation and is known as ketosis.
Going into ketosis is a pretty amazing way to lose a lot of weight quickly, and this type of diet has been widely proven as an effective PCOS therapy (Paoli et al. 20132). These health benefits, however, are largely a result of improvements in insulin regulation, and these same benefits can be achieved without “going keto” as I’ll talk about more in Step 5.
If the keto diet is something that’s piqued your curiosity before then this article on the keto diet for PCOS may be of interest. While you can find a lot of people promoting the ketogenic diet for women with PCOS, in this blog post you’ll find a counter-narrative where I describe five reasons why I’m not a fan of this approach.
Why I Don’t Recommend A Plant Based Diet For Women With PCOS
I also get a lot of questions from the women who do my free 30 Day PCOS Diet Challenge asking if a plant based diet is best for PCOS. This is another legitimate approach that can certainly be effective, but after spending a lot of time looking into it further, I now think that vegetarianism is far less than optimal for women with PCOS.
I totally appreciate the appeal of a plant based diet from an ethical stand point. I used to be a vegetarian for this very reason which made it harder to accept that the best diet for PCOS includes eating animal protein.
So it’s in spite of my personal bias towards the wellbeing of animals that I reluctantly acknowledge these three important facts:
- Eating fish, meat, and eggs is a guaranteed way to ensure you’re getting adequate amounts of all nine essential amino acids. Sure you can do this by eating a wide range of different plant based foods every day, but you need to be exceptionally skilled at it to avoid an amino acid inadequacy while also keeping your carb intake low (see Step 5 below). Of the many vegetarians I know personally, none of them seem to succeed at this.
- Animal sources of protein are all highly bioavailable and the same can’t be said for most plant derived alternatives. It’s one thing for a food to contain an essential amino acid, it’s quite another for that molecule to be readily absorbed and used in your body. Pea protein isolate may be a rare exception here.
- There’s some micro nutrients you just can’t get in adequate amounts from a plant based diet. The most obvious example is vitamin B12, with even the Vegan Society recommending their members either take B12 supplements or consume B12 fortified foods instead. There are many other compelling examples of this such as the powerful antioxidant carnosine (Budzen and Rymaszewska 20136), and the equally anti-inflammatory omega 3 fatty acids DHA and EPA. Studies have also implied that that a creatine deficiency in vegetarians may adversely affect memory and intelligence (Benton and Donohoe 20117; Rae et al. 20038), and athletic performance (Burke et al. 20039).
To be fair to all the women with PCOS that have achieved great results when switching to a plant based diet, I’m not saying it can’t be done. It’s just that it’s not optimal.
I’ve heard plenty of success stories from women who’ve switch to a plant based diet and I think a lot of this has to do with the fact that they’re swapping out pro-inflammatory processed foods for healthy whole foods. This is great as it’s exactly what Step 2 is all about. It’s just that a plant based diet is even better when you also include fish, meat, and eggs while you’re at it.
2. Swap Processed Foods For Nutrient Dense Whole Foods
Principle 2 has to be the least surprising idea here, but there’s more to this general public health recommendation when it comes to PCOS.
The problem with processed foods and PCOS is threefold. The first problem is that if you’re eating processed foods, you’re not eating all the good things that can help heal your PCOS. And as a general rule, processed foods contain pro-inflammatory ingredients that make your symptoms worse. The worst of these are vegetable oils, which I talk about more in Step 8, and sugar which happens to be the next step in your polycystic ovarian syndrome diet induction.
There are also a bunch of compounds in processed foods that people have good reason to be concerned about. These include suspected carcinogens like chemical food coloring, potassium bromate, butylated hydroxytoluene (E321), and its close cousin butylated hydroxyanisole (E320).
To me processed foods are things made in factories, where engineers and food scientists collaborate to produce highly marketable products that play on our evolutionary weak-points. The priorities in this process are cost and convenience rather than health and wellbeing which is kind of counterproductive to using food as medicine.
If it comes in a package and you don’t recognize all of the ingredients then I’d call this a processed food.
Whole foods by comparison, like the ones included in this comprehensive PCOS Diet Cheat Sheet, are foods your granny and great granny would recognize so these should be easy to identify.
3. Exclude Sugar From Your Polycystic Ovary Syndrome Diet
At the risk of becoming your least favorite person, the reality of polycystic ovarian syndrome is that quitting sugar is the most powerful step you can take to overcome your diagnosis.
