The Top Foods to Avoid with PCOS
and What Foods to Eat Instead

Written by: Dr. Ashley Eskew MD, MSCI

Edited by: Dr. Will Haas, MD, MBA

Last updated: January 31st, 2022

Harmful PCOS Foods

As you probably know, there’s an overwhelming amount of well intended yet misguided information on the internet when it comes to the best diets for PCOS. 

Recommendations that often lead to more questions than answers… 

Should you avoid gluten… ? Refined sugar… ? Alcohol… Dairy? 

Should you go vegan or vegetarian?

What about keto? 

At OvulifeMD, we are big believers in adopting a diet and lifestyle that:

Doesn’t require cutting out entire food groups

Makes YOU feel good

✔ Is backed by real facts and evidence

Improves your PCOS symptoms

✔ And is sustainable 

So with that, let’s dive in!

Here’s a quick overview of what you’ll discover: 

How Diet Affects Polycystic Ovary Syndrome

Polycystic ovarian syndrome (PCOS) is a complex condition that impacts everything from fertility to egg quality to metabolism to mental health – all of which often go undiagnosed or unaddressed until women have difficulties trying to conceive.

And while all the mechanisms that contribute to the vast and variable constellation of symptoms with PCOS are not fully understood, chronic inflammation has emerged as a common theme (1). Additionally, scientists know that hyperinsulinemia and insulin resistance are central to the pathophysiology of PCOS. In fact, nearly 40-50% of women with PCOS also have some sort of insulin resistance (2).  

It only stands to reason that the best diet for PCOS is one that lessens the vicious cycle of elevated blood sugar → elevated insulin → insulin resistance → elevated androgens.

Side effects of PCOS

So at this point, you might be asking, “which foods should I avoid to help keep my inflammation levels low and my blood sugar balanced?

Okay maybe you’re not thinking exactly that… but maybe more of “whats the best diet for PCOS?” so let’s explore which foods can worsen and improve PCOS.

Foods to Avoid with PCOS

Pro Inflammatory Foods

Pro-inflammatory foods including foods that are higher in trans-fat such as pre packaged baked goods (cookies, cakes, sweet rolls, etc.), frozen pizzas, fried foods (french fries, doughnuts, fried chicken, etc.) and powdered non-dairy coffee creamer have been associated with a higher risk of ovulatory infertility (3). Sadly, htis is much of what makes up the traditional Western diet.

Beyond that, trans-fats also raise your bad cholesterol, lower your good cholesterol, and increase your risk of type 2 diabetes mellitus. As women with PCOS are already at a higher risk for cardiovascular disease, metabolic syndrome and insulin resistance are definitely something we don’t want to add to the mix (4, 5).

Bottom line, foods that contain trans fats are definitely at the top of the list of foods to avoid for PCOS! You can find specific information about trans fats on your nutrition label, so be sure to check that out before consuming. Other pro-inflammatory foods to avoid include refined carbohydrates, sugary drinks and processed foods. We’ll dive a little deeper into each of these below.

Foods High in Refined Carbohydrates

Refined carbohydrates (or simple carbohydrates) are primarily found in foods that have been processed to remove most of the other nutrients they naturally contain like bran and fiber. These commonly include foods like white bread, white flour, white rice, pizza dough, pastas and actually many breakfast cereals (again, staples in the Western diet).

These ‘simple’ carbs are appropriately named as the body quickly digests them resulting in high glucose (blood sugar) and insulin spikes. You know that ‘post carb crash’ you’ve felt after a quick snack? You’re feeling the effects of simple carbs on your body there.

Simple, refined carbs have been associated with insulin resistance, elevated cholesterol levels, and metabolic syndrome – conditions that a female patient with PCOS is already at a higher risk for (6, 7, 8).  Higher intake of simple carbs has also been associated with a higher risk for ovulatory infertility and lower IVF success rates (9, 10).

