Polycystic Ovarian Syndrome (PCOS) is one of the most public health problems facing women and to make matters worse, weight loss “gurus” aka charlatans, aka lumbering numbskulls, are shoving Weight Watchers, Atkins diet, laxatives or Herbalife in your face to help out.
This article ain’t like that.
In this evidence-based article, I’ll show you how to manage your nutrition, exercise, and lifestyle the right way so that you could lose weight with PCOS without drinking special teas or ingesting exotic supplements.
But before that, you have to learn the nuts and bolts of PCOS, weight gain, and weight loss. Feel free to skip to the nutrition part if you’re are an anomaly who already knows all about PCOS.
P.S. In the end, you’ll have the opportunity to sign up for the 8 Week Nutrition Education Program. It’ll teach you the fundamentals of nutrition for fat loss in a step-by-step format.
“Da Hell PCOS Is & Why Should I Care?”
At least 1 in 10 women are diagnosed with PCOS during their lives1 and up to 70% of affected women remaining undiagnosed2. While PCOS is largely genetic3, its severity is heavily affected by your nutrition, physical activity, and lifestyle.4
I know your main goal is to blast that fat off your frame but PCOS affects your health and wellbeing beyond body weight.
Long-term morbidities of PCOS include vascular dysfunction, neoplastic (yea, I don’t know what that is either but sounds serious), and mental health disorders, hypertension, dyslipidemia, insulin resistance, impaired glucose tolerance, diabetes, and higher susceptibility for metabolic syndrome5.
If you’re thinking, “Uhmm, sounds No Bueno,” you’re right. Dialling in nutrition, physical activity, and changing lifestyle is capital-M Must.
Please, hyperfocus on the fact that women with PCOS tend to have insulin resistance. This means that you probably have higher baseline insulin levels because your body is releasing more of it in response to try and overcome the resistance.
As if that wasn’t enough, glucose is more likely to build up in your bloodstream and this can lead to too high blood sugar levels. Eventually, it leads to metabolic diseases.6
The good news is that weight loss works like some kind of sorcery here and it can reverse most metabolic diseases. Weight loss as little as 5% improves hormonal balance in PCOS, reduces insulin levels, and improves ovulatory function.7
That’s where nutrition comes in. Put on your big man/woman/whatever-gender-you-want-to-identify-as pants and let’s dial in your nutrition.
Turner-McGrievy et al8 found that women with PCOS fail to adopt eating behaviors associated with achieving a healthy weight.
They have a higher tendency to overeat in the presence of highly palatable foods and are susceptible to emotional eating (here’s how to stop it). Also, they don’t even attempt to restrict food intake consciously to achieve weight loss.
I know, it’s weird…
Why is that? Why is there so much confusion when it comes to nutrition for PCOS (and nutrition in general)?
Maaaaybe, just maybe, because the diet industry attracts a lot of quacks and bullshitters who are great at spreading pseudoscience and we’re are great at sucking it all in? Oh-oh, and we pay them for it too.
Here are a few common myths that we gladly deepthroated in recent years:
- Insulin resistance is the cause of why you gain weight with PCOS
Here’s the deal my virtual reader friend—even the scientists aren’t sure why women with PCOS are often overweight. One thing is damn sure though—insulin resistance doesn’t cause weight gain.
If anything, you would lose weight with insulin resistance because if your cells aren’t responding to insulin properly, you can’t store glucose into cells. It just floats in your bloodstream waiting to be burned for energy.
Gaining body fat comes from taking in more calories than you burn. Losing fat comes from burning more calories than you take in. That’s science. Not rocket science but still science.
- You have to go low-carb to lose weight with PCOS
Since insulin controls carbohydrate and fat metabolism, it’s plausible to think that eliminating carbohydrates from your diet would make you a ‘fat-burning furnace.’ Cut carbs, burn fat and kaboom, unwanted flab resting on your belly—no more.
While controlling carbohydrate intake is important, so too controlling calorie intake. Also, heaps of vital vitamins and minerals come from carbohydrates. So you don’t want to go too low with your carbohydrate intake (more about that later).
So stop believing that all you need to do to lose weight is to go full-blown keto (here’s why keto is dumb). I assure you, if you have a maintenance intake of 2,000 calories a day and you eat 5,000 calories a day of protein and fat with no carbs, you will gain fat. A lot. And fast. Lightning-fast.
As Tom Venuto, health and fitness writer once said,
Like the law of gravity, the law of energy balance keeps on working whether you believe in it or not.
- Women with PCOS can’t have sugary foods
It’s true that women with PCOS (like every mortal) have to limit sugary foods. Think juices, dried fruits, gummy bears, ice cream. Refined carbohydrates count too: pizza, donuts, cookies, white bread, etc.
While these foods affect blood glucose levels and might trigger cravings and binge eating, this doesn’t mean that you can’t have them like, ever. Hyper-palatable foods can be part of a healthy PCOS diet if enjoyed in moderation.
You don’t have to deprive yourself of sugary foods completely. Deprivation diets don’t work for three reasons:
1) Your body fights against them;
2) your brain fights against them, and
3) your day-to-day environment fights against them.
Food is a great pleasure in your life—not something you should compromise (I’ll soon teach you how to lose weight without deprivation).
- You have to go gluten-free
Whooooo, poison dipped, mysterious gluten!
You wouldn’t believe how many clients I’ve had who were convinced PCOS requires a gluten-free diet. There’s no scientific evidence to support this claim. None.