When I first learned this, I freaked out. If there were sugar eating Olympics, I’d have taken the podium every year. If you’ve ever seen the Coney Island hot dog eating contest, that’s how I used to plough through Reece’s peanut butter cups and ice cream… okay maybe that’s a slight exaggeration but the point is I get-it if you think this sounds ghastly or impossible.
But there’s just nothing good that can be said about sugar when it comes to PCOS. It causes your body to store rather than burn fat, promotes unwanted facial hair, acne, and male-pattern baldness, and it makes you feel like crap emotionally.
If you’re trying to get pregnant, sugar consumption is really working against you as it’s known to adversely affect egg quality, increase miscarriage rates, and reduce libido.
So who wants sugar now??
Of course you still do…
It would be completely naive to presume that knowing something is bad for us is enough to stop us eating it. After the long struggle I fought to break my own sugar addiction I’d never make this mistake and I certainly could never judge anyone for finding this step the hardest.
Research has clearly demonstrated a number of similarities between food addiction and drug use disorders (Pivarunas and Conner 201510) with the latest reviews finding strong evidence of sugar addiction at a clinical level (Wiss et al. 201849). Other studies have found sugar to be more addictive than cocaine – at least in rats anyway (Ahmed et al. 201311). I guess that having study participants ingest pure sugar for the sake of science would never make it past the ethics review board…
Responding to the social, psychological, and biological challenges of quitting sugar really was a key driver for me when I developed my free 30 Day PCOS Diet Challenge. During this immersive experience I seek to nourish and satisfy any potential cravings, ensuring participants are well supported during the first few weeks of this difficult step.
Karina, a previous Challenge participant, is proof that even the worst sugar addicts among us can be saved. When she started my free Challenge, Karina was so hooked on sugary foods that not only was she suffering from many of the typical PCOS symptoms, but it was making her feel like a monster around the house too. With the wellbeing of her family in mind she took the plunge and went sugar free. While there’s no doubt that she struggled through this process, she stuck with it and was able to lose over 60 pounds to reach her goal weight.
What’s even cooler about Karina’s experience, is that after “getting clean” she now no longer thinks about sweets anymore because she no longer gets cravings. What this shows us is that even if you’re a raving sugar addict to start with, cravings are a short-term problem that go away over time. Another nice benefit of getting off sugar is that your taste buds become much more sensitive, which makes everything else taste sweeter.
While I could literally write about this all day (if only someone else would do the housework), the take home point I want you to think about is this: If you really want to beat PCOS and overcome your symptoms then you’re going to need to make a choice between your long term health goals and your relationship with sugar.
4. Be Smart About Fruit In Your PCOS Diet
But what about fruit I hear you ask? A very good question…
I’ve always felt close to my primate roots, because besides the Lucky Charms and ice cream, I used to eat as much fruit as your average Orangutan – the sweeter the better of course.
I realized after switching to a PCOS friendly diet that fruit can be a tricky food to navigate. While it contains plenty of fructose sugar – suggesting that it’s best avoided, fruit can also be rich in both phytonutrients and fiber.
Here’s where I landed on this one: As a general rule, fructose consumption tends to make your PCOS symptoms worse, which is why Step 3 is so important. For example, a comprehensive analysis has shown that even in people without diabetic-like health concerns, fructose promotes insulin resistance in the liver (ter Horst et al. 201655). While poor liver health by itself is a common concern for women with PCOS (Vassilatou 201437; Kelley et al. 201438) the inflammation caused by fructose consumption can result in a long list of health problems that includes weight gain, infertility, hirsutism, gut issues, anxiety, and depression.
But… and this is a big but…
The presence of fiber and other nutrients in fruit appears to offset the damage caused by this sugar. Even in people with type II diabetes, the fructose found in fruit doesn’t appear to adversely affect liver health (Weber et al. 201856). The upshot of all this is that whole fruit is still healthy for women with PCOS, but it pays to be smart about how you include it in your diet if you want to optimize your health outcomes.
I recommend only having whole fresh fruit and avoiding ALL fruit juices, canned fruit, or processed fruit concentrates. Also make sure to choose fruits that lean towards a tart taste and avoid those that are super sweet.
You can find a comprehensive list of common lower sugar fruits in this Beat PCOS Diet Cheat Sheet.
While you can find published data sources for the fructose content of most fruit, the natural variation found between different species as well as how ripe the fruit is when you eat it means that the best way to tell is by using your taste buds. The sweeter the taste, the higher the sugar content. This means more currants, berries and melons, and less apples, grapes, and bananas.