When looking at studies that simply altered JUST the quality of carbohydrate consumed as a part of diet (not calorie restricting in any way), data has shown that increased intake of low glycemic load carbohydrates in women with PCOS has resulted in (11):

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    • Improved insulin sensitivity
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    • Higher percentage body weight lost
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    • Improved menstrual regularity
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    • Improved emotion and quality of life scores

Take home message… An occasional carb-rich treat is certainly OK in any diet– but for the most part swapping out simple or refined carbohydrates for whole grains and those naturally rich in fiber and antioxidants is the best choice for a delicious and sustainable PCOS diet.

Sugary Snacks and Drinks

Everyone loves to satisfy a sweet tooth, right? 

No matter your favorite indulgence, it’s important to remember that the highest sugar intake doesn’t always come from what we eat, but from what we drink.

One of the top ingredients in most sodas (second to carbonated water of course) is high-fructose corn syrup (i.e., sugar). High-fructose corn syrup, as well as other sweeteners, can wreak havoc on your body by spiking your blood sugar and driving up insulin levels which over time can contribute to insulin resistance – something that’s central to worsening symptoms in PCOS and increasing the risk of type 2 diabetes even further.

Consumption of as little as one sugar-sweetened soda per day has been associated with a 25% reduced fecundability (probability of getting pregnant in a single menstrual cycle) for females (12). And as little as one serving per day has been associated with poorer IVF outcomes as well, including a 12% reduction in cycles resulting in a live birth (13).

We aren’t just calling out soda here… Other sugar-sweetened beverages like sweet tea and ‘fruit juice’ should also be avoided. 

And in terms of sugary snacks, consume them sparingly. Eating an occasional cookie or scoop of ice cream here and there is fine… just be mindful of what you reach into the cabinet for most often. Opt for snacks that have naturally occurring sugars (e.g., berries), but avoid foods with unnecessary added sugars. Many labels will read ‘no added sugar’ which is helpful, but looking at the ingredients label to see how much sugar is contained in one serving size is equally important for optimizing a PCOS diet.

Foods to Eat with PCOS

Antioxidant-Rich Produce

Fruits and vegetables are at the base of our fertility foods pyramid… which means we should eat the most of them! Naturally rich in antioxidants, phytonutrients and fiber produce provides much in the way of nutrients while leaving out all the extra additives. They make a great base for meals, are filling and help reduce inflammation. 

Not a “fruits and veggies” person? Well, long gone are the days of the mushy, wilted tasteless vegetables we were forced to eat as children (anyone else?). Look for different fun ways to prepare vegetables to make them a staple in your diet. Add in new spices and seasonings… or maybe throw them on the grill for different flavor. You can find some great recipes for free online (one of our favorite ways to explore new dishes) or reference your favorite cookbook.

However you choose to incorporate them just make sure you do as a part of your PCOS diet!

Plant Based and Seafood Sources of Protein

In general eating a diet higher in protein and complex carbohydrates has been most consistently associated with improved outcomes in women with polycystic ovary syndrome… including everything from improved menstrual cycle regularity to improved quality of life and lower anxiety and depression scores (14).

When looking at the specific type of protein consumed researchers have found that a diet with increased intake of plant based proteins (like beans, nuts, legumes, tempeh, tofu etc)  has been associated with a lower risk of ovulatory infertility. Simply replacing 25 grams of animal protein with 25 grams of plant protein was associated with a 50% lower risk of ovulatory infertility… which is huge (15)!

And although data looking at the types of protein consumed and outcomes in women with PCOS specifically is lacking, other research has shown that couples who consumed an average of 2 servings of seafood per week in a given menstrual cycle had a 60% shorter time to pregnancy as well as a 13% lower incidence of infertility compared to couples who consumed one or fewer seafood servings during the same period (16). Yes, these findings remained significant even after controlling for intercourse frequency.

More recently, findings from the Environmental and Reproductive Health (EARTH study) showed that women who adhered to a “Pro-Fertility Diet” characterized by increased protein intake from seafood and soy (along with a few other healthy dietary habits) had a 43% higher chance of clinical pregnancy and a 53% higher chance of a live birth following IVF (10).

