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PCOS Diet Plans: Managing Symptoms and Improving Health via Nutrition

Jessica Joseph, RN, BSN, MHA
June 14, 2023
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Polycystic ovarian syndrome (PCOS) is a complex condition that affects female fertility. Healthcare providers refer to the Rotterdam scale to make a diagnosis of PCOS when patients meet 2 of the 3 following criteria:


  • History of amenorrhea or irregular periods (lack of period and lack of ovulation)

  • Polycystic ovaries were seen on ultrasound

  • Blood work to test for hyperandrogenism (high levels of male hormones)


Treatment providers might also look at other blood work, including fasting lipid panel (cholesterol and triglycerides), AMH levels, glucose, insulin, and hemoglobin A1C. 


Guided Fertility™ interviewed Lisa Dreher, MS, RDN, LDN, for her professional standpoints on PCOS diet plans and management with nutrition.  Ms. Dreher is a functional medicine registered dietitian with over a decade of experience. She is the director of nutrition at WeNatal, a prenatal company that offers prenatal supplements for both women and men. She is also the senior nutritionist at Dr. Mark Hyman's UltraWellness Center, where she counsels individuals one-on-one and develops on-demand webinars for the public. 

What is the relationship between glucose, insulin, and PCOS?


Glucose, aka blood sugar, must be kept within a healthy range, or it can lead to insulin resistance and an increased risk of developing PCOS. High glucose levels signal the pancreas to produce insulin. Insulin is the key that removes glucose from the blood and brings it into our cells, where it needs to be converted into energy. But if we eat/drink more carbohydrates than our body needs, there won’t be room in the cells for more glucose. Elevated blood glucose signals the pancreas to produce more insulin to compensate. If this continues, our cells become less sensitive to the effects of insulin, known as insulin resistance, and we begin to see a rise in blood insulin levels.


High insulin levels can trigger the ovaries to produce excess testosterone (an androgen). High levels of androgens, known as hyperandrogenism, can lead to dysregulated ovulation, menstrual changes, infertility, excess hair growth, and acne. This is a significant risk factor for developing PCOS. Most women with PCOS have insulin resistance, so high insulin is both a cause and a symptom of PCOS.


How do nutritionists treat PCOS with nutrition?


We cannot “treat” anyone, but we can help address the root causes of PCOS and support hormonal balance through nutrition interventions. Some of my recommendations include:


  • Remove sugar and foods that raise glucose and insulin.

  • Implement portion control and balance macronutrients (fat, protein, and complex carbohydrates).

  • Eat healthy fat and protein with carbohydrates to slow down the conversion of carbohydrates to glucose. Even healthy, unprocessed carbs like fruit, whole grains, legumes, and root vegetables can raise blood sugar and insulin levels if eaten alone or too large a quantity. And some women are so sensitive to carbohydrates that they may require a very low carbohydrate eating plan that limits/removes even complex carbohydrates.

  • Eat balanced meals about every 4 hours during waking hours.

  • Choose organic fruits and vegetables, wild-caught fish, and grass-fed/pastured meat whenever possible to reduce the toxic burden and exposure to endocrine disruptors.

  • Aim for 30-40 grams of fiber daily from whole food and fiber supplementation, such as psyllium husk, if needed.

  • Incorporate time-restricted eating of 12-14 hours between dinner and breakfast the following morning. It’s ideal to stop eating around 7 pm and then break your fast between 7-9 am the next morning. However, excess fasting can worsen hormone imbalances, so I discourage fasting for too long.

  • Utilize a continuous glucose monitor to determine your sensitivity to various carbohydrates.  Based on these results, a personalized nutrition plan can be devised.


What foods should women with PCOS avoid?


  • Sugar, as well as refined and processed carbohydrates, because these raise glucose and insulin levels the most (bread, pasta, white rice, pastries, cookies, sweetened beverages, etc.).

  • Fried foods and refined oils due to their ability to drive inflammation (soybean oil, corn oil, peanut oil, safflower/sunflower oils, and any fried foods like French fries, potato chips, etc.)

  • Trans fats/hydrogenated oils

  • Dairy: there’s also been a direct relationship identified between milk consumption and an increased risk of developing PCOS. Cow’s milk contains insulin-like growth factor-1 (IGF-1), which is similar to insulin in the human body. The risk of developing PCOS from dairy intake seems to be the highest with low-fat and fat-free dairy.

  • Alcohol should be minimized or avoided if possible

  • Caffeine should be minimized or avoided if possible


In terms of supplements, what would you recommend women with PCOS take to improve fertility?


Supplements are not regulated, so it’s important to look for companies that do 3rd party testing, test for toxins/impurities, and have a certificate of analysis (COA) that they are willing to share when asked.  Supplements I would recommend are:


  • Myo and D-chiro-inositol

  • Magnesium

  • Vitamin D3

  • Methylated B vitamins, especially B12, and folate

  • Chromium

  • Zinc

  • Ideally, a comprehensive multivitamin/mineral or prenatal supplement that includes some or all of the above

  • EPA and DHA omega-3 fatty acids



Are there herbs that can improve PCOS and or promote ovulation?


Herbs are generally safe, but again they are not regulated, and you need to do your due diligence in finding the highest quality options. It’s a good idea to talk with your healthcare provider to ensure these herbs are safe and do not interact with any medications you might be on. Herbs that help fertility are:


  • Chaste Tree, or Chasteberry

  • Red clover

  • Maca

  • Licorice root



Besides diet, what other factors should women with PCOS focus on to promote fertility? 


It’s essential to address and manage stress because of its impact on our adrenal glands and the secretion of hormones like cortisol. Chronically elevated cortisol can increase blood sugar and insulin levels; even with the proper diet, stress can raise these levels independently. Finding stress management practices that work for you, like meditation, yoga, journaling, etc., and prioritizing sleep is critical.


It can also help to cut down or eliminate caffeine (coffee, caffeinated teas, chocolate, etc.) if it’s not already taken out because caffeine can trigger the “fight or flight” response and be its own form of stress on the body.


Exercise regularly, but not too much. Over-exercising can also lead to elevated cortisol and other hormonal imbalances, so make sure you are moving periodically but incorporate enough time for rest and repair. Strength/resistance training and HIIT exercises are great ways to improve insulin sensitivity.

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