How To Eat For PCOS (And Why Most Generic Diet Plans Fall Short)
Many women with polycystic ovary syndrome (PCOS) are instructed to "eat better and lose weight," with no real guidance on what that means for someone whose body has different rules of metabolism. A standard diet plan, based on calorie restriction, won't necessarily make a difference, as PCOS can change the way your body metabolises food and stores fat, which in turn affects the way your body manufactures hormones. Eating well for PCOS starts with correcting your insulin resistance and then addresses chronic inflammation, which can help to manage PCOS symptoms long-term and improve your overall health. If you have a PCOS diagnosis and are seeking someone who understands this, personalised PCOS diet planning services are available at Floralia Wellness.
Why insulin resistance changes the rules for weight loss with PCOS
How blood sugar spikes trigger androgen overproduction
If you consume food that increases your blood sugar (blood glucose) levels, your pancreas releases extra insulin to counteract this increase and lower your blood sugar levels again. In most women, this works like clockwork. However, with polycystic ovary syndrome PCOS, your body's cells are not very responsive to this insulin, so your body overcompensates by producing even more of it. The extra insulin has two key effects that are relevant to your PCOS symptoms: it triggers your ovaries to make extra male sex hormones (androgens), and it increases your body's ability to store fat, especially around your belly, contributing to weight gain and a higher body mass index.
This is the insulin resistance androgen cycle that lies at the base of most PCOS symptoms. Excess hair, acne, irregular or absent periods, inability to lose weight, and unexplained weight gain are just some of the symptoms that result from the process of increased insulin levels in the blood, which is explained in a review published in Nature Reviews Disease Primers in 2024. Polycystic ovarian syndrome is characterised by fluid-filled sacs on the ovaries, along with these hormonal disruptions. Until your PCOS diet is tailored to manage blood sugars consistently, you are not addressing the root cause of your symptoms. Left unmanaged, these hormonal imbalances can also contribute to long-term health risks such as cardiovascular disease and heart disease, as well as fertility problems. If you have not had your androgen levels tested, then testosterone testing in Perth at Floralia Wellness can help you understand your androgen levels.
Why calorie counting alone is not an effective solution for PCOS
This is where most generic weight loss advice falls for women with PCOS. Yes, a calorie deficit works in theory, but it completely overlooks what is going on in terms of hormones. When you restrict calories, your levels of cortisol increase. Increased levels of cortisol make insulin resistance worse, and increased insulin resistance means increased androgen levels and increased levels of abdominal fat storage; the opposite of what you want to be happening.
In the clinic, we observe this phenomenon frequently. A woman is eating 1,200 calories a day, exercising five times a week, and her weight is not budging. She is not doing anything wrong. Her metabolism is responding to a hormonal environment that cannot be changed by a simple calorie deficit. For PCOS sufferers, the content of the meal, rather than the quantity on the plate, is more important. Focusing on blood sugar control and anti-inflammatory foods, as well as protein, changes the body's hormonal environment, and this is when weight loss for women with PCOS is possible. The best diet for managing PCOS prioritises what you eat over how much you eat.
Anti-inflammatory foods that actually improve PCOS symptoms
Healthy fats your hormones need
Fat is the raw material your hormones are made from, and going too low can have negative effects very quickly. The types of healthy fats that are most beneficial for a PCOS diet are those with anti-inflammatory effects. Olive oil, avocados, oily fish such as salmon and sardines, and a few handfuls of walnuts and sunflower seeds are good sources of omega-3 fatty acids and monounsaturated fats that help to reduce insulin resistance, lower chronic inflammation, and increase insulin sensitivity over time.
Chronic low-grade inflammation is now known to be a consistent feature of PCOS, according to a systematic review in the International Journal of Molecular Sciences, which reinforces just why prioritising anti-inflammatory fats and nutritious foods is so important for PCOS management.
Use olive oil for cooking and dressing salads, and add half an avocado to meals where possible. Also, eat two to three servings of oily fish per week to help manage PCOS symptoms and support your overall health.
Low glycemic carbohydrates that stabilise blood sugar levels
Carbohydrates are not bad for you. It's just the type of carbohydrates that you consume and when you consume them. Low glycemic index carbohydrates are better as they will not spike your insulin levels or worsen insulin resistance.
This has been proven through research, where a study published in Advances in Nutrition found that when women with PCOS consume low glycemic index carbohydrates, they show better outcomes than those who consume high glycemic index carbohydrates. The best sources of carbohydrates are brown rice, quinoa, sweet potato, and bread, as well as legumes such as lentils and chickpeas.