And not to worry, despite what you read on the internet… a diet with moderate tofu and soy consumption won’t mess with your estrogen levels. Plant based sources of protein are also naturally packed with those antiinflammatory antioxidants, phytonutrients and fiber while many seafood sources of protein are rich in anti-inflammatory omega-3 fats (more on that in a moment). And we’re not saying that you have to be a vegetarian or pescaterian, but swapping out just a few servings of chicken, turkey or beef a week in favor of eating plants and seafood as a part of your PCOS diet can make a big impact!

So go ahead and add plant based proteins and seafood to the PCOS list of foods to eat.

Healthy Fats

Fats are not the enemy! 

And just like carbs, not all fats aren’t created equal. Fats are essential for our body and brain to function appropriately and to help us absorb important vitamins like vitamin A, D, E and K… which means it comes down to not eliminating, but simply eating the healthy types of fat!

In contrast to increased intake of the proinflammatory, trans-fats mentioned above, data from the Biocycle study has shown that women who consumed the highest amounts of omega-3 fats had a 58% reduced risk of anovulation and higher serum luteal progesterone levels (the hormone that increases after ovulation and supports pregnancy) (17).

Examples of healthy anti-inflammatory omega-3 fats include things like fatty fish (e.g., salmon, mackerel, herring, etc.), or nuts and seeds including chia and hemp seeds (a staple for our Fertility Boosting Smoothie recipes). Avocados, avocado oil , nd olive oil are other great sources of healthy monounsaturated fatty acids which can be added to almost any dish in our opinion 🙂

Other Changes to Help Your Symptoms

Beyond eating a well balanced diet that’s rich in anti-inflammatory fats, whole grains, and plant-based or seafood sources of protein, any amount of physical activity can be beneficial in terms of improving PCOS symptoms as well.

While the specific type of exercise is up for debate, it’s important to note that studies have consistently shown that dietary changes alone OR dietary changes plus exercise produce better health outcomes than JUST exercise alone (18). In fact, exercise combined with dietary changes can result in:

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    • Improved insulin sensitivity
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    • Reduced inflammation levels
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    • Reduced risk of heart disease

And even though it’s not about a number on the scale, small amounts of weight loss (5-10% of your body weight) in those with a body mass index (BMI) > 25 kg/m2 can make a significant difference in PCOS outcomes. No matter your weight loss goals, we recommend that you tap into how you feel. A regular exercise routine has been associated with a whole host of mood boosting benefits as well.

Finally, adding a prenatal vitamin with folic acid (even if you’re not actively TTC) can be beneficial for reproductive health as well. And if you’re looking for a deeper dive on supplements, we’ve got you covered in another post on PCOS Supplements That Deserve a Closer Look

When to See a Fertility Specialist

One of the most common questions we  get is “when should I see a fertility specialist?

It’s a GREAT question!

Infertility is typically defined by having regular unprotected intercourse without conceiving for one year in women 35 years of age or younger OR for more than 6 months among women 35 years or older.

Do you have to wait that long to make an appointment?

Absolutely not.

If your cycles are irregular or you have a known diagnosis of PCOS, make an appointment as soon as you decide you want to start trying. 

Even if you’re not trying to conceive and you have irregular periods, or other symptoms like bothersome male type hair growth, cystic acne or hair loss or are concerned about PCOS, it’s good to go ahead and make an appointment so you have appropriate baseline testing and a better understanding of treatment options.

Final Thoughts on Food and PCOS

More than focusing on what foods to avoid with a PCOS diet we want you to focus on all the food you CAN and should eat. Choosing a diet that is rich in complex, low glycemic load carbohydrates, fruits, and vegetables, plant-based proteins and healthy fats have been associated with favorable outcomes in women with PCOS including:

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    • Weight loss
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    • Menstrual regularity
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    • Decreased androgen levels
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    • Improved quality of life
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    • Improved reproductive outcomes
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    • Improved general health outcomes

And although we say “diet” we really want you to focus on nourishing foods and  eating patterns NOT dieting in this traditional sense of the word. This is a lifestyle change, not a short-term fix. Let’s make it count!