Most importantly I suggest limiting your fruit intake to 1-2 servings per day and by “serving” I mean approximately 1 cup, or one medium sized piece.
5. Eat Low Carb, & Slow Carb, From Whole Food Sources
While unlikely to take off as the next sexy diet fad anytime soon, the principles of low carb, slow carb, from whole food sources describes many of the important nuances of how best to eat carbs when you have PCOS.
In the recipes I prescribe during my free 30 Day PCOS Diet Challenge and in my free 3 Day PCOS Meal Plan I aim to achieve around 20-30% of energy intake from carbohydrates. This is “low” compared to the ill-advised amounts recommended by the USDA, but is greater than that recommended for “very low carbohydrate” ketogenic diets.
Here’s why I think “low carb” is the sweet spot for women with PCOS:
- Keeping carbohydrate intake “low” reduces the amount of insulin our bodies need to produce. Since elevated insulin levels are a major driving force for almost ALL PCOS symptoms (even in women with lean type PCOS) this one’s a bit of a no-brainer right?
- While there’s little question that ketogenic diets can be highly effective in the short term, I’ve yet to meet someone that has found this highly restrictive protocol a happy, healthy, and sustainable lifestyle choice. Unless you’re the kind of person that has a lot of self-control and is really into food and cooking, it’s incredibly challenging to eat healthily while in a truly ketogenic state (see Step 1 for more details).
- Having a little carbohydrate in your system all the time is the best way to stave off sugar and carb cravings. As I mentioned before, quitting sugar is one of the most powerful steps for beating PCOS, yet it’s incredibly difficult because it’s so darn addictive. Our bodies and brains are hard-wired to run on carbs and when we take these away, you can expect a rebellion. Eating a small amount of carbohydrates with every meal is a great strategy for making this essential step easier and more sustainable long term.
Going slow carb on the other hand means choosing carbohydrate food sources that are digested slowly over time. Often referred to as “low GI”, slow carbs cause your blood glucose levels to rise in a controlled manner, which means demand for insulin, whose job it is to move the glucose out of your bloodstream and into your cells, is nice and manageable.
Now I have some major issues with the use of the glycemic index, but for the purposes of choosing carbohydrate food sources it does provide some moderately useful guidance when coupled with the third part of this principle.
Whole food carbohydrates are things you can grow and then harvest without any processing. This means starchy vegetables like sweet potato, yam, taro, and squash. Beans and lentils are another great whole food carbohydrate, while suitable grains include quinoa, buckwheat, or red, black or wild rice.
To put all this into context, as a practical guideline, I generally recommend eating either 3 oz (85 g) of grains, around 5 oz (140 g) of legumes, or approximately 3 – 8 oz (85 – 230 g) of starchy vegetables (depending on how starchy the vegetable is) with every meal.
Bianca, a previous Challenge participant, embraced this dietary principle as a key part of her journey to beating PCOS. Eating low carb, and slow carb, from whole foods sources took Bianca from the brink of gastric surgery when she first joined the Challenge, to finally finding a way to control her weight naturally. While getting off metformin and losing 30 pounds was great, what I love the most about Bianca’s success story is that when she was ready, she was able to conceive naturally and have a healthy happy pregnancy.
My Beat PCOS Diet Cheat Sheet, which is the accompanying download to this article, includes a comprehensive list of PCOS friendly, low GI carbohydrate foods if you want to get started on this principle right away.
6. The Best Diet For PCOS Includes Fish, Meat, & Eggs
Given what I’ve already said in Step 1 about plant based diets being less than optimal, there’s another important reason to eat plenty of fish, meat, and eggs.
If you’re the kind of person that finds it hard not to snack, then there’s a good chance you’re not getting enough bioavailable protein (and fat) in your diet. This is because, our hunger and fullness hormones are cued by protein but not by sugar and carbohydrates. When we eat good sources of protein we not only support our wellbeing, but we feel full for a long time afterwards.
One of my favorite demonstrations of this fact can be seen in the second week of my free 30 Day PCOS Diet Challenge, where I prescribe steak and eggs for one of the breakfast meals. Women who only days earlier had never been able to go without a sugary morning snack, rediscover a new satisfaction they haven’t experienced in years.
This is one of the reasons why whole food sources of fish, meat and eggs are such powerful tools for supporting a good polycystic ovaries diet. Eating these hunger satisfying foods make it far less likely we’ll want a bakery snack in-between meals.