While you might lose weight avoiding gluten, it’s simply because products containing gluten tend to be hyper-palatable, calorie-dense junk. The formula goes something like this:
You cut products containing gluten from your diet → you cut gajillion of calories → you create a calorie deficit → weight loss, baby.
So unless you have celiac disease, there’s no reason to go full-blown gluten-free.
- Dairy is bad for women with PCOS
Again, someone just pulled that one out of his posterior (it must be a man, only men say crap like that).
There’s no scientific evidence to support it. Unless you have lactose intolerance, you don’t have to swear off dairy.
One wrinkle I want to add is that dairy can increase acne in some women. If you suffer from acne, you might want to limit dairy to two or fewer servings per day.
- PCOS and soy products are not a good match
There’s no evidence to support it (yup, I’ve repeated this for the 3rd time). That’s all I have to say about this. Let’s move on. No, seriously, we’re moving on.
Okay, grasshopper, we’re through pseudoscience nonsense. Now let’s see what you should do to both treat PCOS and lose weight:
1. Calorie Control
A healthy PCOS diet should control calorie intake first. Weight loss is only possible if you consume fewer calories than you burn. Reducing overall caloric intake is non-negotiable (read 5 laws of fat loss).
An energy deficit of 15-25% or 500 – 750 kcal/day should be your starting point. Adjust depending on your energy requirements, body weight, and physical activity level.
2. A Middle Finger To FAD Diets
You don’t need to follow FAD diets like keto or paleo to lose fat. In women with PCOS, there’s no or limited evidence that any specific diet type is better than another compared to women without PCOS.
General healthy eating principles should be followed for all women with PCOS versus a diet based on fear and unfounded claims by a misinformed dweeb on the internet.
3. Embrace Moderation & Flexibility
I’ve said this more times than a 15-year-old kid has browsed…: sustainability and dietary adherence are by far the most important factors for both losing and keeping weight off. Therefore, you need to tailor your food choices based on the foods you love and prefer.
Allow for a flexible approach to reducing calorie intake and avoid unduly restrictive and nutritionally unbalanced diets.
4. Control Carbohydrate Intake
As I said, controlling carbohydrate intake is important but so is consuming enough to have your energy high and dietary adherence in check.
Aim for a carbohydrate intake of 30-40% of total daily calories. This would translate to 105-140g per day or 30-40g per meal (if you eat 3-4 times/day) for an average weight female (166 pounds).
The number will vary depending on your body weight, age, and activity level.
5. Increase Protein And Healthy Fat Intake
I’ve discussed the importance of protein ungodly number of times so I’ll leave it out of this article. If you eat 3+ times per day, get 25-40g of protein per meal and you will get enough of it. Now go grab a protein shake.
Hey! Once that shake is down, come back and finish reading, goddammit.
Now that you’re back (you better be) let’s wrap it up.
You can find these fats in walnuts, pumpkin seeds, and linseed bread. Include 3-4 servings of fat each day. Add tuna and salmon to your diet at least 3-4 times a week.
6. Consider Using Supplements
First, you can’t “boost” your metabolism by taking This One Weird Fit Tea. No supplement will result in significant weight loss.
Most supplements suck and they have no magic powers to transport fat to a parallel universe. Stick to the basic supplements.
Again, consider supplementing with omega-3 fatty acids if you struggle to get enough from food. A 2018 meta-analysis showed that it can help with insulin resistance, high total cholesterol, and triglycerides.10
Arentz et al11 showed the possible effectiveness of omega 3, inositol, and Camellia sinensis for women with PCOS.
Here’s a fancy-pants infographic by Gunalan et al12 suggesting potentially effective supplements and effects on women with PCOS:
What’s The Deal With Exercise?
Here’s what we know as a collective group of rambunctious fitness geeks:
The most optimal way to lose weight is to reduce overall caloric intake via a combination of diet and exercise. As James Fell, health, and fitness writer for the Los Angeles Times observed,
You’d be a fool to ignore exercise as part of your weight loss strategy because it creates a suit of armor to protect you from the endless temptations of our toxic food environment.
Exercise improves diet, which reinforces exercising, which improves diet, which … creates a virtuous cycle. When it comes to health and fitness, would you rather be in a virtuous cycle or a death spiral?
Diet alone won’t cut it. Especially for women with PCOS because ANY exercise single-handedly improves insulin sensitivity. Sadly, half of the overweight or obese women with PCOS are not achieving sufficient activity to promote weight loss.13
So get your butt in a gear. You can do better than a typical doughnut-scarfing couch potato!
I’m a big proponent of resistance training but you are welcome to do any sport you find enjoyable. As long as you are not chilling on the couch, you’re good.
If you end up lifting weights though, go get one of my workout programs because there’s more to exercise than playing with pink dumbbells.
Oh-Oh! Just because you show up in the gym 3-4 times a week doesn’t mean you can park yourself on a couch for the rest of the week.
Get your daily 8,000-12,000 steps too (read why NEAT is so crucial).
It’s definitely not a stroll in the park to lose weight with PCOS. It sucks balls. But don’t confuse “hard” with “impossible.”
As long as you control your calorie intake, eat a balanced diet, and stay physically active, you can make it happen.
And please, no FADs and extremes. Focus on sustainable behavioral changes rather than a diet of extreme unsustainability that only allows you to eat foods that taste like an ashtray.
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