With Love & Empowerment,
Dr. Ashley Eskew and Dr. Will Haas

P.S. Be sure to check out our prior posts for a deep dive on how to accurately diagnose PCOS

References:

  1. Riley JK, Jungheim ES. Is there a role for diet in ameliorating the reproductive sequelae associated with chronic low-grade inflammation in polycystic ovary syndrome and obesity? Fertil Steril. 2016;106:520-7.

  2. McCartney CR. Clinical Practice. Polycystic ovary syndrome. N Engl J Med. 2016;375:54-56.

  3. Chavarro JE, Rich-Edwards JW,  Rosner BA, Willett WC. Dietary fatty acid intakes and the risk of ovulatory infertility. Am J Clin Nutr. 2007;85(1):231-7.

  4. Dumesic DA. et al, Scientific statement on the diagnostic criteria, epidemiology, pathophysiology, and molecular genetics of polycystic ovary syndrome. Endocr Rev. 2015;36:487-525.

  5. Wild RA. et al. Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society. J Clin Endocrinol Metab. 2010;95:2038-49.

  6. Willett W., Manson J., Liu, S. Glycemic index, glycemic load, and risk of type 2 diabetes. Am J Clin Nutr. 2002;76(1):274S-80S.

  7. Parks, EJ. Effect of dietary carbohydrate on triglyceride metabolism in humans. J Nutr. 2001;131(10):2772S-2774S.

  8. McKeown NM, Meigs JB, Liu S, Saltzman E, Wilson PWF. Carbohydrate nutrition, insulin resistance, and the prevalence of the metabolic syndrome in the Framingham Offspring Cohort. Diabetes Care. 2004;27(2):538-46.

  9. Chavarro JE, Rich-Edwards JW, Rosner BA, Willett WC. A prospective study of dietary carbohydrate quantity and quality in relation to risk of ovulatory infertility. Eur J Clin Nutr. 2009;63(1):78-86.

  10. Gaskins AJ, Nassan FL, Chiu Y, Arvizu M, Williams PL, et al. Dietary patterns and outcomes of assisted reproduction. Am J Obstet Gynecol. 2019;220(6):567.e1-567.e18.

  11. Marsh KA. et al. Effect of a low glycemic index compared with a conventional healthy diet on polycystic ovary syndrome. Am J Clin Nutr. 2010;92:83-92.

  12. Hatch EE, Wesselink AK, Hahn KA, Michiel JJ, Mikkelsen EM, Sorensen HT, Rothman KJ, Wise LA. Intake of sugar-sweetened beverages and fecundability in a North American preconception cohort. Epidemiology. 2018;29(3):369-378.

  13. Matchinger R, Gaskins AJ, Mansur A, Adir M, Racowsky C, Baccarelli AA, Hauser R, Chavarro JE. Association between preconception maternal beverage intake and in vitro fertilization outcomes. Fertil Steril. 2017;108(6):1026-1033.

  14. Moran LJ, Noakes M, Clifton PM, Tomlinson L, Galletly C, Norman RJ. Dietary composition in restoring reproductive and metabolic physiology in overweight women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2003;88(2):812-9.

  15. Chavarro JE, Rich-Edwards JW, Rosner BA, Willett WC. Protein intake and ovulatory infertility. Am J Obstet Gynecol. 2008;198(2):210.e1-7.

  16. Gaskins AJ, Sundaram R, Buck Louis GM, Chavarro JE. Seafood intake, sexual activity and time to pregnancy. J Clin Endocrinol Metab. 2018;103(7):2680-2688.

  17. Mumford SL, Chavarro JE, Zhang C, Perkins NJ, Sjaarda LA et al. Dietary fat intake and reproductive hormone concentrations and ovulation in regularly menstruating women. Am J Clin Nutr. 2016;103(3)868-877.

  18. Nybacka A, Carlstrom K, Stahle A, Nyren S, Hellstrom PM, Hirschberg AL. Randomized comparison of the influence of dietary management and/or physical exercise on ovarian function and metabolic parameters in overweight women with polycystic ovary syndrome. Fertil Steril. 2011;96(6):1508-13.

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