When it comes to formulating PCOS friendly recipes, like those you’ll find in my free 3 Day PCOS Meal Plan, I generally aim to include approximately 5.3 oz (150 g) of unprocessed meat, 6.3 oz (180 g) of seafood, or 2-3 eggs with every meal (weighed raw). Even breakfast where you can.
My intention is to have you achieve around 100 grams of highly bioavailable protein consumption per day which matches your body’s amino acid demands.
I also generally recommend buying the most well-raised fish, meat, and eggs, you can afford. We’re using food as our medicine after all so I tend to think of it more as a medical expense, rather than as a living expense to be minimized by all means. Ethical considerations aside, “happy meat” is the healthiest meat, with plenty of studies proving this point (Dhiman et al. 199912; Daley et al. 201013; Karsten et al. 201014).
I’m always a little self-conscious when making this statement though as I realize that for many people food costs can be a major constraint and I don’t want this to be a barrier to eating better. We can’t let the perfect be the enemy of the good so to take a more balanced perspective here, you’ll be far better off eating conventionally raised beef and vegetables than chowing down on a big bowl of free-range, grass fed, organic, vegan pasta.
7. Include Plenty Of Healthy Fats In Your PCOS Diet
Thanks to the nonsense propaganda we’ve been bombarded with for the past half century, eating more fat is by far the hardest thing for many women to get their heads around when switching to a PCOS friendly diet.
Through the far reaching interests of the food and agriculture lobby, we’ve all been exposed to the government’s view that a healthy diet is a low fat diet. Despite government health guidelines appealing to “science” in support of their agenda, the real scientific community has been saying for decades that this is clearly not true.
In 2004, Dr Sylvan Lee Weinberg, MD, published a critique of the diet-heart hypothesis in the Journal of the American College of Cardiology and summed things up nicely. She concluded that, “the low-fat-high-carbohydrate diet …may well have played an unintended role in the current epidemics of obesity, lipid abnormalities, type II diabetes, and metabolic syndromes.” And that, “This diet can no longer be defended by appeal to the authority of prestigious medical organizations or by rejecting clinical experience and a growing medical literature…”
This sentiment is widely shared by many of her equally well- informed contemporaries with nutrition researchers like Adele Hite from the University of North Carolina publishing thorough criticisms of the recommendations made by the Dietary Guidelines for Americans Report (Hite et al. 201015; Hite 201716).
Breaking free from the ingrained idea that fat makes us fat is a major milestone towards real results for women wanting to switch to a PCOS diet. For people that’ve been told all their lives that fatty meat and butter are “bad for them” this can prove a cognitive challenge. I still see it daily within my own extended family!
But once we punch through the fear and doubt that’s been brain-washed into us, we can use these foods as a skillful means to achieve our health goals.
When I learned that wholefood sources of fat were good for me, I have to admit, I went a wee bit crazy on the butter and pork belly. I started eating enough saturated fat to give a cardiac surgeon a heart attack but I also monitored my metabolic health markers like fasting glucose, cholesterol, and triglycerides.
To my great surprise, all of them improved a lot!
Eating more fat is the other side to the low carbohydrate coin. Diet intervention studies reliably show that a decrease of dietary carbohydrates along with an increase in fat consumption promotes weight loss, testosterone reduction and improved insulin sensitivity in women with PCOS (Goss et. al 201417; Gower et. al 201319). This is useful beyond just weight loss and the management of insulin resistance though, as these are the kinds of metabolic changes that can help restore ovulation, and reduce the effects of acne and hirsutism.
And while in Step 6 I talk about the benefits of protein to help satiate hunger, our fullness hormones are also perfectly designed to be triggered by fats. This is exactly why foods like coconuts, olives and avocado are so incredibly filling, making them great for staving off sugar cravings.
Previous participants from my free 30 Day PCOS Diet Challenge have seen these exact same results. Katrina for example, had gained 50 pounds since the birth of her daughter, was suffering from secondary infertility, and was upset by the fact that she could grow a full beard. Within months of making these dietary changes, which included eating a lot more fat, she’d lost 19 pounds of body fat and her unwanted hair was gone. But best of all, Katrina was able to fall pregnant naturally and had a “wonderful, energetic pregnancy” unlike her first where she suffered from gestational diabetes.
For anyone looking for an inspirational example, then Katrina’s full story is well worth a read.
So the best diet for PCOS should include lots of fat. You don’t need to worry about eating too much because your fullness hormones will stop you.
