The Mediterranean diet has been considered a health-promoting way of eating for years because of its abundance of whole grains, lean proteins, omega-3 fatty acids and more. But does the Mediterranean diet have benefits for PCOS? In this article, we evaluate the evidence surrounding the Mediterranean diet for PCOS – let’s go!
What is PCOS?
Polycystic ovary syndrome (also known as polycystic ovarian syndrome or PCOS) is a common hormonal disorder. It impacts approximately 1 in 10 people assigned female at birth across the world. Symptoms of PCOS include acne, oily skin, hirsutism, alopecia, irregular periods, infertility and more.
Although PCOS cannot be cured, there are many lifestyle changes you can make to improve symptoms and quality of life. The treatment of PCOS may include adding dietary supplements, enjoying regular movement, taking medication or making nutrition changes.
One of the most well-known diets is the Mediterranean diet, but what is it and can it help PCOS symptoms?
What is the Mediterranean diet?
The Mediterranean diet is a way of eating traditionally followed by those people in countries boarding the Mediterranean Sea such as Italy, Greece, Turkey, Morocco, Tunisia, Libya, Israel and Cyprus. This way of eating is widely recognised for its health benefits, particularly for heart health, which has been associated with a longer lifespan and a reduced risk of various chronic diseases.
It is not what we would consider a usual “diet” per se, it is a way of eating based on the traditional practices of people in Mediterranean countries. Compared to diets like the ketogenic diet, intermittent fasting and low carbohydrate diet, the Mediterranean diet is primarily focused on what you can add to your diet, rather than taking away or restriction.
There are key characteristics of the Mediterranean diet:
- High in Plant-Based Foods: The diet emphasises a high intake of fresh fruits, vegetables, legumes, nuts, seeds, and whole grains. These foods provide essential vitamins, minerals, antioxidants, and fibre.
- Healthy Fats: A cornerstone of the Mediterranean diet is the use of extra-virgin olive oil as the main source of dietary fat, which is rich in monounsaturated fats and has anti-inflammatory properties. It also includes moderate amounts of nuts and seeds.
- Moderate Protein Intake: The diet includes moderate portions of fish, poultry, eggs, and dairy products (especially cheese and yoghurt), and a limited intake of red meat. The focus is on lean proteins and those high in omega-3 fatty acids, like fish.
- Low in Red and Processed Meats: There is a reduced consumption of red and processed meats, which are eaten in smaller amounts and less frequently compared to a typical Western diet.
- Wine in Moderation: It traditionally includes the moderate consumption of red wine during meals, though this is optional and should be consumed according to individual health recommendations.
- Whole Grains: Whole grains are consumed instead of refined grains, providing more nutrients and fibre.
- Herbs and Spices: The diet favours the use of herbs and spices over salt to flavour foods, which contributes to lower sodium intake and increased antioxidant consumption.
7 benefits of the Mediterranean diet for PCOS
Various studies have been carried out to understand the potential benefits of the Mediterranean diet on various aspects of PCOS. More evidence is required – particularly long-term studies with more participants – but let’s take a look at the evidence for the beneficial effects we have so far.
Improves insulin resistance
One of the key symptoms and drivers of PCOS is insulin resistance, where the body’s cells don’t respond effectively to insulin. The Mediterranean diet, which is high in fibre and healthy fats, may help.
A study published in Metabolites outlines a plan to investigate how an unrestricted Mediterranean diet affects insulin sensitivity among people with PCOS. Their study involved a 12-week randomised control trial with 42 participants and found that insulin resistance and blood sugar levels improved in those receiving dietary advice adhering to a Mediterranean diet. Of course, this study is small and short-term but the results are interesting.
Reduces chronic inflammation
Chronic inflammation is a silent symptom for many with PCOS. The anti-inflammatory properties of the Mediterranean diet—thanks to its abundance of antioxidants found in fruits, vegetables, and olive oil—may be able to combat this chronic low-grade inflammation.
As highlighted in a comprehensive review, these anti-inflammatory and antioxidant-rich components could reduce inflammatory markers in the body. A recent 2023 review concluded that the Mediterranean diet “may contribute to the reduction of inflammation through different mechanisms” because of its high quantity of omega-3, antioxidants and dietary fibre.
