If you have polycystic ovary syndrome (PCOS), you likely have at least some degree of insulin resistance that is driving your PCOS symptoms. Nutrition and lifestyle changes can be highly effective at improving insulin sensitivity, which will also improve PCOS symptoms like acne, irregular periods, excessive facial and body hair, hair thinning, and weight gain.

Many of the snacks we've often been told are healthy (a piece of fruit, a granola bar, a handful of crackers, or low-fat yogurt with added sugars) are actually not that great for women with PCOS. All of them are "naked carbs," carbs eaten on their own, which will cause blood sugar spikes and worsen insulin resistance. They will also lead to blood sugar crashes a couple of hours later, and this low blood sugar will tell your brain to eat some more carbohydrates to bring your blood sugar levels back up. This blood sugar rollercoaster often leads to eating more food than you actually need.

So let's talk about what makes up a good snack!

A good snack will fit into one of the following categories:

• Just healthy fats

• Just protein

• Healthy fats and protein

• Healthy fats and low glycemic load carbs (we'll talk about what this means next!)

• Protein, healthy fats, and low glycemic load carbs

A less good snack has:

• Naked carbs (carbs eaten without protein or fat)

Okay, let's talk about what low glycemic load carbs are... But to do that, we need to understand the glycemic index.

WHAT IS THE GLYCEMIC INDEX?

Every time you consume a food that contains carbohydrates, the concentration of sugar in your blood (what we refer to as your blood sugar) goes up until your body has a chance to either burn the sugar or store it. Once all of the carbohydrates you’ve consumed have been used or stored, your blood sugar returns to its baseline level. You can see the plot of blood sugar following breakfast in the photo here. 

To calculate the glycemic index, researchers have people consume a reference food, usually white bread or straight glucose. They calculate the area under the blood sugar spike for this reference food, and this is then considered to be a glycemic index of 100. They then feed participants other foods containing the same grams of carbohydrates as the reference foods. For example, if the reference food was 100 g of glucose (commonly used), and the researchers were testing watermelon, they’d feed the test subjects about 9 cups of diced watermelon (there are 11 g of carbohydrates per 1 cup of diced watermelon). 

These other foods create smaller blood sugar spikes because they are digested more slowly. The areas under their curves are then compared to the area under the curve created by the reference food. If the new area is 80% of the original area, the glycemic index for the tested food is 80 (Dodd et al. 2011). For watermelon, the area under the curve is 76% of the area for straight glucose, so it has a glycemic index of 76. For white rice, it is 72.

Relative to pure glucose, a glycemic index of 70 or higher is considered to have a high glycemic index, 56 to 69 is considered a medium glycemic index, and 55 or lower is considered to be low glycemic.

WHAT IS GLYCEMIC LOAD?

The glycemic load recognizes that we generally eat different quantities of foods. When was the last time you ate 9 cups of diced watermelon? Maybe never? In contrast, there are about 50 g of carbohydrates in one cup of rice (varying a little depending on the type of rice). Have you ever eaten 2 cups of rice in one sitting? Maybe that last time you ordered a large plate of fried rice at your favorite Asian restaurant or a bowl of risotto at your favorite Italian restaurant? 

The glycemic load adjusts the glycemic index based on the amount of carbohydrates in a serving. The glycemic load for watermelon is only 8 while the glycemic load for white rice is 35 (Higdon et al. 2023). 

While the glycemic index is probably better known, we really should pay more attention to glycemic load. This number better represents what happens in our bodies under realistic conditions. A glycemic load per serving of less than 10 is considered low, 10 to 20 is medium, and more than 20 is high.

WHY DO WE CARE ABOUT GLYCEMIC INDEX AND GLYCEMIC LOAD FOR PCOS?

The glycemic index and glycemic load indicate how hard our bodies have to work to bring blood sugar levels back to baseline after consuming a meal. 

Women with PCOS tend to have insulin resistance (see an earlier post all about this!), which means that our bodies are not as good at bringing blood sugar levels back to baseline without producing a lot of insulin in the process. Our ovaries are also more sensitive to insulin and produce more testosterone in the presence of high insulin.

The more time our blood sugar remains elevated, the more insulin we secrete, and the more testosterone we secrete. Which means… more acne, more hair where we don’t want it, less hair where we do want it, and a ripple effect on our reproductive hormones that throw off our menstrual cycles. 

Eating foods that have less of an impact on our blood sugar can help prevent this cascade of effects. So a low glycemic load diet makes a lot of sense for women with PCOS.

All of the carbs in the snacks below are low glycemic load carbs, which means your blood sugar will remain nice and stable after eating them!

My Favorite PCOS-Friendly Snacks

Fats on their own:

1. Chocolate: Chocolate with 85% (or higher) cocoa content has no effect on blood sugar for most people. Chocolate is also a great source of magnesium, zinc, iron, and fiber, all nutrients that are especially helpful for PCOS. Can't stand 85% dark chocolate yet? Start with 70% and work your way up! Some of my favorite options include Alter Eco Blackout Chocolate, especially the mint - so good, Theo 85% Salted Cashew, Endangered Species 88% dark chocolate, and Evolve Hazelnut Dark Chocolate Cups.

