This post has been updated since it was originally published on 12/15/22 by contributor Ali McGowan, MS, RD, LDN.
If you’re curious about the best nutrition for individuals with polycystic ovary syndrome (PCOS) who want to lose weight, you’re not alone! By some estimates, up to 88% of women with PCOS have overweight or obesity. Losing even a few pounds may help improve PCOS symptoms and can lower your risk for chronic health problems like diabetes, heart disease, and cancer. In this post, we’ll cover evidence-based diet strategies to help manage PCOS symptoms and promote sustainable weight loss, which in turn may improve overall quality of life.
What is PCOS?
PCOS is a common health problem that impacts women and is caused by an imbalance of reproductive hormones. It is one of the leading causes of female infertility.
PCOS is a diagnosis of exclusion. This means other conditions must be ruled out first before PCOS can be diagnosed. This can mean it may take a long time to confirm a PCOS diagnosis, since other conditions that mimic PCOS si gns and symptoms (like thyroid disease) must be explored and excluded first.
Once other conditions are excluded, you may be diagnosed with PCOS if two of the following are met:
- You have irregular periods, including periods that come too often, not often enough, or not at all.
- You have signs of high androgen levels, which can come from:
◦ Extra hair growth on your face, chin, and body (this is referred to as hirsutism)
◦ Acne
◦ Thinning of scalp hair
- Higher than normal levels of androgen in the blood
- Multiple cysts on one or both ovaries
PCOS can lead to lifelong complications and other conditions and morbidities, including anxiety, depression, eating disorders (particularly binge eating disorder), obesity, impaired fasting glucose, type 2 diabetes, non-alcoholic liver disease, cardiovascular disease, metabolic syndrome, obstructive sleep apnea, infertility, and endometrial cancer.
While the exact causes of PCOS are unknown, insulin resistance and inflammation appear to be involved.
What are the signs and symptoms of PCOS?
Individuals with PCOS may experience:
- Irregular menstrual cycles
- Excess facial and body hair (i.e., hirsutism)
- Acne on face, chest, and upper back
- Thinning hair or male pattern baldness
- Obesity, weight gain, and/or difficult losing weight,
- Small cysts on ovaries
- Insulin resistance
- Anxiety and depression
- Infertility/trouble conceiving
- Darkening of skin, particularly in body folds and creases typically in armpits, neck, and groin (this is called Acanthosis nigricans)
- Skin tags (small excess flaps of skin typically in the armpits or neck area)
- Hunger after eating
Can nutrition help with PCOS?
The short answer, yes! While there is no cure for PCOS, nutrition should be the first intervention for managing signs and symptoms of PCOS like insulin resistance and to aid in weight loss in those with overweight or obesity. Making appropriate dietary changes can help individuals with PCOS achieve 5-10% weight loss, improve insulin sensitivity, and lower lipid levels, while also aiding in the following: controlling acne, managing excess hair growth, and regulating menstrual cycles.
Additionally, a number of medications, including metformin and other weight-management medications such as a GLP-1, can also assist in treating PCOS-related obesity and other symptoms. However, if dietary factors are not modified as well, individuals with PCOS are at an increased risk for type 2 diabetes, high blood pressure (also called hypertension), high cholesterol and other blood lipid abnormalities (also called hyperlipidemia), and cardiovascular disease.
What’s the best diet for individuals with PCOS who want to lose weight?
The best nutrition plan is a nutrient-rich diet you can follow long-term without feeling deprived. While there is no one “perfect” diet for PCOS, research shows that a number of dietary approaches including the DASH diet, the Mediterranean diet, and plant-based diets have been effective in managing PCOS-related symptoms. All of these dietary approaches share common themes that make up our recommendations below.
Key PCOS principle: Aim for a healthy diet that minimizes blood sugar spikes
Any food with calories turns into energy for the body. The main source of this energy comes from carbohydrates, which the body breaks down into glucose (sometimes this is referred to as just sugar). This glucose or sugar is what the body’s cells use for energy inside the cell. However, this glucose first enters the bloodstream before it enters the cells. Insulin is an important hormone made by the pancreas that is involved in getting glucose out of the bloodstream and into cells. Insulin serves as the key that unlocks the cell to let the glucose from the bloodstream in. Remember, the glucose is used inside the cell for energy.