My definition of “healthy fats” are any fats that are sourced from whole foods with minimal prior processing (for a full list of healthy fats make sure to download this PCOS Diet Cheat Sheet). This includes saturated fats which despite what everyone else believes, are actually really good for you. While I know this might sound completely loopy if this is the first time you’ve heard it, belief in the idea that dietary cholesterol has an adverse effect on your health, puts you at odds with the growing body of evidence suggesting this outdated theory has run its course. Even as far back as 1991, one of the original proponents of the diet-heart hypothesis, described the effect of dietary cholesterol on blood cholesterol levels as “minimal” (Keys 199157).
For more information on this topic you can read my 6 reasons to add saturated fat to your PCOS diet here.
I especially like to use a lot of coconut oil in my recipes as this healthy fat has been shown to help with fat loss – particularly from around the stomach and thighs (Mumme and Stonehouse 201524). And I also include plenty of beef and butter since these fats are the richest source of conjugated linoleic acids (CLA).
If you haven’t heard of CLA before, this family of fats is known to:
- Be good for your arteries (Mooney and McCarthy 201225).
- Help with glucose tolerance and insulin action (Ryder et al. 200126; Castro-Webb et al. 201227).
- Help reduce body fat (Blankson et al. 200028; Kennedy et al. 201029).
This is saying nothing for how much better everything tastes with a good serving of butter on top!
Of course all the usual, more widely accepted “healthy fats” apply too. Things like nuts, seeds, and avocado feature heavily in all my recipes with oily fish making a regular cameo also.
So if you want to beat PCOS then eat more fat. You’ll be amazed at how much difference this step will make.
You won’t “get fat” provided you’re following the other 12 steps. And if you have some surplus body fat, then this is one of the easiest ways to lose it.
8. Replace Vegetable Oils With Healthy Fats
If you got the bit about inflammation being a problem for PCOS, then Step 8 is another no brainer. Vegetable oils are straight out pro-inflammatory so eliminating these from your PCOS diet is a fairly easy win.
Despite the name, vegetable oils are not really from vegetables at all, but rather are processed seed oils coming from soybeans, sunflower, corn, canola, cottonseed, and safflower etc. The reason these oils are inflammatory is because they have high ratios of omega-6 fatty acids.
They can also contain industrial trans fats as a result of how they’re made, with an older study finding as much as 4.2% trans fats in consumer soybean and canola oils (O’Keefe et al. 199430).
Industrial trans fats are really bad for us. They’re highly toxic and are linked to heart disease, cancer, diabetes, and obesity. Trans fats are another great reason to avoid high processed foods because the FDA only requires these to be included on the nutritional facts label if there is more than 0.5 grams per serving.
This is a changing regulatory environment however, and it seems that trans fats are about to be phased out completely in the coming years. In the meantime, I recommend avoiding any food products that include “hydrogenated”, or “partially hydrogenated” vegetable oils in the ingredients list as these are trans fats, just by another name.
During my free 30 Day PCOS Diet Challenge and in my free 3 Day PCOS Meal Plan I have women switch out vegetable oils for more PCOS friendly alternatives. I recommend using coconut oil, lard, or ghee for high temperature cooking (deep frying/baking); and using butter, olive oil, avocado oil, or macadamia nut oil for low temperature cooking (stir frying), or to have cold in a dressing.
9. Eat Foods That Cultivate Your Gut Microbiome
Understanding the influence of the gut microbiome on our health and wellbeing is by far one of the most exciting fields in medical research at the moment.
In just the last decade, studies have shown that the microbiome affects how much we eat (Fetissov et al. 200831), our metabolism (Backhed 201132; Ramakrishna 201333), and even the way in which we absorb nutrients (Jumpertz et al. 201134). Beyond just an associative relationship, a causal link has now been established between the bacteria in our guts and insulin resistance and obesity (Saad et al. 201635; Rabot et al. 201040).
One of the main ways in which sugar is “bad” for us is that the fructose component of sugar changes our microbiome for the worse. This has been shown to negatively affect liver health (Vos 201542; Neuschwander-Tetri 201343), while studies on mice suggest alterations of the microbiome may also reduce cognitive capacity (Magnusson et al. 201541)
Making positive changes to our gut flora is one of the biggest reasons why a PCOS diet works so well.
Some of the most valuable research that’s been done in this space shows that women with PCOS have a lower diversity of healthy gut bacteria and that these differences matter (Torres et al. 201844; Liu et al. 201745). Rodent studies have even suggested that dysbiosis of the gut microbiome may play a causal role in PCOS and that improvements to the microbiome may be a potential treatment option (Torres et al. 201950). While this might sound exceptionally complicated, we also now know that if we want to make positive changes to the makeup of our microbiome we need only change the foods we eat (Prince et al. 201646).
