The Hormonal Acne Diet for PCOS/PMOS: What Is Worth Changing?

Diet plays a major role in the development and worsening of acne. Many forms of adult acne are driven by an underlying hormonal imbalance. With PCOS, now also called PMOS, that imbalance is excess androgens like testosterone, which cause the breakouts around your chin, jawline and upper lip that often flare around your period.

The changes worth making either bring those androgens down or give your skin what it needs to heal: a high-protein breakfast, two cups of spearmint tea a day, a break from dairy, less sugar, and foods to eat for clear skin, like oysters, beef liver, salmon and berries.

What I would actually change

Start with your breakfast. It is the most impactful habit you can change for your PCOS: a higher carbohydrate breakfast like cereal, toast, fruit or oats makes your body release more insulin, and insulin tells your ovaries to make more androgens. The PCOS Repair Breakfast is 30 to 40 grams of protein, no grains, starchy vegetables or legumes, as many non-starchy vegetables as you like, a serve of low sugar fruit such as berries, no sugar or sweeteners, and some healthy fat.

If most meals are built around sweet drinks, refined cereal, white bread, pastries, sweets, or large portions of rapidly digested carbohydrate without much protein, fiber, or fat, that pattern is the next thing to change.

This does not require a carbohydrate ban. Start with the choices you repeat most often. Replace sweet drinks or refined, low-fiber staples with meals that digest more slowly and that you will actually keep eating, using foods such as beans, intact grains, vegetables, fruit, and a protein source that suits you.

Glycemic load, insulin and your skin

Insulin is the link between your plate and your skin. At least 80 percent of women with PCOS have insulin resistance, and high insulin triggers your ovaries to produce extra testosterone, which increases the oil in your skin, blocking pores and causing acne. Keep your insulin low by pairing every carbohydrate with protein or healthy fat, never a piece of fruit or a cracker on its own, and keep dessert to once a week while your skin heals.

Glycemic load combines how quickly a carbohydrate raises blood glucose with the amount of available carbohydrate in the portion.

In a 12-week randomized trial of 43 young men (Smith et al. 2007), total acne lesion counts fell more with a lower-glycemic-load, higher-protein diet than with a carbohydrate-dense control diet. The lower-glycemic group also lost more weight and improved insulin sensitivity. A later systematic review (Meixiong et al. 2022) found a modest overall acne signal for higher glycemic index and load.

The current international PCOS guideline prioritizes sustainable healthy eating adapted to the individual (Teede et al. 2023).

Does dairy cause hormonal acne?

Yes. Dairy can cause hormonal acne, and cow's dairy tops my list of foods to avoid because of the way it can trigger breakouts. Milk is made to grow a calf into a cow, and the growth signals it carries, insulin-like growth factor 1 (IGF-1) and branched-chain amino acids (BCAAs), spike your insulin. Higher insulin means more testosterone from your ovaries and more oil in your skin, and that oil blocks pores and causes acne. Low-fat dairy is one of the most insulin-stimulating foods there is, more so than white bread.

If acne is one of your major symptoms, whatever your PCOS type, I suggest avoiding all dairy except butter and ghee for at least three months, and that includes whey protein: swap it for pea, collagen, brown rice or egg white protein. I love almond milk in my morning smoothie and coconut yoghurt with fruit as a snack, and if you are really craving cheese, a small amount of hard cheese has less impact.

A meta-analysis of 14 observational studies (Juhl et al. 2018) involving 78,529 children and young adults found that higher dairy intake often travelled with acne.

How to learn something from a food experiment

Make one food change at a time, beginning with breakfast, and stay with it for at least two to three weeks before you make the next one. Over those first 21 days your hunger and taste buds adapt, and the next change gets much easier. Lasting changes to your skin can take up to six months to be seen, so keep persevering, and track them like this:

1. Choose one change with a real reason behind it, such as the PCOS Repair Breakfast or taking dairy out. 2. Keep the rest of the diet and acne treatment as stable as practical. 3. Record the starting point with consistent photos and a simple lesion count rather than relying on how yesterday felt. 4. Decide what would make the change worth keeping before you start.

Foods that help clear acne

Addressing hormonal acne is multifactorial, so none of these foods is a treatment on its own. What they do is give your skin the nutrients it uses to fight acne and heal, while the breakfast, the tea and the break from dairy bring your androgens down.

