Less Processed Foods and More Plants: How to Manage PCOS With Diet

Polycystic ovary syndrome (PCOS) impacts millions of people all over the world, including around 5 million Americans, according to the Centers for Disease Control and Prevention (CDC). The hormonal condition is incurable, but it is manageable with treatment, which often includes medication (birth control pills are often used to control PCOS), and sometimes surgery. But lifestyle changes may also make a big difference for some people with PCOS. We spoke to Alyssa Pacheco, RD, LDN, who founded the platform The PCOS Nutritionist Alyssa, to find out why making some simple dietary changes can be beneficial for many people with PCOS.

What are the symptoms of PCOS?

PCOS is a chronic health condition that affects women and people who were assigned female at birth. It’s characterized by an imbalance of hormones—people with PCOS tend to have higher levels of androgens, which are a type of sex hormone responsible for producing certain male characteristics. 

This happens because people with PCOS have cysts and underdeveloped follicles, which contain eggs that do not mature adequately to lead to regular ovulation. Because ovulation is inconsistent or even non-existent, hormone levels become out of balance, leaving androgen levels (like testosterone) to be higher than they should be.

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Per Healthline, the three main features of PCOS are high levels of male hormones, ovarian cysts, and irregular periods. Symptoms may also include heavy bleeding, excessive body hair growth, acne, and weight gain. 

Many people with PCOS tend to have higher levels of insulin, which can contribute to the hormonal imbalances present in the condition. “Up to 80 percent of people with PCOS have some degree of insulin resistance,” explains Pacheco.

“Insulin resistance can cause weight gain, carb cravings, and an increased risk of type 2 diabetes,” she adds. “High insulin levels can cause the ovaries to increase testosterone production, which can lead to a lot of the classic PCOS symptoms such as irregular periods, unwanted hair growth, and acne.”

What foods should you avoid with PCOS?

Research suggests that people with PCOS are more likely to suffer from type 2 diabetes, as well as metabolic syndrome and chronic inflammation, which increases the risk of chronic diseases like heart disease. This is why many experts recommend avoiding foods that may also contribute to a higher risk of these conditions.

Foods high in saturated fat, like processed meat, for example, may worsen chronic inflammation, while plant-based whole foods tend to reduce it.

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“Foods like ultra-processed foods, processed meats, refined carbs, added sugar, saturated and trans fats, and excessive alcohol are all known to contribute to chronic inflammation,” explains Pacheco. “Of course, having any of these foods occasionally is likely fine. Your overall diet pattern is the most important factor when it comes to lower inflammation.”

She adds that maintaining stable blood sugar—by eating high-fiber foods with protein and healthy fats—is also important for people with PCOS because it might help to lower insulin resistance. “It [will help to] reduce erratic rises and falls in blood sugar levels,” she adds. “Including these macronutrient combinations at meals can help your body become more sensitive to insulin over time and ultimately lower insulin resistance.”

Chia seed pudding is one example of a meal that contains fiber, protein, and healthy fats. Vegetable soup with wholegrain bread, hearty salads with legumes like chickpeas or beans, and stir-fried tofu with vegetables are also healthy meal ideas that can help keep blood sugar levels consistent.

What is the best diet for PCOS?

According to Pacheco, there are a few essential nutrients for managing PCOS. These include magnesium (present in foods like pumpkin seeds, chia seeds, almonds, cashews, beans, and spinach), vitamin D (present in fortified milks and mushrooms), and zinc (present in ingredients like pumpkin seeds, cashews, and oats).

Research suggests that all of these nutrients may help to lower insulin resistance, reduce inflammation, and manage testosterone levels. All are common on a plant-forward, Mediterranean diet. In fact, the nutrient density of the Mediterranean diet is why it has been named the healthiest diet by The US News and World Report seven times in a row.

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“The Mediterranean diet focuses on diet quality rather than a single nutrient or food group,” noted the publication earlier this year, which compiled its 2024 diet list with the help of more than 40 nationally recognized dietitians. “Numerous studies have shown that it reduces the risk of chronic health conditions, including heart disease and type 2 diabetes while promoting longevity and improving quality of life.”

Pacheco notes that while there isn’t any single diet that has been crowned as “the best” for people with PCOS, prioritizing nutrient-dense foods, and reducing intake of saturated fats and ultra-processed foods, is the way forward.

“There are many different types of eating patterns that can be effective for managing PCOS,” she says. “Regardless of the dietary pattern, someone will want to ensure that they’re eating in a pattern that maintains stable blood sugar levels and includes a lot of anti-inflammatory foods.”