Vegan Guide to Polycystic Ovary Syndrome (PCOS)
Have you gotten mixed messages about whether being vegan is good or bad for PCOS? You’re not alone. With the rise in popularity of extremely low-carb diets such as keto, lots of conflicting information on the internet, and everyone having a opinion on nutrition, several of my vegan clients with PCOS tell me they’ve heard some confusing things like
vegan diets are too high in carbs
you need animal protein if you have PCOS
soy is bad for hormone health
being vegan isn’t “optimal” for PCOS
If you’ve wondered about any of these things or are looking to manage PCOS as a vegan this post is for you!
This article is NOT saying you have to go vegan to manage PCOS (so please don’t @ me).
This article IS for vegans with PCOS who feel they’ve been put in a position of having to choose between their health and ethics. Thankfully it’s not necessary to eat animal products to manage PCOS! You deserve respectful care that takes your preferences and ethics into consideration, along with evidence-based guidelines. Even if you’re not vegan, you may find something helpful or interesting here.
When I help clients with PCOS make supportive nutrition and lifestyle changes we are typically aiming to do a few key things:
reduce inflammation
increase insulin sensitivity
stabilize blood sugar
improve gut health
Guess which of these things eating plants can help with? All of them!
Which in turn can help improve PCOS symptoms like regulating your menstrual cycle, decreasing androgens (hormones that can cause increased hair growth, acne, and other symptoms), and protect against developing conditions those with PCOS are at a higher risk for, such as heart disease and type 2 diabetes.
There are so many misunderstandings about nutrition in general, but add in veganism + PCOS and things can seem even more unclear. Let’s break down some of the main misconceptions out there.
Vegans eat too many carbs
Poor carbohydrates are currently being demonized, yet carbs from sources like whole grains, legumes, fruit, and starchy vegetables are loaded with vitamins, minerals, antioxidants, and fiber and are associated with multiple health benefits. Lower levels of inflammation, improved egg quality, a healthy gut microbiome, and decreased risk for type 2 diabetes and heart disease are a few that are important for people with PCOS.
But don’t carbs raise blood sugar and insulin levels?
First I want to say that it’s normal for our blood sugar and insulin to rise after eating. Blood sugar = glucose = energy for our cells and bodies to function. Insulin is what helps glucose get into our cells to use so when glucose rises after eating so does insulin. If you have PCOS, your cells might be resistant to insulin, which means it can’t do its job of getting glucose into your cells as well. The good news is that plant-based dietary patterns are associated with decreased insulin resistance!
Second, pairing carbohydrates with protein, fat, and fiber helps blood sugar (and insulin) rise more gradually, as does eating carbs consistently throughout the day with each meal/snack. An example of a vegan meal with all these components might look like black beans (protein + carbs + fiber), sweet potato (carbs + fiber), mixed greens (fiber), and avocado (fat).
Research has shown that low-carb diets can increase cortisol, a stress hormone, in the body which can lead to more inflammation. Restricting carbs (or calories) has also been shown to lead to strong cravings and binge eating. Have you ever tried to avoid carbs and ended up feeling out of control with them after you ate them again? This is why!
Let me say this loud and clear: it’s ok and even beneficial to eat foods with carbs if you have PCOS! In addition to the benefits listed above, eating foods with carbs help you feel satisfied and of course are delicious.
Where do you get your protein?
There’s also the question of whether vegans can get enough protein from plant sources and the answer is YES. Legumes (beans, peas, and lentils), whole grains, nuts, seeds, tofu, tempeh, seitan, and vegan mock meats are all good sources of plant-based protein. Vegetables even have some protein and contribute to the total protein content of a meal. One cup of cooked spinach, sugar snap peas, or artichokes has about 5 grams of protein. A cup of green peas has 9 grams!
