Nutritional Interventions for PCOS

by , | January 14, 2024 | Articles, Hormone Health, Nutrition

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Written by Lindley Wells; Select sections of article written by and article reviewed by Dr. Bojana Jankovic Weatherly.

Upon receiving a PCOS diagnosis there are many different approaches that can be taken to manage the condition. However, in order to best address your specific needs, an individualized treatment approach is critical to long term success and healing. An approach that implements nutritional, lifestyle, supplemental and pharmaceutical interventions in an evidence-informed, personalized manner, is the optimal way to manage PCOS. Below is a starting place for nutrition recommendations that may be helpful for those with PCOS. We recommend you discuss your specific needs and symptoms with your doctor to ensure the best and most individualized treatment.

PCOS is characterized by low grade inflammation and multiple studies have found women with PCOS have elevated circulating CRP (C reactive protein) which is a marker for inflammation.[i] One of the best-known nutritional interventions for those with PCOS is following a diet that lowers inflammation, is low glycemic, supports stable blood sugar, and is rich in healthy fats and protein. We recommend following a Mediterranean-leaning diet, focusing on getting sufficient fiber, eating a variety of vegetables and low glycemic load fruit, incorporating small amounts complex carbs such as legumes and whole grains, eating leaner cuts of animal protein, and keeping red meat, dairy, refined sugar, caffeine, alcohol, and processed foods to a minimum or completely removed from the diet if possible.[ii]

Focusing on fiber and balanced meals (adequate protein, healthy fats, and the appropriate amount of carbohydrates) helps to support and better maintain and improve glucose and insulin levels- both of which are often elevated in individuals with PCOS.  Additionally, focusing on gut health is critical for individuals with PCOS as they generally have much lower diversity in gut microbiota in comparison to control groups.[iii] Studies have found that less diversity in the gut means a reduction in spore forming bacteria, and as a result, an increase in LPS producing bacteria (which can cause acute inflammatory responses and the release of inflammatory cytokines).[iv]

 When building a PCOS-supportive plate, ensure you have:

  • 2-3 cups of non-starchy veggies (think leafy greens and cruciferous veggies)
  • 1-2 tablespoons of healthy fats (olive oil, avocado oil, nuts, and/or seeds) or ¼-1/2 of an avocado
  • 4-6 oz of lean animal protein (roughly the size of your palm)
  • At least one daily serving (1-4 Tbs.) of a fermented food (kimchi, sauerkraut, fermented veggies, miso, etc)
  • Aim for about ½ cup or less of a complex low glycemic carbohydrate per meal (brown rice, sweet potatoes, legumes, etc.)[v]

Some additional nutrition recommendations for those with PCOS are:

Trialing a period with no gluten or low gluten diet. Gluten is associated with low grade inflammation and while there is no direct research showing the necessity of those with PCOS going gluten free, we recommend seeing if a period of removal improves symptoms (specifically inflammation and overall gut health). [vi] [vii]

Additionally, for those who have been consuming dairy, we recommend a period of removal. Hormones can be found in dairy which can have negative impacts on those consuming them.[viii] Dairy consumption can increase IGF-1 levels which are often already elevated in those with PCOS. [ix] Finally, dairy can be inflammatory, lead to more acne, and may increase the risk of insulin resistance.[x] [xi]

Consider removing or significantly reducing alcohol consumption. Alcohol consumption can lead to GI disturbances, inflammation, hormonal imbalances, and dysregulated blood sugar. [xii] [xiii] [xiv]

The following are specific nutrients and foods to focus on that can help alleviate PCOS symptoms and optimize overall health:

Short Chain Fatty Acids (SCFAs) and Fiber

Gut dysbiosis may contribute to the development of PCOS, therefore it is critical to support gut health in those with PCOS. One way to do this is through the consumption of more fiber and SCFAs[xv].

SCFAs help to maintain the function of our intestinal mucosa and also play an important role in helping stimulate insulin release from our pancreatic Beta-cells[xvi].