Lots of women with PCOS are less sensitive to the effects of insulin. This condition is referred to as insulin resistance. In people who have insulin resistance, the pancreas compensates by making more and more insulin.
Trying to minimize large insulin spikes may help with some of the PCOS symptoms if you have insulin resistance. And the best way to avoid large insulin spikes is to follow a healthy diet.
Let’s talk about how to do that.
Priority #1: Fill up on fiber from fruits, vegetables, and complex carbohydrates
Fiber is a specific type of carbohydrate that passes through the digestive tract mostly undigested. Carbohydrates that contain fiber are often referred to as “complex” carbohydrates, while carbohydrates that lack fiber are often referred to as “simple” carbohydrates.
Unlike simple carbohydrates, complex carbohydrates have a stabilizing effect on blood sugar and insulin levels, and even support a healthy gut microbiome, which may improve PCOS symptoms.
Not only does fiber slow how quickly we digest our food, it also adds volume to our meals, helping us to get and stay fuller for longer. As a result, adding more fiber to your diet can help you to eat less food overall.
And, if you’re like most women with PCOS, you may not be getting the recommended 25-30 grams per day.
You can boost your fiber intake by eating more non-starchy vegetables like asparagus or broccoli, beans, legumes, lentils, sweet potatoes, whole grains, fruit, berries, artichokes, avocados, oats, almonds, and other fiber-rich foods. Focusing on fiber-rich foods that you enjoy (versus forcing foods you dislike) is a great way to increase your intake.
Beyond fiber, fruits and vegetables are rich in phytochemicals, which are plant compounds that also assist in insulin sensitivity. Aiming for around two cups of non-starchy vegetables (or 1 ⁄ 2 of your plate) at lunch and dinner is a great starting point for increasing your intake of these foods.
Priority #2: Eat protein at every meal and snack
Protein helps you feel fuller and more satisfied at meals and snacks, and it also helps slow down the absorption of sugar into the blood.
Current dietary guidelines call for just 0.36 grams of protein per pound of body weight per day, which is 72 grams for a person who weighs 200 pounds.
But several clinical trials have found that protein intakes higher than the recommended daily allowance are optimal for weight loss in adults with obesity.
There aren’t many studies that have looked at high-protein diets for weight loss with PCOS, specifically. But in one small study, xIn general for weight loss, we recommend consuming at least 1 to 1.5 grams of protein per kilogram of body weight.
Lean protein is key here. Some high protein foods also come with a lot of fat, which means excess calories, so we recommend leaner protein options. This includes things like skinless poultry, fish, lean beef and pork, tofu, beans, non-fat and low-fat dairy such as Greek yogurt and cottage cheese, eggs, nuts, and seeds. To get enough protein, we recommend eating these at most meals and snacks. For most individuals, aiming for a minimum of 30-40 grams of protein with meals and 10-15 grams of protein with snacks is a good starting point.
Priority #3: Limit added sugar & processed carbohydrates
Sugary foods and drinks increase blood glucose levels more rapidly than other foods, which can lead to more insulin production.
Limiting added sugars will help keep your blood sugar and insulin levels from spiking too much. Plus, limiting these will help cut out low-nutrient calories in the process further aiding in weight loss!
You can find out how much sugar is in packaged foods by looking at added sugars on the food labels. It’s also safe to assume that most baked goods contain sugar, so it’s best to save those for special occasions.
The American Heart Association recommends limiting added sugars to about 25 grams per day (which is about 100 calories from added sugar), for the average female. This will aid in weight loss, but also optimize health.
Some examples of simple swaps for reducing your intake of added sugars include:
- Choosing a piece of fruit or adding a splash of fruit juice to sparkling water instead of drinking juice
- Swapping store bought dressings for homemade vinaigrettes
- Opting for homemade snacks that are rich in fiber and complex carbohydrates
- Opting for zero calorie beverages (such as water, sparkling water, unsweetened beverages and diet drinks) instead of sugar-sweetened beverages (like juice, sweetened iced teas and coffees, and regular soda)
Priority #4: Keep your carbohydrate intake consistent instead of eliminating carbohydrates
Spreading your carb intake evenly throughout the day facilitates weight loss by keeping your blood sugar and insulin levels relatively steady and prevents cravings or increased hunger that can be caused from larger blood sugar swings. The secret to reducing your carb cravings isn’t to eliminate carbs, but rather to focus on fiber-rich versions and incorporate them consistently throughout your day.