Plant-based Protein in Selected Foods
Tempeh (½ cup): 17 grams
Tofu (½ cup): 11 grams
Lentils (red, brown, green) (½ cup): 9 grams
Beans (all varieties) (½ cup): 8 grams
Seitan (½ cup): 30 grams
Quinoa (1/2 cup): 5 grams
Hemp seeds (2 TBS): 7 grams
Peanut butter (2 TBS): 8 grams
Almonds (¼ cup): 8 grams
Soy milk (1 cup): 8 grams
Nutritional yeast (2 TBS): 4 grams
Make sure you’re including some of these higher protein foods at each meal. Eating a variety of plant-based protein sources emphasizing at least three servings of legumes per day, ensures that you get all of the essential amino acids as well as other vitamins, minerals, and antioxidants.
Looking for some high protein meal ideas? Check out these videos (part one and part two) by fellow dietitian Sadia Badiei!
It’s true that some plant-based protein sources, like beans and lentils, also contain carbohydrates but due to their high fiber and protein content they’re considered low-glycemic foods (which means they digest more slowly, helping blood sugar stay stable). You can read more about why eating beans is good for PCOS here.
Is more protein/animal protein better?
Not necessarily. Research from the Nurses’ Health Study II has shown that women who had the highest protein intake were 41% more likely to experience ovulatory infertility than women in the lowest protein intake group. The type of protein matters, as well. The women who ate more plant-based protein had lower levels of infertility than women who ate the most animal-based protein.
Doesn’t soy affect hormones?
There are a lot of misconceptions about eating soy, which some vegans include in their diet. Soy is a bean that’s consumed in many different forms such as fresh (edamame), dried (soybeans), fermented (miso), tofu, tempeh, soymilk, soy sauce, isolated protein powders, and mock meats like soy hot dogs and burgers. Soy is considered a complete protein, as it contains all 9 essential amino acids.
The main controversy about soy comes from the phytoestrogens it contains. Phytoestrogens are different from human estrogen, and have been shown in studies to have health benefits, such as improved cardiovascular health, reduced rates of breast and uterine cancer, and less symptoms of menopause.
Several plant foods such as beans, lentils, flaxseeds, and wheat berries also contain phytoestrogens, so it’s interesting that this particular bean gets so much flak! Unless you have a soy allergy, it’s safe to include soy in your diet.
For a breakdown of the research on soy and PCOS, read this article by registered dietitian Angela Grassi. I also often use this handout with my clients who are concerned about the safety of soy.
Being vegan isn’t “optimal” for PCOS
Optimal according to who? What research? This implies that there is an optimal or best diet for PCOS and we just don’t have that data at this point. There is currently no standard dietary approach for PCOS and individualized medical nutrition therapy is key. Both vegans and omnivores alike can have balanced or unbalanced diets.
While there are no long term studies on vegans with PCOS, what we do have is research on vegetarian and vegan dietary patterns related to health outcomes in PCOS, like type 2 diabetes, heart disease, insulin resistance, cholesterol and triglycerides, inflammation, and fertility.
A 2017 review study on nutrition for PCOS concluded that a favorable dietary plan to improve symptoms of PCOS and reduce the risk of developing other chronic diseases associated with insulin resistance should contain low amounts of saturated fats, include omega-3s, and emphasize high fiber foods such as whole grains, legumes, vegetables and fruits. Vegans can meet these guidelines by regularly including a good source of omega-3 in their diet or supplementing (more on food sources and supplements below).
While it might be true that getting some nutrients from animal products (like concentrated protein and vitamin B-12) is easier, it doesn't mean it’s impossible or even difficult to get them from eating plants or supplementing when necessary, in the case of vitamin B-12.
Are there nutrients vegans with PCOS should be concerned about?
Everyone with PCOS should make sure they’re getting enough of the nutrients listed below, either with food or supplements if necessary.
Supplementing with vitamin B-12 is recommended for vegans and those taking metformin, as metformin can deplete B-12 levels by lowering its absorption. In general, adults should supplement with 25-100 mcg of vitamin B-12 per day or 1,000 mcg twice per week, but check with your healthcare provider. A blood test can determine if you might require a higher dosage.
Many people with PCOS have suboptimal levels of vitamin D. In fact many people have vitamin D insufficiency or deficiency period, regardless if they’re vegan or not, and it’s challenging to get enough through diet alone. The RDA for vitamin D is 600 IU but you may need more if your levels are low.