SCFAs help to improve our insulin sensitivity and also play in appetite regulation.

Consuming a wide variety of fiber rich foods is important to support microbial diversity

Soluble fiber helps in the production of SCFAs, rich food sources of soluble fiber include: legumes, avocado, Brussels sprouts, asparagus, turnip, psyllium husk, and sweet potatoes. 

Foods rich in Butyrate (a type of SCFA that has anti-inflammatory effects) serve as the food source (think of it as fuel) for intestinal cells. Aim to incorporate these into the diet: leeks, lentils, Jerusalem artichoke, jicama, dandelion green, asparagus, raspberries, almonds, walnuts, avocados, legumes, pistachios, garlic, onion, leafy greens, and kiwi.

Omega 3s

Consumption of more omega-3 fatty acids can help to decrease inflammation, lower waist and hip circumference, lower fasting blood sugar, improve hirsutism, improve insulin resistance, and improve lipid profiles[xvii] [xviii].

Rich sources of Omega-3s include: Chia seeds, hemp seeds, cold water fish (sardines, salmon, anchovies, mackerel, herring), dark leafy greens, flax seeds, olives and organic cold pressed olive oil, avocados 

Vitamin D

Vitamin D deficiency is very common in women with PCOS, in fact 67-85% of women with PCOS have a vitamin D level below 20 ng/ml. [xix]

Healthy vitamin D levels are important for menstrual regularity, hormone balance and production, glucose balance, and carbohydrate metabolism[xx]

Vitamin D is not easily found in food sources so supplementation is often necessary. The richest food sources of Vitamin D include: salmon, trout, cod liver oil, sardines, mackerel, tuna, eggs


It is common for women with PCOS to have lower serum levels of zinc and this may play a role in the pathogenesis of PCOS. [xxi]

Zinc plays a role in glucose metabolism, has anti- androgenic effects, can help decrease hirsutism, and may help lower inflammation[xxii]

Rich sources of Zinc include: oysters, crab, lobster, chicken, chickpeas, cashews, almonds, scallops, pumpkin seeds, sesame seeds, spinach, asparagus, lentils.

 Brassica Vegetables

Brassicas have phytochemicals (bioactive compounds) in them that reduce oxidative stress, promote detoxification enzymes, and support estrogen balance.[xxiii]

Specifically, brassicas contain the compound indole-3-carbinol (I3C) which helps regulation of estrogen activity and metabolism 

The Brassica Family includes: broccoli, cabbage, Brussels sprouts, kale, turnips, cauliflower, collard greens, bok choy, horseradish, kohlrabi, mustard greens, radishes, rutabagas.

Brassicas are also goitrogens which means they can produce a goiter or can cause the thyroid gland to become enlarged. If you have a known thyroid condition, please work with your health care provider before adding these foods into your diet.

Endocrine disrupting chemicals

In addition to changes in eating habits and nutritional interventions to support those with PCOS, there are also impactful lifestyle changes that can be made. We strongly recommend doing your best to avoid plastics (food storage containers, water bottles, cooking implements, make up and beauty product containers) and endocrine disrupting chemicals (EDCs), specifically BPA, phthalates and parabens. The exact mechanism by which these chemicals impact hormones or lead to the development of PCOS is not entirely understood. However, it is probable that exposure to EDCs plays a role in the etiology of PCOS due to the fact that EDCs have been shown to impact hormone function, reproduction, insulin signaling and insulin receptors, and metabolic and cardiovascular health.[xxiv] [xxv] It is well documented that EDCs can mimic or block action of certain hormones. BPA can mimic estrogen by activating estrogen receptors. BPA has been associated with PCOS, endometrial hyperplasia, obesity and recurrent miscarriages. [xxvi] Women with PCOS have been shown in multiple studies to have higher levels of BPA than in control groups. Once absorbed into the body, EDCs can be similar in configuration to hormones and some even closely mimic hormone structures which can disrupt and interfere with processes in the body that involve hormones. In turn, these EDCs, due to the nature of their structure, can also block our endogenous hormones from receptor sites and as a result impact hormone levels, alter hormone metabolism, and even alter the way hormones function. [xxvii] [xxviii]