2. Nuts: Nuts of any kind are an amazing snack! Raw or dry roasted are ideal because most roasted nuts are roasted with oils that oxidize easily. If you're opting for flavored ones (Thai chili cashews are a personal weakness of mine!), check the package for sugar content. I usually aim for less than 1 gram of added sugar on my nuts if going for flavored ones. 

3. Pumpkin seeds: These are getting their own category because they are exceptionally nutrient-dense, and in particular, they are high in important minerals for PCOS like magnesium and selenium.

4. Olives: Olives are packed with healthy fats, and if you've got a craving for a salty snack, I think olives really hit the spot. You can't go wrong with any kind of olive!

5. Avocado: Throw a little everything bagel seasoning on half of an avocado and enjoy! Packed with healthy fats and even a good bit of fiber, avocados are amazing little things!

6. Peanut butter, almond butter, or cashew butter straight from the jar: Yep, this is a favorite snack of mine. Super simple, super delicious, lots of good fats! I look for options that don't have added sugar or added oils. Added salt is just fine. My shelf is currently stocked with Publix Greenwise Creamy Peanut Butter. Fix and Fogg Everything Butter is also a favorite, and I always stock up when it's on sale. 

8. Super seed bark: This is a recipe from a recent Women's Health Meal Plan. Add 3 oz dark chocolate (preferably 85%) and 1/2 tbsp coconut oil to a small pot. Heat over medium heat, stirring continuously. Once the chocolate is about 75% melted, remove it from the heat, and stir to melt the remaining chocolate. Stir in 3 tbsp pumpkin seeds, 3 tbsp sunflower seeds, and 2 tbsp hemp seeds. Line a baking sheet with parchment paper and spread the chocolate seed mixture out into a thin layer. Freeze for about 30 minutes or until solid. Move to the fridge or freeze for longer-term storage.  Serves 5 (one serving for each day of the work week!). 

7. Cheese: If dairy works for you, cheese is a great snack! Some fat, some protein, super satisfying, and no effect on blood sugar! It's a win!

Protein On Its Own

8. Leftover meat from last night's dinner: I'm not sure why it's not socially acceptable to have a leftover chicken thigh or a piece of salmon for a snack, but it should be! Most women aren't getting enough protein, and if you've got some on hand, it's a perfect snack. It's also super satisfying. 

9. Meat Jerky: Jerky is a tricky one because there are lots of options that are packed with sugar, but sugar-free options are great snack options! Some sugar-free options include Country Archer zero sugar jerky, Chomps meat sticks, Tillamook zero sugar jerky, and Epic jerky. 

10. Hard-boiled eggs: I waffled about putting this as a protein + fat snack because I think technically it is, but it's a single-ingredient snack, so I decided to put it here. Eggs have been a bit villainized, but they contain healthy fats and are packed with nutrients like vitamin D, choline, and folate. So slice your egg in half, sprinkle it with some salt and pepper or everything bagel seasoning, and enjoy!

11. Cottage cheese: If dairy agrees with you, cottage cheese is a great source of protein! However, it is high in casein, which can be inflammatory for some people, so be sure to notice if you experience any signs of increased inflammation like allergy flare-ups, changes in bowel movements, etc.

Healthy Fats + Protein

12. Smoked salmon and avocado: ​Wrap small pieces of smoked salmon around slices of avocado and enjoy! This snack is packed with healthy omega-3 fatty acids and is a great option for a satisfying snack.

13. Full-fat Greek yogurt with nut butter​: I've recently discovered how good peanut butter is on Greek yogurt, and it's quickly become one of my favorite snacks. Both are good sources of protein and healthy fats.

Healthy fats + low glycemic load carbs

13. Peanut butter (or your favorite nut butter) with celery, apple slices, pear slices, or dark chocolate: Nut butters are a good source of healthy fats which will slow the digestion of the sugars found in fruits like apples. Apples on their own, while touted as a healthy snack, can spike blood sugar from the natural sugar they contain. Adding a little peanut butter not only makes them more delicious (in my opinion) but also lessens the blood sugar spike. Note - peanut butter and banana is also one of my favorite combinations! The glycemic load of bananas actually varies by ripeness. If you love this combination as well, stick to bananas that still have a tinge of green to them. Ones that are starting to get brown spots are higher in sugar and higher in glycemic load. 

14. Roasted mung beans, lentils, fava beans, or chickpeas: All of these are great alternatives to potato chips, tortilla chips, etc. when you’ve got a craving for a salty snack. You can either purchase pre-packaged options or make your own. Try out taco spiced chickpeas as provided in a recent Women's Health Meal Plan: Preheat your oven to 400 degrees. Line a baking sheet with parchment paper. Rinse and dry 2.5 cups of canned chickpeas. In a medium bowl, mix the chickpeas, 1 tbsp olive oil, 2 tsp taco seasoning, and salt and black pepper to taste. Spread the chickpeas on the baking sheet and roast for 25 - 30 minutes, mixing halfway through. Chickpeas should be lightly browned and crispy when done.