Iodine, which is important for thyroid health and fetal brain development, is typically found in dairy products, sea animals, and seaweed, however seaweed isn’t a reliable source as the amount of iodine varies widely. Relying on seaweed or kelp tablets can lead to iodine toxicity. A simple way to meet needs is to use iodized salt in your cooking. ⅜ of a teaspoon meets the daily RDA of 150 mcg. Supplements are another option.
Magnesium is abundant in plant-based foods like avocados, nuts, beans, and dark leafy greens. According to one study, women with PCOS were found to be 19 times more likely to have a magnesium deficiency. Therefore, in addition to eating magnesium-rich foods, supplementing may be necessary. The RDA for adult women is 320 mg; adult males 420 mg.
Vegans should include several servings daily of calcium-rich foods such as collard greens, broccoli, calcium-set tofu, almonds, and fortified plant-milks and yogurt. Aim for 1,000 mg per day.
Zinc is another mineral people with PCOS tend to be low in, but it’s unclear whether it’s due to lower intake, increased excretion, or reduced absorption. Zinc has multiple functions in the body, but the effects most notable for PCOS are reduced PMS symptoms, reduced hair loss, improved fertility, lower inflammation, and reductions in acne. Plant-based sources of zinc include beans, lentils, whole grains, nuts, and seeds.
Omega-3 fatty acids are essential fats that can help reduce triglycerides and insulin levels, improve fertility, and lower inflammation. There are three forms of omega-3 fatty acids: ALA, EPA, and DHA. Fish such as salmon and fish oil are touted as the best sources, but you don’t have to eat fish to get your omega-3s.
Walnuts, flax, hemp, and chia seeds, and canola oil are all good plant sources of ALA. Our bodies convert ALA to EPA and DHA, but that conversion isn’t super efficient so to ensure adequate intake I often suggest taking an algae-based EPA/DHA supplement. Fun fact: fish get their omega-3s from eating algae! If you want to go more in depth into plant-based omega-3s, check out this article by Taylor Wolfram, MS, RDN.
Beyond diet for PCOS
What you eat is only one aspect of managing PCOS, so I always emphasize not placing too much importance on it or trying to get it perfect (because there’s no such thing as a perfect way to eat anyway)! You don’t have to restrict foods you love or eat only whole foods, despite what Instagram PCOS influencers say. There are multiple things you can do to feel your best with PCOS.
A healthy relationship with food and your body- This, by far, is the most important aspect of PCOS management and your overall physical and mental health! Many people with PCOS struggle with their relationship with food, have a negative body image, and have a higher risk of an eating disorder. Getting help from a professional is highly advised if you deal with any of these things.
Stress relief- Chronic stress can cause increased inflammation, fatigue, and other PCOS symptoms to worsen. Finding ways to wind down and calm your nervous system daily is so important.
Enjoyable movement- Exercise is beneficial for those with PCOS but too often it’s used in a punishing way. Find forms of movement that feel good to you and that you can do regularly! Yoga is one activity that has been shown to be helpful for PCOS. Taking a walk after meals has been shown to improve insulin sensitivity.
Therapy- Mood disorders such as anxiety and depression are common co-occurrences with PCOS. Getting help from a qualified therapist can be part of a holistic health plan for PCOS.
Supplements- This deserves its own post.There are several different supplements that can be used to help improve symptoms of PCOS. A few that I use regularly with clients are inositol, EPA/DHA, and magnesium. Work with your doctor or registered dietitian to learn what supplements may be helpful for you.
Medication- Your doctor can advise you on whether taking any medications is right for you. Metformin, spironolactone, and hormonal birth control are commonly prescribed for PCOS.
Putting together a PCOS plan
To sum up all the above into some general guidelines vegans with PCOS can use:
Eat regularly to keep blood sugar and energy levels stable (every 3-4ish hours).
Include protein, carbs, fats (including omega-3s), and fiber in most meals. Experiment to find the amount of each that feels best to you (some people feel better with more or less carbs or protein, for example).