Just as foods higher in sugar can lead to larger blood sugar spikes, so can eating a lot of carbs in one sitting — even if they’re healthy carbs like fruit and whole grains.
This might happen if, for example, you avoid carbs for breakfast and lunch but consume a large serving of carbs at dinner. Or, if you eat a carbohydrate-rich breakfast and stick to protein and fat for the rest of your meals.
A good rule of thumb is to stick with a small-to-moderate portion (or about 1 cup or 1 fistful) of complex carbohydrates at each meal, rather than eating large portions of carbs sporadically throughout the day.
Priority #5: Focus on heart-healthy fats
Research suggests that individuals with PCOS may have a different reaction to saturated fats than individuals without PCOS, and that the consumption of saturated fats may worsen inflammation in women with PCOS. This effect may be even greater in women with PCOS who also have obesity.
While this research is still emerging, there is strong evidence that suggests the consumption of heart-healthy fats, particularly omega-3 fatty acids, have a beneficial effect on PCOS symptoms, as well as generally supporting other areas of health, such as heart health. Omega-3 fatty acids—a particular type of polyunsaturated fat—reduce pro-inflammatory proteins, increase insulin sensitivity, and reduce the body’s creation of LDL (the “bad”) cholesterol. In one study, supplementation of omega-3 fatty acids for six months decreased lipid profiles and waist circumference in women with PCOS. Consuming two 4-ounce servings of fatty fish (like salmon, trout, or tuna) per week is enough to meet your omega-3 needs. Sea algae and algal oil are also great sources for vegans, vegetarians, or individuals who are allergic to fish. Other plant forms of omega-3 fatty acids (like ground flaxseeds or flaxseed oil, chia seeds, hemp seeds, or walnuts) are also good plant-based omega-3 options, but these are harder to convert to the form that is most biologically available to the body, so more of them is often needed.
Other heart-healthy fats beyond those that are rich in omega-3 fatty acids include avocados, olive oil, nuts, and seeds.
Priority #6: Be mindful of alcohol
A number of studies have suggested that alcohol may impact how the body processes the hormone estrogen and may lead to increased estrogen levels. Women with PCOS may experience imbalances in the ratio of the hormones estrogen to progesterone and research suggests that alcohol intake may further aggravate this imbalance. Moreover, alcohol also interferes with blood sugar levels. Moderate amounts of alcohol can increase blood sugar, while excessive amounts can have the opposite effect and lead to abnormally low blood sugar levels.
Since many women with PCOS are insulin resistant, alcohol consumption may further worsen insulin resistance. If you have PCOS and enjoy alcohol, do so in moderation and be sure to consume alcohol with a balanced meal that has plenty of protein, fiber, and healthy fats. What is considered “moderate?” A moderate amount of alcohol is around 1 drink per day for women. As always, consult with your physician for individualized medical advice.
Make it easier to create a calorie deficit
While weight loss requires a calorie deficit, we know that the advice to “eat less, move more” isn’t effective and doesn’t consider every part of the calories-in versus calories-out equation.
While many of the strategies listed above—like prioritizing protein and fiber, balancing blood sugar, and limiting alcohol intake—will aid in weight loss, the additional strategies below may help you further create a calorie deficit.
- Eat more lean protein, fruits, and vegetables, and less highly refined foods. Lean protein, fruits, and vegetables typically have fewer calories while providing more healthy nutrients and fiber (in fruits and vegetables), which aids in keeping you fuller longer.
- SSwap in complex carbohydrates and whole grains for your starch. Complex carbs and whole grains have more fiber and nutrients than processed carbohydrates and tend to be more satisfying, even in smaller portions.
- Reduce your intake of high-fat foods and high-fat cooking methods, which can be a source of significant calories. Examples include creamy soups and sauces, breaded and fried foods, fatty meat (red meat, salami, skin-on poultry), cheese in large quantities, and butter or cream-based dishes.