While quitting sugar can reduce the kinds of microbes that work against your health goals, eating both probiotic and prebiotic foods help support the good guys.
Probiotic foods contain live strains of healthy gut bacteria, while prebiotic foods contain a specific kind of soluble fiber that enables these microorganisms to thrive. It’s like probiotics are the seed, while prebiotics are the water and sunshine.
During my Beat PCOS 10 Week Program I invite participants to try probiotic foods as one of their weekly challenges. I normally suggest starting with either coconut yogurt, pickles, kombucha, sauerkraut, kimchi, miso, or tempeh. These are all fantastic snacks that slide easily into a PCOS friendly diet, which is why I include them in my PCOS Diet Cheat Sheet.
Prebiotics on the other hand are something that come fairly automatically when following the best diet for PCOS. I say this because the best sources of these compounds are found in certain fruits and vegetables as I discuss in more detail below.
10. Eat Plenty Of Non-Starchy Vegetables With Every Meal
Before I started the health transformation that eventually led to me falling pregnant naturally despite years of failed fertility treatments, vegetables were something I knew were good for me, but rarely featured as a high priority at meal times.
I’m sure most people reading this will be far more sensible about food than I use to be, but for the few who like me need reminding, non-starchy vegetables are an essential part of any good PCOS diet plan. While carbs, protein, and fats are the major components of any PCOS friendly meal, eating a wide range of non-starchy vegetables is also essential for good health.
Without wanting to bore you with an unnecessary rant about why vegetables are good for you, let me explain the three biggest reasons that motivated me to improve my delinquent vegetable habits.
The first reason is phytonutrients. Phytonutrients are micronutrients that can only be found in plants and science is just beginning to understand some of their amazing health promoting properties.
Let me use turmeric as an example. Many people are aware that turmeric is anti-inflammatory, but this is because it’s a rich source of the carotenoid phytonutrient curcumin. This leads many people to take turmeric supplements. But as I explain in my Beat PCOS Supplements Guide, the low bioavailability of curcumin means that most (but not all) commercially available turmeric supplements pass straight through you. Now if you get your curcumin from eating plenty of fresh ginger, or enjoying regular curry dishes on the other hand, you’re consuming this phytonutrient (as well as many others) as nature intended and a lot more of it is absorbed by your gut.
Over 25,000 phytonutrients have been discovered so far, and if you wanted to get scientific about it you could find some of these in almost every vegetable you look at. Carrots, tomato, bell peppers, spinach, kale, and broccoli. Seriously. Pick a vegetable and it’s likely to be rich in some special nutrient.
But if you’re like me and you just want to get on with your life knowing you’re doing yourself some good, the take home point is that more vegetables means more phytonutrients, and more phytonutrients means better health all around.
The second big discovery which really changed my attitude towards vegetables was the knowledge that this is where many prebiotic foods come from (see Step 9 above). Prebiotic foods are high in certain kinds of fiber or resistant starch which provide the energy and carbon source needed for our microbiome to flourish. A diet low in these substances has been shown to reduce bacterial abundance (Halmos et al. 201547), while a high intake of these non-digestible carbohydrates can improve their composition (Cotillard et al. 201348).
While this is far from an exhaustive list, some of the vegetables that are known to be high in prebiotics include Jerusalem artichokes, garlic, onion, leek, shallots, spring onion, asparagus, beetroot, fennel bulb, green peas, snow peas, sweet corn, and savoy cabbage (Monash University 201636).
The third good reason I decided to get my rabbit on, was the knowledge of how fiber affects our gut health. While we can’t digest fiber it plays an important role in aiding the passage of food through our intestines.
One of the risks of eating a low carb diet that includes plenty of fish, meat, and eggs is that you can become constipated from inadequate fiber intake. The answer of course, is to make sure you’re eating lots of high fiber vegetables like garlic, artichokes, Brussel sprouts, spinach, carrots, broccoli, beetroot, and cabbage.
When it comes to the question of how many vegetables is enough, all the recipes included in my free 3 Day PCOS Meal Plan and free 30 Day PCOS Diet Challenge seek to include two cups of non-starchy vegetables with every meal, with a particular focus on leafy greens.
This can be a lot more than what people are used to, but trust me when I say your body will thank you for it.
