Managing Polycystic Ovary Syndrome with Nutrition

Wondering what to eat for PCOS? According to Melissa Groves Azzaro, RDN, of The Hormone Dietitian in Keene, New Hampshire, several key dietary principles can be helpful when you’re building a PCOS-friendly eating plan. “First, insulin resistance is a common driver of PCOS symptoms, so following a blood-sugar-balancing diet may help,” she says.

“Increasing protein and fiber and eating a moderate amount of carbohydrates with an emphasis on whole grains, legumes, fruits, and vegetables is a good place to start.”

Meanwhile, a focus on anti-inflammatory foods (which also include whole grains, legumes, fruits, and veggies, fatty fish, and some herbs and spices) is another good approach. “(This) helps lower the inflammation levels common in PCOS,” Groves Azzaro says. And if you support your gut and hormone health with both soluble and insoluble fiber, probiotics, and prebiotics, it can help your body effectively get rid of excess hormones, she says.

Several mainstream diets may have a positive effect on PCOS. Here’s what we know so far.

A Low-Carb or Ketogenic Diet

Low-carb and ketogenic diets are popular among women with PCOS, especially those looking to lose weight or improve insulin resistance, says Alyssa Pacheco, RD, the Boston-based creator of PCOS Nutritionist Alyssa. “Limiting carbs can decrease blood sugar levels and ultimately reduce insulin resistance. It can also promote weight loss, which may improve symptoms as well,” she says.

There’s another potential benefit to a low-carb eating plan: “Lower carb intake has been shown to improve fertility and ovulation rates among those with PCOS,” Pacheco says. A study published in 2023 revealed that women with PCOS who followed a ketogenic diet for 45 days or more experienced improvements in reproductive hormones.

On the other hand, Pacheco points out that a keto diet has some significant drawbacks for PCOS. With its extreme carbohydrate restriction, it can be difficult to stick with. “Dieting and weight cycling can lead to worse metabolic health and a higher body weight in the long run,” she says. Plus, going low-carb often means cutting fiber — not a good thing for those with this condition. “Women with PCOS are already at a disadvantage when it comes to gut health,” Pacheco says. “Research has found that women with PCOS tend to have a less diverse gut microbiome. Limiting dietary fiber may negatively impact the gut microbiome long term.”

Mediterranean Diet

This diet is based on the eating patterns of people living around the Mediterranean Sea and abounds in whole foods, especially vegetables, fruits, fish, seafood, legumes, nuts, whole grains, and olive oil. “These foods naturally contain antioxidants and anti-inflammatory properties that can help to lower chronic inflammation, which is common for women with PCOS,” says Pacheco. “The foods consumed on a Mediterranean diet also tend to be high fiber, which is an important nutrient for improving gut health and stabilizing blood sugar levels.” She adds that the anti-inflammatory nature of a Mediterranean diet could also reduce insulin resistance.

Research backs these principles. One study found that a Mediterranean diet could play a therapeutic role in reducing inflammation and normalizing hormone levels in women with PCOS.

DASH Diet

Like the Mediterranean diet, the DASH diet (which stands for Dietary Approaches to Stop Hypertension) focuses on increasing fruits and vegetables, whole grains, and lean proteins while decreasing processed foods. Some research has found that this eating plan could benefit PCOS. In an older study, for example, 48 women with PCOS were assigned to either a DASH diet or a calorie-restricted control diet. Those who adhered to DASH’s principles had significantly reduced levels of serum insulin, triglycerides, and LDL cholesterol.

For Americans, a DASH diet may have an advantage over a Mediterranean diet because it typically involves foods that are more familiar to people used to eating a Western diet. “This can be easier to adhere to for some than a dietary pattern that is very different from what they’re currently eating,” says Groves Azzaro. “And since PCOS is a lifelong condition, any diet changes that you plan on making, you need to be able to stick with for a lifetime.”

A Low-Carb or Ketogenic Diet

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