Include foods that are satisfying and delicious even if they’re villainized as “bad” foods (if this is tough for you, I can help).
Take a vitamin B-12 supplement and have your vitamin D levels tested to see if you need a supplement to correct a deficiency/insufficiency or maintain your levels.
Consult your doctor or registered dietitian to determine if any additional supplements may be helpful.
Don’t place too much importance on your diet. Many factors go into a happy, healthy life and eating should feel supportive, not stressful.
Work with a qualified health professional if you suspect you have an eating disorder or negative relationship with food and your body.
The bottom line
There is no such thing as a magic bullet diet for PCOS (and you should run from anyone trying to sell you on that) but there is research on nutrition and PCOS that certainly doesn’t contraindicate a balanced vegan diet. The best way to eat is individual - what helps you feel your best, is satisfying, sustainable, flexible, and fits your personal values and ethics? Whether you’re vegan or not, you can find what diet and lifestyle strategies work best to manage your PCOS symptoms and support your overall health.
Is there anything else you’d like to know about veganism and PCOS that I didn’t cover? Let me know in the comments below!
Are you interested in individual PCOS recommendations and support? Ready to get started?
Additional references
A plant-based diet for the prevention and treatment of type 2 diabetes J Geriatr Cardiol. 2017 May; 14(5): 342–354. doi: 10.11909/j.issn.1671-5411.2017.05.009
Ebbeling CB, Swain JF, Feldman HA, Wong WW, Hachey DL, Garcia-Lago E, Ludwig DS. Effects of dietary composition on energy expenditure during weight-loss maintenance. Jama. 2012 Jun 27;307(24):2627-34.
Stimson RH, Johnstone AM, Homer NZ, Wake DJ, Morton NM, Andrew R, Lobley GE, Walker BR. Dietary macronutrient content alters cortisol metabolism independently of body weight changes in obese men. The Journal of Clinical Endocrinology & Metabolism. 2007 Nov 1;92(11):4480-4.
Diet components can suppress inflammation and reduce cancer risk W. Elaine Hardman Nutr Res Pract. 2014 Jun; 8(3): 233–240. Published online 2014 May 15. doi: 10.4162/nrp.2014.8.3.233
Whole grain diet reduces systemic inflammation: A meta-analysis of 9 randomized trialsMedicine (Baltimore). 2018 Oct; 97(43): e12995. Published online 2018 Oct 26. doi: 10.1097/MD.0000000000012995
Vegetarian diets show potential for boosting insulin sensitivity Cui X, et al. Nutr Metab Cardiovasc Dis. 2019;doi:10.1016/j.numecd.2019.01.012.
Chen Z, Zuurmond MG, van der Schaft N, et al. Plant versus animal based diets and insulin resistance, prediabetes and type 2 diabetes: the Rotterdam Study. Eur J Epidemiol. 2018;33(9):883-893. doi:10.1007/s10654-018-0414-8
Kahleova H, Tura A, Hill M, Holubkov R, Barnard ND. A Plant-Based Dietary Intervention Improves Beta-Cell Function and Insulin Resistance in Overweight Adults: A 16-Week Randomized Clinical Trial. Nutrients. 2018;10(2):189. Published 2018 Feb 9. doi:10.3390/nu10020189
Dinu M, Abbate R, Gensini GF, Casini A, Sofi F. Vegetarian, vegan diets and multiple health outcomes: A systematic review with meta-analysis of observational studies. Crit Rev Food Sci Nutr. 2017;57(17):3640-3649. doi:10.1080/10408398.2016.1138447
Kahleova H, Levin S, Barnard N. Cardio-Metabolic Benefits of Plant-Based Diets. Nutrients. 2017;9(8):848. Published 2017 Aug 9. doi:10.3390/nu9080848
Sharifi F, Mazloomi S, Hajihosseini R et al. Serum magnesium concentrations in polycystic ovary syndrome and its association with insulin resistance. Gynecol Endocrinol. 2012;28(1):7-11.
Norris, J. Iodine. Vegan Health website. Updated January 2020. Accessed September 20, 2020. https://veganhealth.org/iodine/