11. Cut Out Gluten And Dairy
Found in just about anything made from wheat, gluten is a protein that for some reason is particularly problematic for women with PCOS. Whether you’re aware of the effects or not, foods containing gluten can wreak havoc on your digestive system and are a primary cause of inflammation.
As I explain in this article about how gut health and inflammation affect PCOS it’s super common for women with PCOS to be intolerant to gluten without actually knowing it. The common term for this kind of intolerance is non-celiac gluten sensitivity which is a condition that can’t be diagnosed by the normal celiac blood tests or even an intestinal biopsy.
Rather than messing around with costly and potentially inaccurate immunoglobulin blood tests, the best way to find out how gluten affects your health is to do your own experiment. It’s really easy and it costs you nothing.
Here’s how you do it:
- Avoid gluten for several months and see how you feel. You can download a copy of this Foods to Avoid Checklist to see many of the most common gluten containing foods. Assuming gluten is a problem for you, you’ll need to clean it out of your diet entirely to let your gut heal properly. If you begin to feel better during this time like the majority of women who take this trial seriously do, then that should be your first clue.
- You can then spend a day gorging yourself on all your favorite wheat laden foods and then see how you feel. If you feel like rubbish, then that’s your second big clue!
I’m all about self-experimentation like this because there’s nothing more motivating or compelling than seeing real results.
Nellsy Martinez is a perfect example of what can be achieved when applying this principle as part of a PCOS friendly diet. While taking part in my free 30 Day PCOS Diet Challenge, Nellsy eliminated both gluten and dairy from her diet as well as following the rest of the principles laid out in this article. Not only did she start feeling great, but she lost weight and started getting her periods again for the first time in years. After about 8 months, Nellsy managed to fall pregnant naturally with her beautiful baby, Vivianna.
She gave me permission to include this touching message she posted in my PCOS Support Facebook Group soon after her daughter was born.
The key to success is finding alternatives to bread, pasta, breakfast cereals, and other gluten containing food products, which is not as hard as it sounds with the right information and support.
If you’re following Steps 2, 3, and 5 from above, you’re most of the way there already.
In my 3 Day PCOS Meal Plan for example, I swap out pasta for zucchini noodles (zoodles), I use lettuce leaves instead of burger buns, and I suggest a flaxseed and almond meal porridge that’s 100 times more PCOS friendly than any gluten filled breakfast cereal you’ll find in most “health food’ isles.
While possibly not quite as prevalent as gluten sensitivity, it’s also really common for women with PCOS to suffer from a subclinical dairy intolerance. While lactose is often the culprit, many people don’t realize that both the casein and whey proteins in dairy can also cause inflammation.
An important nuance to this PCOS diet principle is that butter and ghee are generally well tolerated (you’ll see both of these dairy derived foods in the PCOS Cheat Sheet that accompanies this article). Ghee is essentially perfectly purified milk fat so it doesn’t contain any lactose, whey, or casein, while butter contains less than 2% of these compounds in total. This amount is hardly worth worrying about given how healthy milk fat is (see Step 7 if this sounds like crazy-talk).
Again, I recommend a little self-experimentation here to discover your personal sensitivity to dairy.
Many women use my free 30 Day PCOS Diet Challenge as a starting point for this process as all the recipes I provide are completely gluten and dairy free (apart from butter of course).
12. Know Your Personal Intolerances
Since women with PCOS are so sensitive to inflammation, it’s also worth going the extra mile to discover and then eliminate any other foods that trigger your immune system.
If after eliminating vegetable oils, gluten, and dairy you still have residual gut issues, it’s worth considering extending your investigation to other potential subclinical food sensitivities. Common culprits include eggs, peanuts, tree nuts, fish and shellfish.
If you’re especially unlucky and have a lot of persistent gut problems, there’s an outside chance that you may also have sensitivities to the group of foods known as FODMAPS (fermentable ogliosaccharides, disaccharides, monosaccharides and polyols).
FODMAPS are small carbohydrates found in many common foods including some fruit and vegetables that are otherwise perfectly healthy. FODMAP sensitivity is synonymous with a condition rightly named irritable bowel syndrome (IBS) and you’ll definitely want to see a functional medicine practitioner or naturopathic doctor to help you navigate your way through this challenging health issue. My brother has IBS, so I’ve seen firsthand what it takes to get on top of this.
While the cheapest and easiest way to investigate your personal food intolerances is to do a medically supervised elimination diet, there’re a few lab tests out there that can make the process a lot less painful.