If you or someone you know is dealing with PCOS or has received a PCOS diagnosis, you can begin to make immediate and impactful changes by making lifestyle and nutrition modifications. We always recommend consulting with your doctor as well as a nutrition professional to further personalize nutritional recommendations and to determine if supplemental or pharmacological interventions are necessary. To learn more about PCOS and symptoms, signs and diagnosis you can read our blog here.

[i] Aboeldalyl, S., James, C., Seyam, E., Ibrahim, E. M., Shawki, H. E., & Amer, S. (2021). The Role of Chronic Inflammation in Polycystic Ovarian Syndrome-A Systematic Review and Meta-Analysis. International journal of molecular sciences, 22(5), 2734.

[ii] Rishor-Olney, C. R., & Hinson, M. R. (2022). Mediterranean Diet. In StatPearls. StatPearls Publishing.

[iii] Lindheim, L., Bashir, M., Münzker, J., Trummer, C., Zachhuber, V., Leber, B., Horvath, A., Pieber, T. R., Gorkiewicz, G., Stadlbauer, V., & Obermayer-Pietsch, B. (2017). Alterations in Gut Microbiome Composition and Barrier Function Are Associated with Reproductive and Metabolic Defects in Women with Polycystic Ovary Syndrome (PCOS): A Pilot Study. PloS one, 12(1), e0168390.

[iv] Liu, R., Zhang, C., Shi, Y., Zhang, F., Li, L., Wang, X., Ling, Y., Fu, H., Dong, W., Shen, J., Reeves, A., Greenberg, A. S., Zhao, L., Peng, Y., & Ding, X. (2017). Dysbiosis of Gut Microbiota Associated with Clinical Parameters in Polycystic Ovary Syndrome. Frontiers in microbiology, 8, 324.

[v] Saadati, N., Haidari, F., Barati, M., Nikbakht, R., Mirmomeni, G., & Rahim, F. (2021). The effect of low glycemic index diet on the reproductive and clinical profile in women with polycystic ovarian syndrome: A systematic review and meta-analysis. Heliyon, 7(11), e08338.

[vi] Antvorskov, J. C., Fundova, P., Buschard, K., & Funda, D. P. (2013). Dietary gluten alters the balance of pro-inflammatory and anti-inflammatory cytokines in T cells of BALB/c mice. Immunology, 138(1), 23–33.

[vii] Haupt-Jorgensen, M., Holm, L. J., Josefsen, K., & Buschard, K. (2018). Possible Prevention of Diabetes with a Gluten-Free Diet. Nutrients, 10(11), 1746.

[viii] Malekinejad, H., & Rezabakhsh, A. (2015). Hormones in Dairy Foods and Their Impact on Public Health – A Narrative Review Article. Iranian journal of public health, 44(6), 742–758.

[ix] Melnik, B. C., & Schmitz, G. (2009). Role of insulin, insulin-like growth factor-1, hyperglycaemic food and milk consumption in the pathogenesis of acne vulgaris. Experimental dermatology, 18(10), 833–841.

[x] Ulvestad, M., Bjertness, E., Dalgard, F., & Halvorsen, J. A. (2017). Acne and dairy products in adolescence: results from a Norwegian longitudinal study. Journal of the European Academy of Dermatology and Venereology : JEADV, 31(3), 530–535.

[xi] Janiszewska, J., Ostrowska, J., & Szostak-Węgierek, D. (2020). Milk and Dairy Products and Their Impact on Carbohydrate Metabolism and Fertility-A Potential Role in the Diet of Women with Polycystic Ovary Syndrome. Nutrients, 12(11), 3491.

