Top Tips: Heart Healthy Swaps for PCOS

If you have PCOS and have been told your cholesterol is “a bit high”, or you are worried about long-term heart health, you are not overreacting. PCOS is not just about periods or fertility. For many women, it overlaps with insulin resistance, inflammation and changes in lipid metabolism, all of which can influence cardiovascular risk over time. 

The aim of this blog is not perfection. It is about small, realistic food swaps that add up. These changes are especially helpful in PCOS because they support both cardiometabolic health and the underlying drivers of symptoms.

Why small swaps matter in PCOS

In PCOS, heart health is often shaped by the bigger pattern, not one “bad” food. When insulin levels are running high, the body may be more likely to show a classic pattern on blood tests: higher triglycerides, lower HDL cholesterol, and changes in LDL-related risk. This is one reason the 2023 international PCOS guidelines highlight having regular assessment of cardiometabolic risk factors, such as lipids and blood pressure. 

Practical heart-healthy changes for daily meals:

• Swap industrial fats for stable, whole-food fats

When we talk about fats and heart health, the conversation often becomes overly simplistic. Saturated fat is frequently grouped together as something to avoid, but the evidence does not support treating all saturated fats as equal.

Whole-food fats such as butter, ghee and coconut oil have been part of traditional diets for generations and are chemically stable, particularly at higher cooking temperatures. In contrast, the strongest evidence of harm relates to industrial trans fats and highly processed sources of saturated fat, such as those found in commercially baked goods, pastries, deep-fried foods and processed meats.

In PCOS, this distinction matters. Many women are already dealing with insulin resistance and inflammation, and diets high in ultra-processed foods are consistently associated with poorer cardiometabolic outcomes.

Rather than eliminating traditional fats, a more practical and evidence-informed approach is to:

• Avoid trans fats and highly processed foods as much as possible
• Use stable fats such as butter, ghee or coconut oil in moderation, particularly for cooking
• Include naturally occurring unsaturated fats from whole foods such as olives, olive oil, avocados, nuts and seeds as part of an overall balanced pattern

Research suggests that replacing ultra-processed fats with whole-food fat sources, alongside improving overall diet quality, is more relevant for cardiovascular risk than focusing on saturated fat intake in isolation.

For women with PCOS, this approach also supports satiety, blood sugar stability and hormonal balance, which indirectly influences cholesterol markers, triglycerides and inflammation over time.

• Swap processed lunch options for protein plus plants

Many women with PCOS are trying to “eat healthily” but still end up with meals that are low in protein and fibre, which can worsen cravings later.

A simple template is: protein + vegetables + fibre. For example, a shop-bought sandwich and crisps can become a grain bowl, soup plus chicken, or leftovers with added salad, seeds and olive oil.

This matters because triglycerides and HDL cholesterol are often influenced by overall meal structure and blood sugar stability. It is also relevant for ApoB, as higher triglycerides can be a clue that particle-based risk markers may be worth checking. 

• Swap refined carbohydrates for fibre you can tolerate

Fibre supports gut health, blood sugar regulation and lipid balance, all of which matter in PCOS.

Soluble fibre is particularly helpful for cholesterol. A 2023 dose-response meta-analysis of randomised controlled trials found that each additional 5g per day of soluble fibre supplementation reduced LDL cholesterol by about 5.6 mg/dL. 

Food-first sources include oats, barley, beans and lentils, ground flaxseed, chia, apples, citrus, carrots and psyllium. If you are prone to bloating, build slowly and pair fibre with adequate fluids.

• Swap some red and processed meat for oily fish, beans or poultry

You do not need to stop eating meat to support heart health, but reducing processed meats is a sensible evidence-based shift.

Oily fish is particularly useful in PCOS because omega-3 fats support inflammatory balance and triglyceride metabolism, and they complement a Mediterranean-style pattern. 

If you do not enjoy fish, swapping in beans and lentils still supports fibre intake and cardiometabolic health.

• Swap ultra-processed snacks for “steady energy” snacks

Ultra-processed foods are consistently linked with poorer cardiometabolic outcomes at a population level, including cardiovascular disease risk. 

A practical swap is to build snacks, when you need them, around protein, fibre and healthy fats together. This can help reduce the blood sugar swings that often drive afternoon crashes, cravings and mood dips in PCOS.

• Swap “just eat less salt” for a blood pressure supportive pattern

Blood pressure is an important piece of cardiovascular risk in PCOS, and it is not only about salt.

A DASH-style dietary pattern has been shown in randomised controlled trial meta-analyses to reduce blood pressure in adults with and without hypertension. 

In day-to-day life, this looks like more vegetables, fruit, legumes, nuts, seeds and minimally processed foods, while reducing ultra-processed foods that often contribute the most sodium.

If you have kidney disease or take medications that affect potassium, always check with your GP before significantly increasing potassium-rich foods.

• Swap “all or nothing” for consistency you can repeat

This is the swap that matters most.

PCOS can come with a long history of diet pressure and black-and-white thinking. For heart health, the goal is to create a pattern you can repeat week to week. That is how you reduce risk over time, whether your main concern is LDL cholesterol, triglycerides, ApoB-related particle burden, or inherited markers like Lp(a). 

If you would like help choosing the two or three swaps that will make the biggest difference for your results and symptoms, why not book in a call to chat to us further.

Short disclaimer

This blog is for educational purposes only and is not medical advice. As a BANT-registered Nutritional Therapist, I do not diagnose or treat medical conditions and I do not advise on prescription medications. If you have concerns about cholesterol, blood pressure, cardiovascular risk or blood test results, please speak with your GP or relevant medical specialist.