What is the best milk for PCOS? As a PCOS registered dietitian, this is a question I get asked frequently. Women with PCOS want to know whether traditional milk or non-dairy milk substitutes are best for PCOS.
This blog will address dairy milk, non-dairy milk alternatives, and how they affect PCOS symptoms. By the end of the article, you’ll be able to determine what the best milk for PCOS is going to be for you.
But first, let’s do a quick recap of PCOS and some key factors that we’ll be talking about when it comes to milk.
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Polycystic ovarian syndrome (PCOS) is a common hormonal disorder that affects 6-12% of women of reproductive age in the United States (1). Common symptoms of PCOS include irregular periods, infertility, painful periods, hair loss, unwanted hair growth (hirsutism), acne, mood swings, fatigue, weight gain, weight loss resistance, and cravings.
PCOS is linked with insulin resistance, chronic inflammation, and high androgen levels (aka male hormones such as testosterone). In fact, up to 80% of women with PCOS have insulin resistance (2). Over time, insulin resistance and inflammation increase the risk of type 2 diabetes and heart disease.
The good news is that a balanced diet that includes mostly whole foods, along with lifestyle modifications, can dramatically improve your symptoms and reduce your risk of developing other health conditions.
For more details on a balanced diet (and a meal plan!) for PCOS, check out: A Dietitian’s 7 Day PCOS Diet Plan (PDF Included).
Now let’s talk about how milk impacts PCOS.
Is Milk Bad For PCOS?
This question seems to be asked again and again. If you were to ask me about carbs and PCOS or gluten and PCOS, the answer would be pretty straightforward. But for milk, or dairy in general, the answer is more gray. That’s because although there has been a lot of research on dairy done in the general population, the results have often been conflicting for a variety of reasons.
Even worse, we have very limited research on dairy in those with PCOS specifically. That means that we need to take the research that was done in women without PCOS and try to interpret it and apply it to PCOS…which is obviously not ideal.
Don’t worry though, I’m going to walk you through what the research says. Let’s first talk about the benefits of milk or dairy. Then we’ll dive into some of the potential cons so you can make an informed decision on what’s best for you.
Milk Nutritional Value & Health Benefits
Dairy, including milk, has many important nutrients. It’s considered a high-quality protein source since it’s a complete protein, meaning it has all of the amino acids (aka protein’s building blocks) that our body cannot make on its own.
Cow milk is also a good source of calcium, choline, phosphorus, vitamin B12, vitamin D, and zinc. Additionally, some fermented dairy products made from milk are good sources of probiotics, which are the good bacteria that can improve your gut health and relieve digestive symptoms such as bloating.
While these nutrients are vital for everyone, some of these nutrients are especially important for PCOS and for those who are pregnant or trying to conceive. Read more here: 5 Best Prenatal Vitamins For PCOS.
Now that we’ve talked about some of the nutritional highlights of milk, let’s talk about some of the most common objections people have to milk for PCOS and what the research says.
Insulin Resistance & Type 2 Diabetes
There have been numerous clinical trials done on the effects of dairy on insulin resistance, pre-diabetes, and type 2 diabetes. There have been conflicting results, however, overall it appears that higher dairy intake lowers insulin resistance and the risk of developing prediabetes or type 2 diabetes in women. This may be due to the fact that milk has the ability to increase insulin-like growth factor (IGF-1) concentrations, which increases the absorption of glucose (aka your blood sugar) into muscle and fat tissues and improves insulin sensitivity (3, 4).
Yogurt may be particularly beneficial because it also increases GLP-1 and peptide YY concentrations which improves blood sugar levels. One study found that women who were randomly assigned to consume yogurt had lower insulin levels than those who were assigned to consume milk.
There was a study done in 2014 that is often cited when people recommend a dairy-free diet. This study studied the effects of a low starch and low dairy diet on 24 women with PCOS. They were instructed to eliminate starches such as whole grains and beans, and to eliminate dairy except for 1oz of full-fat cheese allowed daily.