[xii] Wang, H. J., Zakhari, S., & Jung, M. K. (2010). Alcohol, inflammation, and gut-liver-brain interactions in tissue damage and disease development. World journal of gastroenterology, 16(11), 1304–1313.

[xiii] Gupta, H., Suk, K. T., & Kim, D. J. (2021). Gut Microbiota at the Intersection of Alcohol, Brain, and the Liver. Journal of clinical medicine, 10(3), 541.

[xiv] Rachdaoui, N., & Sarkar, D. K. (2017). Pathophysiology of the Effects of Alcohol Abuse on the Endocrine System. Alcohol research : current reviews, 38(2), 255–276.

[xvi] Tang, R., & Li, L. (2021). Modulation of Short-Chain Fatty Acids as Potential Therapy Method for Type 2 Diabetes Mellitus. The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale, 2021, 6632266.

[xvii] Khani, B., Mardanian, F., & Fesharaki, S. J. (2017). Omega-3 supplementation effects on polycystic ovary syndrome symptoms and metabolic syndrome. Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences, 22, 64.

[xviii] Oner, G., & Muderris, I. I. (2013). Efficacy of omega-3 in the treatment of polycystic ovary syndrome. Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology, 33(3), 289–291.

[xix] Lin, M. W., & Wu, M. H. (2015). The role of vitamin D in polycystic ovary syndrome. The Indian journal of medical research, 142(3), 238–240.

[xx] Lin, M. W., & Wu, M. H. (2015). The role of vitamin D in polycystic ovary syndrome. The Indian journal of medical research, 142(3), 238–240.

[xxi] Nasiadek, M., Stragierowicz, J., Klimczak, M., & Kilanowicz, A. (2020). The Role of Zinc in Selected Female Reproductive System Disorders. Nutrients, 12(8), 2464.

[xxii] Jamilian, M., Foroozanfard, F., Bahmani, F., Talaee, R., Monavari, M., & Asemi, Z. (2016). Effects of Zinc Supplementation on Endocrine Outcomes in Women with Polycystic Ovary Syndrome: a Randomized, Double-Blind, Placebo-Controlled Trial. Biological trace element research, 170(2), 271–278.

[xxiii] Kapusta-Duch, J., Kopeć, A., Piatkowska, E., Borczak, B., & Leszczyńska, T. (2012). The beneficial effects of Brassica vegetables on human health. Roczniki Panstwowego Zakladu Higieny, 63(4), 389–395.

[xxiv] Jozkowiak, M., Piotrowska-Kempisty, H., Kobylarek, D., Gorska, N., Mozdziak, P., Kempisty, B., Rachon, D., & Spaczynski, R. Z. (2022). Endocrine Disrupting Chemicals in Polycystic Ovary Syndrome: The Relevant Role of the Theca and Granulosa Cells in the Pathogenesis of the Ovarian Dysfunction. Cells, 12(1), 174.

[xxv] Mukhopadhyay, R., Prabhu, N. B., Kabekkodu, S. P., & Rai, P. S. (2022). Review on bisphenol A and the risk of polycystic ovarian syndrome: an insight from endocrine and gene expression. Environmental science and pollution research international, 29(22), 32631–32650.

[xxvi] Lidia Caporossi and Bruno Papaleo (2015).  Exposure to Bisphenol a and Gender Differences: From Rodents to Humans Evidences and Hypothesis about the Health Effects J Xenobiot. 5(1): 5264. 

[xxvii] Diamanti-Kandarakis, E., Bourguignon, J. P., Giudice, L. C., Hauser, R., Prins, G. S., Soto, A. M., Zoeller, R. T., & Gore, A. C. (2009). Endocrine-disrupting chemicals: an Endocrine Society scientific statement. Endocrine reviews, 30(4), 293–342.

[xxviii] Guarnotta, V., Amodei, R., Frasca, F., Aversa, A., & Giordano, C. (2022). Impact of Chemical Endocrine Disruptors and Hormone Modulators on the Endocrine System. International journal of molecular sciences, 23(10), 5710.


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