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 can help improve PCOS symptoms and 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 genetic, hormonal, metabolic, and reproductive disorder that affects women and is the leading cause of female infertility. PCOS is characterized by meeting at least two of the three criteria below:
- Irregular menstrual periods: Including erratic menstrual cycles and/or lack of ovulation
- Elevated androgen hormones (hyperandrogenism): Including elevated free and/or total testosterone, acne, excess male-like facial hair growth (hirsutism), and/or scalp hair loss/male pattern baldness.
- Polycystic ovaries: Small cysts on ovaries indicated through ultrasound or laparoscopy
PCOS is a diagnosis of exclusion and may take years to confirm as other disorders that mimic PCOS signs and symptoms (like thyroid disease) must be excluded.
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 II diabetes, non-alcoholic fatty 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 key causal components.
What are the signs and symptoms of PCOS?
Individuals with PCOS may experience:
- Irregular menstrual cycles
- Excess facial and body hair (i.e., hirsutism)
- Severe acne/oily skin
- Small cysts on ovaries
- Insulin resistance
- Anxiety and depression
- Infertility/trouble conceiving
- Weight gain
- Male pattern baldness
- Acanthosis nigricans (dark discoloration in body folds and creases typically in armpits, neck, and groin), also known as “skin patches”
- Skin tags
- Imbalanced labs
- 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 promoting weight loss in those with overweight or obesity. Making dietary changes can help individuals with PCOS achieve 5-10% weight loss, control acne, manage excess hair growth, regulate menstrual cycles, lower lipid levels, and improve insulin sensitivity.
A number of weight management medications can also assist in treating PCOS-related obesity and other symptoms. However, if dietary factors are not modified, individuals with PCOS are at an increased risk for type II diabetes, hypertension, hyperlipidemia, and cardiovascular disease. For a deep dive into weight management medications that may be suitable for individuals with PCOS, check out this blog post.
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, a low-glycemic diet, and plant-based diets have been effective in managing PCOS related symptoms including but not limited to PCOS-related weight gain, irregular menstrual cycles, fertility, blood sugar control, and excess body hair. All of these dietary approaches share common themes that make up our recommendations below.
Key PCOS principle: Keep blood sugar steady
Insulin is a hormone that helps regulate blood sugar levels. It allows sugar in the bloodstream to enter the body’s cells to be utilized for energy.
Lots of women with PCOS are less sensitive to the effects of insulin. In people who have this condition (called insulin resistance), the pancreas compensates by making more and more insulin.
Avoiding insulin spikes may help with some of the PCOS symptoms if you have insulin resistance. And the best way to keep your insulin levels in check is to keep your blood sugar within normal range.
Let’s talk about how to do that.
Priority #1: Fill up on fiber from fruits, vegetables & complex carbohydrates
Fiber is a specific type of carbohydrate that passes through the digestive tract mostly undigested. Carbohydrates that contain fiber are called “complex” carbs, while carbs that lack fiber are called “simple” carbs.
Unlike simple carbs, complex carbs 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 25-35 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 surefire 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 ~2 cups of non-starchy vegetables at lunch and dinner is a great starting point for increasing your intake of plant 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 just 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, PCOS patients who followed a high-protein diet lost more weight and more belly fat after six months than women who ate less protein.
This is to say that eating more protein is worth a try if you’re trying to lose weight with PCOS.
Be sure to include a high-protein food—like chicken, fish, lean meats, tofu, beans, Greek yogurt, cottage cheese, eggs, nuts, and seeds—at every meal and snack. For most individuals, aiming for a minimum of 20-30 grams of protein with meals and 5-15 grams of protein with snacks is a good starting point. And, for individuals who wish to lose weight, aiming for 1.2-1.5 grams per kilogram of bodyweight may provide a good daily target. (If you’re a member here at Sequence, be sure to check with your Registered Dietitian about your unique protein needs.)
Priority #3: Limit added sugar & processed carbohydrates
Sugary foods and drinks increase blood glucose levels more rapidly than other foods, which only leads to more insulin production.
Limiting added sugars will help keep your blood sugar and insulin levels under control (and cut out some low-nutrient calories in the process!) and reduce inflammation
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 6% of your daily calories, or about 25 grams per day, for the average female, for weight loss and optimal 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
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 steady and prevents cravings or increased hunger that can result from intense 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 sugary foods can lead to blood sugar spikes, so can eating lots 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 all day and 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. For additional guidance, check out our blog post on how to craft a balanced, healthy meal.
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. Omega-3 fatty acids—a particular type of polyunsaturated fat—reduce pro-inflammatory proteins, increase insulin sensitivity, and reduce the synthesis of LDL (i.e., “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 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, as other plant forms of omega-3 fatty acids (like chia seeds, hemp seeds, or walnuts) may be harder to convert to the form that is most biologically available to the body.
Other heart healthy fats beyond those that are rich in omega-3 fatty acids includes 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 balance. 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 “moderate?” A moderate amount of alcohol is ~1 drink per day for women. As always, consult with your physician for individualized medical advice.
Create a natural 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 strategies listed below may help create a natural calorie deficit.
- Eat more lean protein, fruits, vegetables, and less processed foods - these typically have fewer calories while providing more healthy nutrients.
- Swap 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 Balanced 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, tea, and water infusions; instead of having a smoothie or green juice, have a salad or a piece of fruit.
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, which has been shown to promote sustained long-term weight loss.
Move Your Body
Exercise can support weight loss by increasing your daily calorie burn, of course. But there’s another reason why PCOS patients who want to lose weight should work out more.
Once again, it comes down to 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 sugar from the blood 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, including 90 minutes of intense physical activity. For best results, you’ll also want to incorporate at least two resistance training sessions per week.
Prioritize self care
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. Check out these blog posts on sleep and stress for more tips.
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 keeping the blood sugar stable, eating plenty of protein, moving your body, and medications can help.
But having a support system also increases the odds of successful and sustainable weight loss, and we’d love to help with that!
Our program 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.
Click here to learn more about improving your total health with Sequence.
For more on PCOS, check out these blog posts:
- If you have PCOS, these weight management medications may help featuring an overview of PCOS and medications that may help treat PCOS-related obesity
- Weekly meals for PCOS featuring strategies for building a PCOS friendly plate and weekly meal inspiration
- PCOS and metabolic syndrome featuring an explanation of the link between these conditions