After 8 weeks of following the diet, there were reductions in body weight, BMI, waist circumference, testosterone levels, insulin levels, and insulin resistance (5). While these results are promising, it only studied 24 women with PCOS, which is hardly representative of everyone with this condition. This study also simultaneously eliminated starches and dairy…so it’s difficult to determine if the positive results were because of a lower dairy intake, a lower carbohydrate and calorie intake, or a combination of the two.
A recent meta-analysis found that dairy intake has been associated with increased acne, regardless of whether it is milk, yogurt, or cheese (6). One notable study that examined milk intake in women found that higher milk intake, particularly skim milk, was linked with an increased risk of acne also (7).
Ovulation and Fertility
Ovulation and fertility is another topic where the research has provided conflicting results.
One large study, the Nurses Health Study II (NHS II), found that low-fat dairy products increased the risk of ovulatory infertility by 11%. Alternatively, it also found that adding one serving of whole milk daily decreased ovulatory infertility by over 50% (8).
The authors of the NHS II study explained that a higher intake of low fat dairy products may cause higher concentrations of IGF-1 in the bloodstream, which creates a negative effect on ovarian function and antral follicle count. The higher fat content of whole milk doesn’t raise IGF-1 concentrations as much as low-fat dairy, which is why there may have been a decrease in infertility seen.
Another study found that a higher dairy intake was associated with more live births in women over the age of 35 undergoing fertility treatments (9).
Just to note though, none of these studies were conducted in those with PCOS specifically.
Of course, if you are allergic to milk or have an intolerance, consuming milk or dairy products will result in inflammation. One study did find that a higher amount of women with PCOS had lactose intolerance compared to the general population (12).
What about other dairy products?
A recent systematic review found that fermented dairy products such as kefir and yogurt consistently show positive health benefits. Some of these benefits include a reduced risk of breast cancer, colorectal cancer and type 2 diabetes, improved weight maintenance, and improved cardiovascular, bone, and gut health.
These fermented dairy products contain live cultures called probiotics that can play a role in shifting the gut microbiome to improve health. I recommend incorporating these types of dairy products if you’re able to.
Should You Choose A Milk Alternative?
If you’re feeling even more confused now than you were when you started, trust me, you’re not alone. The research for those of us with PCOS is seriously lacking and underwhelming…and the research in the general population isn’t exactly straightforward either.
Here’s my take on dairy and who should avoid it when it comes to PCOS:
Who Should Definitely Avoid Milk & Dairy Products:
- Those with a milk allergy or intolerance
Who Should Maybe Avoid Milk & Dairy Products:
- Those with significant or severe acne or hidradenitis suppurativa that hasn’t responded to modest dietary changes may benefit from a dairy-free or low-dairy diet trial
- Those with lactose intolerance. Many people with lactose intolerance can tolerate fermented dairy products since they have a very low amount of lactose
If you don’t meet any of the above criteria, then you may be able to include dairy in your diet. Since we don’t know all that we need to know, I generally err on the side of caution and recommend a low to moderate intake of dairy.
In general, I recommend trying to incorporate fermented dairy products such as Greek yogurt, kefir, or cottage cheese more routinely. These foods are great sources of probiotics, quality protein, calcium, vitamin D, and other micronutrients associated with improved health.
If you need to (or you’re choosing to) use non-dairy milks, let’s run through which ones are the best options.
Non-Dairy Milk Alternatives For PCOS
In terms of nutritional value, most non-dairy milks aren’t equal to traditional milk. Most of them differ in terms of protein, calcium, vitamin D, and other micronutrients. Even more, different brands can differ greatly too. I’m going to break down some common dairy free milk options below.
Almond Milk: Is Almond Milk Good For PCOS?
Unsweetened almond milk is a great option for PCOS. It’s made from water and almonds and it’s one of the most popular alternative milk options. It’s a low calorie and low carb option that’s great for adding to smoothies, oatmeal, overnight oats, or just drinking a glass as is.