As a general rule food intolerance testing is of poor quality resulting in many inaccurate results as Chris Kresser explains beautifully in this podcast. The one lab that by far seems to have the best reputation amongst doctors I trust is Cyrex Laboratories. They offer a range of different panels depending on your needs, but you’ll need your doctor to order the tests for you.
13. Reconsider Caffeine And Alcohol In Your PCOS Diet Plan
Without wanting to sound like the Food Grinch, it’s fair to say that caffeine and alcohol don’t mix well with a PCOS diagnosis.
I think caffeine is best avoided because it increases your stress hormones which in turn increases your insulin levels. Regular consumption can also decrease your insulin sensitivity making it more difficult to regulate your blood sugar levels across the day. Caffeine can disrupt sleep and promote anxiety while the acidity of coffee in particular can cause digestive discomfort, indigestion, heart burn and imbalances in our gut microbiome.
Alcohol on the other hand has been shown to be a particularly problematic substance for women with PCOS. We have higher rates of liver disease because of this disorder (Vassilatou 201437; Kelley et al. 201438) and even small amounts of alcohol consumption increase these risks (Noreen et al. 201139).
Moving away from caffeine and alcohol also makes it easier to avoid sugar and empty carbohydrates, which are often found in these drinks.
I’m not saying never, but these two particular beverage ingredients are well worth reconsidering.
To make this process possible, it’s important to find suitable alternatives that meet your needs and I share several of my personal favorites in my PCOS Diet Cheat Sheet. Ground roasted cocoa in particular can totally transform your belief that you must have coffee in the mornings.
Most Importantly Be Kind With Yourself
If you’ve gotten this far, then you’re obviously serious about beating PCOS and I take my hat off to you. There’s a lot to digest with these 13 steps, and I know I’ve risked overwhelming you despite my intention not to.
This is exactly why I created my free 30 Day PCOS Diet Challenge and if you’re ready to begin, this is a great place to start. The goal of this free program is to make it both fun and easy for people like you to put these 13 food principles into practice. As well as the weekly meal plans, recipes, and shopping lists I’ve already mentioned, the 30 Day Challenge includes video lessons, and daily mindset exercises, all within a vibrant and supportive community environment.
I run the Challenge four times a year as a live event, but if you’re feeling especially inspired and want to get started right now then I recommend downloading my 3 Day PCOS Diet Meal Plan also. This 15 page free ebook includes a collection of some of my most popular PCOS recipes with an accompanying shopping list and further information about how to use food to beat PCOS.
Here’s the most important thing to keep in mind though when starting your journey towards a PCOS friendly diet:
Be realistic with your expectations.
While it drives me crazy whenever my mom says it to me, there’s a lot of truth in the cliché that Rome wasn’t built in a day.
Beating PCOS is not a race, and if it were, it’d only be with yourself.
To be entirely honest with you, it took me years to fully incorporate these 13 principles into my everyday life so I’m certainly not going to tell you this process is easy. Having the right information and support can definitely make it “easier”, but even the best dietary changes can feel like a drag at times.
It’s totally fine if it ever feels unfair. Because it freakin is!
Given my previously terrible relationship with food, I can assure you there was ample cognitive dissonance as I went about implementing a PCOS friendly diet. It’s only because I know how hopeless I used to be, and all the short cuts I tried to take, that I’m 100% confident that anyone can get there eventually.
So take your time, and be good to yourself.
Be honest about your weaknesses, leaving your negative self-judgment at the door. Focus on your health goals, and set yourself up for success.
Learn and experiment until you find what works for you, and when you slip-up, shake it off and keep on going. Channel your inner TayTay if that’s what it takes.
You can do it!
Kym Campbell is a Health Coach and PCOS expert with a strong passion for using evidence-based lifestyle interventions to manage this disorder. Kym combines rigorous scientific analysis with the advice from leading clinicians to disseminate the most helpful PCOS patient-centric information you can find online. You can read more about Kym and her team here.
This blog post has been critically reviewed to ensure accurate interpretation and presentation of the scientific literature by Dr. Jessica A McCoy, Ph.D. Dr McCoy has a master’s degree in cellular and molecular biology, and a doctorate in reproductive biology and environmental health. She currently serves as a University professor at the College of Charleston, South Carolina.
This blog post has also been medically reviewed and approved by Dr. Sarah Lee, M.D. Dr. Lee is a board-certified Physician practicing with Intermountain Healthcare in Utah. She obtained a Bachelor of Science in Biology from the University of Texas at Austin before earning her Doctor of Medicine from UT Health San Antonio.
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