It's important to consume carbohydrates with either proteins or healthy fats at every meal. This will ensure that the carbohydrates are digested slowly, keeping blood sugar levels balanced. For example, brown rice on its own will cause a spike in insulin levels, but brown rice with fish and vegetables will not.
Non-starchy vegetables and whole grains to build meals around
Make sure your plate is half full of non starchy vegetables at lunch and dinner. Vegetables such as broccoli, leafy greens, zucchini, capsicum, and cauliflower are high in fibre, have a low glycemic index, and provide the nutrients required for detoxification by your liver, which gets rid of excess hormones in your body.
Whole grains form the remainder of your plate, along with your protein source. Don't think in terms of recipes, think in terms of plates to build your meals. A base of whole grains or legumes, a protein source the size of your hand, plenty of non starchy vegetables, and some healthy fats. Building meals around whole foods and nutritious foods like these is one of the most effective management strategies for PCOS.
The worst foods for PCOS
Processed foods, added sugars and inflammatory oils
Processed foods have it all; refined carbs and added sugar, and oils that cause inflammation. White bread, pizza crust, hot dogs, processed meats, potato chips, processed snacks, and anything with a long list of ingredients are sure to drive your blood sugar and insulin levels in the wrong direction. These inflammatory foods are among the worst dietary choices for PCOS sufferers.
Added sugar, in particular, is problematic and is found in other foods where you would least expect it, such as in sauces, salad dressings, flavoured yogurts, and instant oatmeal. Do not be fooled by labels that look healthy but have high amounts of added sugar. French fries and fried chicken have not only refined carbs but also oils that are bad for inflammation. Fried foods in general should be avoided, as the effect of these foods is felt in your blood glucose and inflammation levels simultaneously. Reducing your intake of processed foods and inflammatory foods is a key step in any PCOS diet.
The drinks most people overlook
Liquid sugar enters the bloodstream faster than nearly any other substance, as there are no fibres or fats to slow it down. The obvious culprits are soft drinks, but sports drinks, fruit juices, flavoured coffees, and sweetened iced teas are just as bad.
Drink water and herbal teas, or black coffee and tea without sugar. If water just doesn’t feel exciting enough, try adding slices of lemon or fresh mint leaves. This is an easy substitution, but for some women, it eliminates a major cause of daily blood sugar issues that they had not previously considered.
What a realistic day of eating looks like with PCOS
While it's one thing to know what to eat, it's quite another to know what that looks like on a day-to-day basis. Here's what that might look like, with the focus on blood sugar balance and anti-inflammatory whole foods.
Breakfast: Scrambled eggs with spinach and half an avocado on a slice of whole-grain bread. This will slow down the absorption of carbohydrates from bread, and you will not experience a dip in energy in the morning.
For lunch, create your own bowl on a bed of brown rice or quinoa. Add grilled chicken or chickpeas, roasted non-starchy vegetables, olive oil, and some sunflower seeds. This meal will provide you with your daily dose of protein, healthy fats, fibre, and complex carbohydrates.
Afternoon snack: a small handful of walnuts with some low glycemic fruit, such as berries or a green apple. Combining fruit with fat or protein will prevent the blood sugar rush that occurs with eating just fruit.
Dinner could be salmon baked in the oven with a large portion of roasted broccoli, sweet potatoes, and a dressing made from olive oil and lemon. Oily fish eaten two or three times per week will improve insulin sensitivity and reduce inflammation.
Consider this more of a template than a strict meal plan. Feel free to vary the protein and vegetables however you like and vary the serving sizes based on your hunger. The idea remains the same: all meals have protein, good fats, fibre, and low glycemic carbs in some combination.
Why fad diets can backfire with polycystic ovary syndrome
Keto, intermittent fasting and extreme restriction
Keto diets may help with insulin resistance in the short term, but in the long term, very low carb diets have been shown to have a negative impact on cortisol and thyroid function in women with PCOS. It can even make their menstrual cycles worse. The weight loss in the short term is not fat but water and glycogen loss, and it is very difficult to sustain beyond a few months.
Similarly, intermittent fasting poses the same risks. Intermittent fasting can raise cortisol levels, especially in women who already have high stress hormones. For women who already have irregular or non-existent menstrual cycles, intermittent fasting can make their cycles worse. Some women may do well with a mild fasting schedule of twelve hours overnight. However, the more aggressive fasting schedules that some online advocates recommend, such as the 16:8 or 20:4 plans, may not be suitable.