Almond milk is usually fortified with calcium and vitamin D. It has more calcium than cow’s milk and a comparable amount of vitamin D. Unlike traditional cow’s milk though, almond milk is not a good source of protein, with only 1 gram of protein per 8oz serving.
Similar to any of the milk alternatives I’m going to discuss, be sure to choose unsweetened almond milk. The sweetened versions will have more carbs and sugar because of the added sugar which may negatively impact blood sugar levels if you’re having a lot.
Oat Milk: Is Oat Milk Good For PCOS?
Oat milk is a great milk substitute for those with PCOS. It’s a particularly good option for those with a nut allergy. Since it’s made from oats and water, and since oats are a carbohydrate, unsweetened oat milk has a higher carbohydrate content than some other milk alternatives. Sweetened oat milk will have an even higher amount of carbs and sugar due to the added sugar. If you’re trying to be mindful of your carb intake, this may be something to think about.
Most oat milks are fortified with calcium and vitamin D, with most popular brands having more calcium and vitamin D than traditional milk. Similar to almond milk though, oat milk is not a good source of protein.
Soy milk is the O.G. when it comes to non-dairy milk. It’s one of the most comparable milk alternatives to cow’s milk. It’s made from a combination of soy beans and water, and is sometimes fortified with additional nutrients including calcium and vitamin D. It has the same amount of protein as cow’s milk, and this protein is a good quality source of protein. I recommend choosing unsweetened soy milk rather than sweetened versions.
There’s a lot of misguided debate about whether soy is beneficial for PCOS or not. Several research studies show significant benefits to including soy in PCOS, including reductions in insulin resistance, BMI, triglycerides, inflammation, and testosterone (13, 14).
Similar to oat milk, even unsweetened rice milk is going to be a higher carb option compared to other milk alternatives. Most rice milks are fortified with additional nutrients such as calcium and vitamin D, however, rice milk has zero protein in it.
Rice milk is a great option for people with nut or soy allergies. It also tends to digest well so it may be a good option for those with digestive issues.
Coconut oil had its moment, so it’s only fitting for coconut milk to be a milk alternative you’re wondering about. I’ve found that coconut milk drinks tend to vary greatly among brands in regards to nutrition.
Typically, coconut milk has no protein and is a low carb option. Most of the calories in coconut milk come from fat, in particular it has high amounts of saturated fat. Saturated fat can worsen insulin resistance and increase cholesterol levels, so it’s not typically a milk I recommend for routine use.
Pea milk is one of the new kids on the block when it comes to non-dairy milks. It’s made from a combination of water and pea protein powder. Most brands will fortify their products with nutrients like calcium, vitamin D, vitamin B12, and phosphorus to make it more comparable to cow’s milk.
Similar to cow’s milk, pea milk also has 8 grams of protein and is a complete protein source. Pea protein has been shown to perform similarly to whey protein when it comes to building muscle mass. Read more about these two different protein powders here: The Best Protein Powder For PCOS (And Which To Avoid).
Despite there being an online campaign for dairy-free diets for PCOS, it may not be necessary for everyone with PCOS.
Research has shown that dairy may be helpful in reducing insulin resistance, type 2 diabetes risk, and inflammation. Full-fat dairy products may improve fertility and live birth rates. A definite downside though is that dairy intake, especially skim milk, is associated with worsened acne.
High-fat dairy may have more benefits than low fat dairy products. Fermented dairy products appear to have even more health benefits than traditional milk.
If you choose to opt for dairy-free milks or milk products in your diet, there isn’t one single best option. There are many options that are good for PCOS depending on your goals. Some examples are almond milk, pea milk, soy milk, or oat milk.
For some PCOS friendly recipes, check out this post: 75 Easy PCOS Recipes
Disclaimer: This information is for informational purposes only. It is not intended to replace medical advice for the management of polycystic ovary syndrome (PCOS). Always discuss your individualized needs with your registered dietitian or healthcare provider.