- Pay attention to your portions. Start with a small 7” dinner plate and fill it up with 50% vegetables, 25% protein, and 25% carbohydrates. We refer to this as the Plate Method and love that it provides structure to meals and promotes healthy dietary patterns without requiring intense calorie or macro tracking.
- Practice mindful snacking. Have healthy snacks conveniently available and aim to include a source of protein and fiber like an apple with a pack of almonds or a cheese stick. Portioning snacks from the start can increase awareness and prevent overeating. For example, eating straight out of a bag of chips may reduce our ability to estimate how much we eat, while eating from a bowl increases awareness of our portion sizes.
- Reduce your beverage calories. Beverages typically don’t satisfy hunger the way solid food does, which makes it very easy to consume a lot of calories without noticing. Replace sodas and juices with seltzers, unsweetened tea, and water infusions; instead of having a smoothie or green juice, have a salad or a piece of fruit. If opting for a smoothie, opt for one that includes protein, non-starchy vegetables, and only a handful of fruit or one piece of fruit, and a low-calorie liquid like water, unsweetened nut milk, or skim or low-fat cow’s milk.
- Utilize our app and program to guide you! The Points program is designed to help create a calorie deficit when you’re consistently within your daily plus weekly budget. Our Points system and ZeroPoint® foods simplifies the nutritional panel of foods to guide you into creating a calorie deficit. Plus, you’ll find additional support and community in our app and workshops. For those taking a GLP-1 medication, using our GLP-1 program can ensure you’re consuming enough protein, fruits, vegetables, and water to aid in healthy weight loss.
These changes shouldn’t leave you feeling deprived or hungry, and they make a big impact over time. Because these changes aren’t extreme, weight loss will be slower and steady. The good news is this slow and steady approach has been shown to help keep the weight off long-term.
Move Your Body
Exercise can support weight loss by increasing your daily calorie burn, of course. But there’s another reason why those with PCOS who want to lose weight should work out more.
Once again, it comes down to the hormone insulin.
Your muscles need energy to fuel your workouts. And exercise makes your body more sensitive to the effects of insulin, allowing your muscles to pull more glucose or sugar from the blood into the cells for energy.
The insulin-sensitizing benefits of exercise appear to last long after your workout ends. By some estimates, your body uses insulin more effectively for 16 hours or more after intense exercise!
If you don’t already work out, build up to at least 150 minutes of moderate-intensity aerobic exercise per week. For best results, you’ll also want to incorporate at least two resistance training sessions per week. Resistance training has the additional benefit of helping you maintain more lean muscle mass during your weight-loss journey, so it’s a win-win!
Prioritize self care
Other aspects of self care, such as sleep, stress management, and social support, are also essential for women with PCOS.
Evidence suggests that the synthesis of melatonin—a hormone our body releases when it’s time to wind down—may be reduced in women with PCOS and that sleep disorders can intensify the pathways associated with insulin resistance. Aim for a minimum of 7-8 hours per night. Moreover, stress may worsen PCOS symptoms as it stimulates the adrenal glands and may contribute to already increased levels of androgens in the body. Depression and anxiety are common in women with PCOS due to the distressing nature of the condition, and social support may ease these effects. Setting boundaries, prioritizing your mental and physical health, and staying connected to loved ones can improve PCOS symptoms and overall quality of life.
Medications may help
Staying in a calorie deficit is challenging, and obstacles like food cravings and hunger certainly don’t make it easier.
A handful of studies have linked PCOS with hormone imbalances that can increase food cravings and hunger levels while decreasing satisfaction after meals.
Medications like GLP-1s can help lower the appetite and reduce food cravings, making weight loss easier and more attainable for those with PCOS.
Need help losing weight with PCOS?
The hormone changes that occur with PCOS can make weight loss feel even more overwhelming and challenging.
Staying in a calorie deficit is important, and other approaches like preventing large blood sugar spikes, eating plenty of protein, moving your body, and medications can help.
Additionally, having a support system also increases the odds of successful and sustainable weight loss, and we’d love to help with that!
The WeightWatchers Clinic includes a team of physicians, trainers, and registered dietitians committed to helping you reach your weight loss goal and a community of individuals who are on similar journeys.