More research is needed on people with PCOS on the effect of the Mediterranean diet on inflammatory markers to make a conclusive recommendation for this way of eating.
Reduces the risk of cardiovascular disease
People with PCOS face a heightened risk of cardiovascular disease. The Mediterranean diet’s heart-healthy fats, like those from extra-virgin olive oil and nuts, plus its emphasis on whole grains and lean proteins, appear to reduce the risk of cardiovascular disease. We don’t have PCOS-specific studies to bolster this particular claim yet.
Could improve ovarian form
PCOS is a leading cause of fertility issues, but this dietary pattern could help turn the tide. Its balance of nutrients supports overall reproductive health, which may enhance fertility. Research indicates that diet can impact fertility outcomes positively, making the Mediterranean diet a potentially effective intervention for those looking to conceive.
A 2020 study investigated the impact the Mediterranian diet, the DASH diet and two “healthy eating index” diets have on Ovarian Dysmorphology in reproductive-age people assigned female at birth. They found that adhering to a Mediterranean diet resulted in significant improvements in ovarian form. We need more studies looking at the impact on fertility in people with PCOS.
May lower testosterone levels
High testosterone levels and other hormonal imbalances are another struggle for people with PCOS. Emerging research suggests that the Mediterranean diet might help reduce these levels, thereby alleviating symptoms like hirsutism and acne. A 12-week study on people patients looked at the effect of a Mediterranean diet combined with a low-carb diet compared to a low-fat diet on various markers. They found that total testosterone levels were significantly reduced following the intervention.
The study only had 72 patients participating, and combined the Mediterranean diet with a low-carb diet so we can’t be sure what was influencing the markers in participants.
Could boost gut health
A healthy gut is key for overall well-being, and the Mediterranean diet’s fibre-rich components are prebiotics, feeding the good bacteria in the gut. There has been an interesting emergence of evidence of the impact of gut health on PCOS symptoms, as highlighted by a review in “Nutrients”. More research is needed but a high-fibre, nutrient-dense diet is likely to improve gut health which could have positive effects on PCOS symptoms.
May improve non-alcoholic fatty liver disease
Non-alcoholic fatty liver disease (NAFLD) is linked with PCOS, potentially because of androgen excess. The Mediterranean diet, with its high intake of antioxidants, could be protective against liver diseases. As it may reduce insulin resistance and inflammation, it may also counteract the progression of NAFLD.
How to eat a Mediterranean diet
If you choose to follow a more Mediterranean-style diet then here are some key ways you can make the change:
- Eat plenty of fruits and vegetables
- Use extra-virgin olive oil as your main cooking fat
- Consume fish (particularly oil fish) a couple of times a week
- Add legumes, nuts and seeds to your meals and snacks
- Swap in wholegrains where suitable (i.e. brown bread for white bread, add in quinoa or oats to your diet)
- Drink red wine in moderation if you choose to consume alcohol
Key takeaways: Mediterranean diet and PCOS
Although there are promising studies about the Mediterranean diet on PCOS symptoms, more evidence is needed to conclusively state that this way of eating is a reliable treatment for PCOS. We encourage you to uncouple strict diet rules and your PCOS as there is no one PCOS diet.
Instead, choosing some of the aspects of the Mediterranean diet such as consuming more fruits and vegetables, boosting your omega-3 fatty acids with oily fish and consuming more wholegrains to boost fibre intake are likely to be beneficial for your PCOS symptoms – without following a strict regime. Speak with our Registered Dietitian or Nutritionists in our PCOS clinic for bespoke support.
Founder and Editor | Registered Associate Nutritionist
Founder of Be The Collective LTD [The PCOS Collective & The Endo Collective] Alex Okell ANutr is a London-based reproductive health nutritionist with experience in research, private practice and digital media. She holds a Master’s degree in Nutrition from King’s College London and has co-authored papers with the University of Cambridge, King’s College London, The Food Foundation and the Food Standards Agency. Alex offers 1:1 PCOS support in our virtual PCOS clinic.