15. Dark Chocolate Almond Mousse: Another Women's Health Meal Plan snack combines healthy fats and carbs via chia seeds. Chia seeds are relatively high in carbohydrates relative to other seeds, but they are packed with fiber, making them a great source of carbohydrates. In a blender, mix 1/2 cup unsweetened almond milk, 2 tbsp chia seeds, 2 tbsp cocoa powder, 1 tsp honey, 1/4 tsp vanilla extract, and 1/4 tsp sea salt. Blend on high for 2 - 3 minutes until the mixture is smooth and creamy. Refrigerate for 3 hours and then enjoy. Serves 1.

16. Air-popped popcorn with butter or walnut oil: Popcorn is a great low glycemic load carbohydrate and by making it in an air-popper, you can control the ingredients used. I like to drizzle my popcorn with walnut oil (so good if you haven't tried it!) and sprinkle it with sea salt. You can also try out other flavor combinations like adding garlic powder and/or smoked paprika or Italian seasonings. Don't have any walnut oil? Melt a little grass-fed butter instead and drizzle it over the popcorn. 

Protein + healthy fats + low glycemic load carbs

16. Full-fat plain Greek yogurt topped with your favorite berries and a dollop of nut butter: I like to think of this as peanut butter and jelly yogurt. Sometimes I even make a large serving of this to eat as a meal. It's got protein, healthy fats, and fiber and makes for a nutritious snack or quick meal. 

17. Smoked salmon-wrapped cucumber​: Wrap slices of smoked salmon around slices of cucumber. As mentioned above, smoked salmon is a great source of omega-3 fatty acids as well as protein. Cucumber is a great low-carb snack option. 

18. Tuna salad on apple slices: I personally think the best tuna salads have apple chunks in them. This snack plays on this idea by putting regular tuna salad on apple slices. Protein, fat, some low-glycemic load carbs, and crunch make this a great snack option!

19. Hummus with veggie slices: Hummus is a great source of complex carbohydrates, healthy fats, and a bit of protein. Serve it with slices of bell peppers, carrot sticks, broccoli florets, snap peas, or any of your other favorite raw vegetables.

20. Chia seed pudding: There are a lot of variations on chia seed pudding on the internet! I'd stay away from ones with a lot of sweeteners in them. I like this simple one that combines 2 tbsp chia seeds and 1/2 c unsweetened almond milk. Refrigerate for at least 20 minutes or overnight. Top with 1/4 cup berries, 1 tbsp peanut butter or almond butter, and a sprinkling of dark chocolate chips. 

Snacks that are not ideal when consumed regularly:

1. Most conventional cookies, cupcakes, donuts, muffins, pastries, etc.: These are for sure great options once in a while, simply because they are delicious, but if you're eating a donut at the office every day, it's probably not moving your health in the right direction. All of these items are high glycemic load carbohydrates.

2. Any liquid carbohydrates: This includes fruit smoothies and your favorite sugary latte from Starbucks. Your body absorbs liquid sugar very quickly, and this will cause a big blood sugar spike that will require your body to pump out a ton of insulin to combat. Those high insulin levels then worsen the symptoms of PCOS. If you're committed to drinking smoothies, limit the amount of fruit to the amount you'd reasonably eat in one sitting if eating the fruit whole, add a good source of fiber like chia seeds or leafy greens, a scoop of protein powder, and a source of fat like nut butter. The fat, fiber, and protein will slow your digestion a bit and lessen the blood sugar spike.

3. Fruit eaten on its own: ​Fruit is definitely part of a healthy diet and can be included in healthy snacking. But for those of us with insulin resistance, the sugar in fruit is likely to cause blood sugar spikes when that fruit is eaten all by itself. 

4. Many pre-packaged granola bars and protein bars​: Many include a high amount of sugar and/or refined carbohydrates that your body will absorb a bit too quickly. Even oat-based bars, which contain whole grains and fiber, can be problematic for blood sugar for some people. I also think that whole food is almost always a better option than packaged, processed foods. There is increasing evidence that "ultra-processed foods," (foods that contain ingredients not commonly found in the average person's fridge or pantry) are associated with obesity. 

5. Whole grains eaten by themselves: Whole grain crackers and whole grain toast are often touted as heart-healthy snacks, but these are all high glycemic load options, that I do not recommend. Honestly, I don't even recommend whole-grain crackers or breads when eaten with fat and protein because of their high glycemic load. Low glycemic load grains include quinoa, bran, and black wild rice. These options are great when eaten with protein, fat, and fiber!

References

Dodd H, Williams S, Brown R, and Venn B. 2011. Calculating meal glycemic index by using measured and published food values compared with directly measured meal glycemic index. The American Journal of Clinical Nutrition, 94(4):992-996 https://doi.org/10.3945/ajcn.111.012138

Higdon J. 2023. Glycemic Index and Glycemic Load. Linus Pauling Institute. Available: https://lpi.oregonstate.edu/mic/food-beverages/glycemic-index-glycemic-load#table-1

Disclaimer: This post is not intended to diagnose or treat any medical issues. It is intended for informational purposes only. I am not a medical practitioner. Always consult a trusted healthcare provider with any questions you may have about a medical condition or treatment and before starting any new health care regimen.