Oysters and other zinc-rich foods: Zinc kills the bacteria in your skin that lead to acne, reduces oil production and lowers androgens, and it helps existing spots heal so they are less likely to scar. Oysters, beef, crab, pumpkin seeds and cashews are some of the richest sources.

Salmon and other oily fish: Salmon, sardines and mackerel are rich in omega-3 fats, which help reduce acne by lowering inflammation in your skin. In a trial of people with acne, the 15 who took omega-3 had fewer inflammatory lesions after 10 weeks (Jung et al. 2014). Aim to enjoy oily fish three to four times a week; wild salmon is my favourite. If you are pregnant, trying to conceive or breastfeeding, keep oily fish to two portions a week, because of the pollutants it can carry (NHS fish guidance).

Berries: Dark berries like blueberries, raspberries and blackberries are rich in antioxidants, which help repair your skin and calm inflamed spots, and in vitamin C, which your skin needs to make collagen. They are also low in sugar compared with most fruit, so they won't spike your blood sugar as much. I add ½ to 1 cup of frozen berries to my morning smoothie.

Apple cider vinegar: There is a strong link between your gut health and acne breakouts, and I find a tablespoon of apple cider vinegar in a small glass of water, about ten minutes before breakfast, improves my digestion. If it is new for you, start with a teaspoon and work up, use less if it gives you heartburn, and rinse your mouth afterwards to protect your teeth.

Spearmint tea: Spearmint (not peppermint) tea naturally lowers androgens like testosterone, the hormones driving your breakouts. In a 30-day trial, free and total testosterone fell in women with PCOS who drank two cups a day (Grant 2010). Your goal is two cups a day, hot, iced or in a smoothie. I sourced Androgen Relief Tea as 100% certified organic loose-leaf spearmint so you can enjoy it in its purest form; leave it out while you are pregnant or breastfeeding.

Beef liver and desiccated liver capsules: Liver and organ meats are some of the richest sources of nutrients for your skin, and what makes beef liver good for acne is its high level of preformed vitamin A, the form most easily absorbed and used in your skin to reduce acne. Carrots, sweet potato and pumpkin only give you beta-carotene, which your body has to convert, and some women convert very little of it. If you struggle with the taste (this is a big one for me!), ask your butcher to grind the liver and add small amounts to mince dishes like bolognese; you won't even know it's there. Find the thought of eating liver too challenging? Beef liver supplements in capsule form are the easier option.

Preformed vitamin A builds up in your body, so small amounts are all you need. If you are pregnant or trying to conceive, leave out liver and liver capsules, because too much vitamin A can harm your baby's development (NHS pregnancy guidance).

How PCOS causes acne

Acne around your chin, jawline, upper lip, neck, chest and back is one of the most common signs of excess androgens, even when your blood test comes back normal. A blood test only measures the testosterone circulating in your blood, not what is bound up in your skin, and it cannot show how strongly your body is turning testosterone into dihydrotestosterone (DHT), a much more potent form that also causes acne.

What drives those androgens depends on your root cause: insulin, stress, coming off hormonal birth control, or inflammation. Take my free root-cause quiz to find out which of the four types is behind your acne, and my book, The PCOS Repair Protocol, gives you the core treatment for each type.

Topical treatments do play a role in clearing dead skin cells and build-up from your pores, and the American Academy of Dermatology guideline (Reynolds et al. 2024) strongly recommends established acne treatments including benzoyl peroxide and topical retinoids. Keep using what works on the surface while these changes deal with why your spots are emerging from deeper within your body.

When to see your doctor, and when to add a supplement

Two kinds of acne need your doctor before anything else: acne that is leaving scars, and acne that came on quickly along with fast-growing facial hair, hair loss on your scalp or a deepening voice.

Otherwise, if diet alone hasn't cleared your skin after several months, or you want faster results, add an anti-androgen supplement. I created AndroEase Plus after my clients got sick of taking handfuls of pills each day, putting the androgen-blocking nutrients I had used with them for years into one daily blend that helps with hormonal acne. Leave it out if you are pregnant, breastfeeding or trying to conceive, when inositol is my choice instead, and check with your doctor first if you are on the pill or another regular medicine.

My guide to supplements for hormonal acne goes through the others one by one.