Extreme calorie restriction, as discussed earlier, will exacerbate the hormonal problems of PCOS. Any diet that asks you to eat fewer than 1,200 calories or that eliminates entire food groups without medical necessity is not a diet for a body that already fights insulin resistance and excess androgens.
How to spot a PCOS diet plan that is not evidence-based
Avoid a PCOS diet plan that promises fast weight loss or touts a single supplement as the answer. A PCOS diet plan that touts a single food item as a "cure" for your problems is not worth your time. PCOS treatment involves lifestyle changes that require dedication, not a four-week fix.
A good plan will begin with insulin resistance as a foundation, include a variety of healthy food choices instead of restriction, and recognise that it takes time to get results. If a plan does not ask about your symptoms, your cycle, your blood work, or your stress levels before offering recommendations, it is most likely generic information repackaged and sold to you as PCOS information. A PCOS specialist, who knows your entire picture, provides the information that a generic plan does not have time to include. Our team of experienced PCOS specialists in Perth at Floralia Wellness can provide you with the information you need.
The lifestyle factors that make or break your PCOS diet
Physical activity and insulin sensitivity
Exercise is known to improve insulin sensitivity even without weight loss. This makes exercise one of the most powerful tools for managing PCOS, in addition to your diet. You don't have to exercise strenuously every day. Three sessions a week, or even every other day, for 30 minutes, is enough to significantly improve your insulin sensitivity. This is important in managing PCOS.
A word about resistance training. Muscle tissue is very important in this regard. More muscle tissue means more insulin receptors in your body. More insulin receptors mean greater insulin sensitivity. So, even if you just do resistance training twice a week and walk most days, your metabolic picture will change significantly in just a few months.
Sleep disturbances, stress and how they affect your hormones
If you don’t get enough sleep, your cortisol levels go up. If your cortisol is too high, your insulin resistance goes up. This is the same mechanism that makes extreme dieting counterproductive, and it is at work every night you don’t get enough sleep. Women with PCOS already have a higher incidence of sleep issues, and this is not a minor factor. It is a contributing factor to the severity of your symptoms.
If you are in a stressful situation at work or in your life, your cortisol is still too high. This means that your ability to improve your diet and your use of the good food you are providing your body is being sabotaged.
When diet alone is not enough to manage PCOS
How a naturopath can help identify what is causing your specific symptoms
PCOS is not one disease with one cause. Some women are primarily insulin-driven, with weight gain and skin tags being their primary symptoms, sometimes accompanied by acanthosis nigricans. Others are more inflammatory in their presentation, with high CRP and food sensitivities playing a larger role. And finally, there are those with adrenal androgen excess, in whom stress hormones, not insulin, are driving their high androgens.
This is important to understand, as the dietary solution for insulin-driven PCOS may not be the best solution for those with adrenal PCOS.
A naturopath trained in functional medicine can determine your particular type of PCOS by taking a detailed case history and interpreting your blood tests, including your insulin, glucose, inflammatory markers, and full hormone panel. Occasionally, we will also use a hormone test such as a DUTCH test.
Nutritional support, testing and personalised treatment at Floralia
Your naturopath at Floralia Wellness will review your current blood work or order new pathology testing to determine what your specific drivers are, and then design a treatment plan that works with your body with specific dietary changes and nutritional and herbal medicine support.
Inositol and other nutrients like magnesium have well-documented benefits in improving insulin sensitivity.
A meta-analysis published in the Journal of Clinical Endocrinology & Metabolism, conducted to update the international PCOS guidelines in 2023, confirmed that inositol can improve metabolic and hormonal outcomes in women with PCOS. Zinc helps regulate menstrual cycles. Peony and liquorice-based herbal medicine combinations have clinical evidence for reducing androgen levels in PCOS. These clinical tools will assist your dietary plan and help you achieve your goals faster. It's important to work with a qualified women's health naturopath who can prescribe these nutritional supplements and herbal remedies prescribe them at clinical-grade strengths based on your pathology results.
A range of hormone tests will also help your naturopath develop a treatment plan. You can have hormone testing in Perth at the Floralia clinic. If you have already seen a fertility specialist or your GP, our naturopaths will work in conjunction with your medical team. This means your dietary plan will not undermine your medical treatment but will work in conjunction with it.
