PCOS Weight Loss

How to Lose Weight with PCOS

Polycystic ovarian syndrome (PCOS) is the most common hormonal and metabolic disorder in women. It impacts up to 20% of women during the reproductive years, from puberty to menopause.

Up to 80% of women with PCOS struggle with weight; PCOS can promote weight gain and make weight loss incredibly challenging. Because lifestyle factors, like nutrition, exercise, and sleep habits, influence hormone production and metabolism, lifestyle changes are a necessary part of the PCOS weight loss approach.

Beyond conventional PCOS medications, such as metformin and birth control pills, integrative and functional medicine works to uncover the root causes of disease and bring the underlying factors into balance.

The goal isn’t simply short-term weight loss but long-term health, regular menstrual cycles, hormonal balance, and a well-functioning metabolism. A crash diet won’t get you there; treatment requires a multifactor approach and time to build new lifestyle habits.

Keep reading as we explore PCOS and weight loss. This article will cover:

• The PCOS-weight connection
• What is the best diet for PCOS? PCOS nutrition research
• Weight loss vs. weight maintenance
• Integrative support for PCOS

PCOS and Weight

PCOS is a complex disorder diagnosed when there are two of the three criteria present:

1. Elevated androgens or androgenic symptoms
2. Irregular or absent menstrual cycles
3. Polycystic ovaries

The brain, ovaries, and adrenal glands are the primary endocrine systems involved with PCOS. Besides elevated androgens (like testosterone and DHEA), other hormonal imbalances, including insulin resistance and estrogen dominance, can also affect metabolism and weight. PCOS hormonal imbalances drive weight gain, and weight gain drives imbalances.

Women who are overweight or obese and have PCOS have lower levels of sex hormone-binding globulin (SHBG) compared to women with a “normal” BMI, which increases free testosterone levels and disrupts ovulation and fertility. Women with PCOS already have a greater risk for diabetes, and obesity increases this risk more.

PCOS exists on a spectrum, and the symptoms and hormonal imbalances women experience can vary greatly. While not everyone with PCOS is overweight, weight loss is primary reason women with PCOS seek integrative care.

PCOS Nutrition Research

Nutrition plays a role in PCOS development (although PCOS also has a genetic component), and nutrition is also an essential piece of the PCOS treatment and weight loss strategy. But what is the best diet for PCOS? Let’s look at some of the research.

Several diet strategies have been investigated and show benefits for shifting metabolic markers, hormone levels, and weight. Here are some diets PCOS researchers have studied:

• A balanced diet and nutrition education: Nutrition education along with dietary changes leads to greater weight loss than diet alone. Support when making lifestyle changes influences the outcomes.

• Plant Rich Mediterranean diet: This strategy supports weight loss and reduces inflammation by focusing on complex, fiber-rich carbohydrates, antioxidants, omega-3 fats, and monounsaturated fats (like olive oil).

One study compared nutrition logs of PCOS patients with matched controls following a Mediterranean eating plan. In the study, women with PCOS ate less olive oil, beans, fish, and nuts and more simple carbs and total fats than the control group. This data suggests that adherence to the prescribed diet is an important piece of the intervention.

• Ketogenic diet: With a ketogenic diet, 70% of daily calories come from fat, and with a very low-carb ketogenic diet, fat accounts for up to 90% of the daily intake. These very high fat approaches shift the metabolism into burning fat (including body fat) for energy. In PCOS, ketogenic diets are associated with improvements in body weight, body composition, and hormone levels. However, long-term adherence to a ketogenic diet is challenging and may require extra support from your healthcare team to adhere to a cardio-metabolically healthy version that is low in saturated fats and high in polyunsaturated fats.

• Low-glycemic diet: Choosing low-glycemic carbohydrates (high-fiber whole carbs) produces a lower insulin response than high-glycemic ones (refined grains and sugar) and helps with blood sugar management. Research suggests a low-glycemic diet helps manage PCOS symptoms.

• DASH diet: Dietary Approaches to Stop Hypertension (DASH) is a diet strategy developed for blood pressure management. It can also help improve insulin resistance, inflammation, and the hormone profile in women with PCOS. This diet emphasizes fruits, vegetables, whole grains, beans, and low-fat dairy, while removing red meat, refined grains, and sugar.

Research suggests many dietary approaches support weight loss in women with PCOS. The common denominator between all diets is a plant-rich approach. There are benefits to a high protein diet, low fat (like DASH) or high fat (like ketogenic), or low carb (like ketogenic) or higher carb (like Mediterranean). Researchers have even compared approaches, finding no significant difference between a vegan diet and an omnivorous one or between a low-glycemic diet and a low-calorie diet. It matters that the overall dietary pattern is high in fiber, antioxidants, polyphenols and healthy fats and low in saturated fat, trans fats and refined carbohydrates.

The truth is, you’ll see benefits anytime you shift the diet away from a standard American diet (SAD) and processed food and toward a nutrition pattern composed primarily of whole foods.

Weight Loss Vs. Maintenance

Most research looking at specific nutrition interventions provides short-term data. Participants will follow a dietary approach for a few weeks to a few months. This timeframe is important to keep in mind as many diets will produce initial results. What’s much harder is maintaining nutrition habits and a healthy body composition over time. If you’ve ever followed a weight loss plan and lost weight only to regain it, you’ve experienced this firsthand.

Contradictory nutrition data and the lack of consensus about the “best” diet for PCOS also speak to the importance of personalized nutrition. There isn’t one approach that will work for everyone with PCOS who wants to lose weight. And there isn’t one approach that will be sustainable for each person, given their lifestyle, genetics, goals, and other factors.

Integrative Support

An integrative PCOS weight loss strategy is personalized for each woman’s needs and focuses on healing from multiple angles. An integrative approach considers Western medical approaches (like medications) and holistic modalities, including nutrition, lifestyle, and supplements.

Let’s look at some of the key integrative strategies to support weight loss in women with PCOS:

• Reframe weight loss. Yes, weight loss is important, but what’s more critical is correcting metabolic dysfunction and achieving a healthy body composition for you. Focusing on this mindset shift takes the pressure off the number on the scale and helps you focus on the strategies that will produce results.

• Personalize nutrition. Work with your TārāMD nutritionist for guidance and support. Start by shifting to a whole-food plan, cooking more, and building new habits. Within this framework, there is ample room to personalize your nutrition for your body’s needs and find strategies for long-term success.

• Address the root causes. Your TārāMD team will help you uncover and address the root causes of PCOS, inflammation, and excess weight. These may include:
  • Gut health
  • Stress
  • Blood sugar regulation
  • Nutrient deficiencies
  • Hormones
  • Thyroid health
  • Endocrine disruptors
  • Mindset

Please read A Functional Medicine Approach to Weight Loss to learn more about this root cause approach.

• Increase exercise intensity. Exercise is a crucial component for shifting metabolic health with PCOS. Research suggests that exercise intensity is more important than dose. Vigorous aerobic exercise improves body composition, cardiovascular fitness, and insulin resistance in PCOS. Recommendations range from 90 to 120 minutes of higher intensity exercise per week as part of the 150 minutes minimum total physical activity.

• Prioritize sleep. Quality sleep is essential for healthy hunger cues, insulin response, and metabolic health. Prioritize 7 to 8 hours of uninterrupted sleep each night. If sleep is challenging, please read How to Get Better Sleep for Women’s Health for strategies.

• Treat drug-nutrient interactions. Most medications, including prescription and over-the-counter medications, deplete some of the body’s nutrition. For example, Metformin is commonly prescribed in PCOS to help improve insulin sensitivity, and in the process it depletes thiamin (vitamin B1) and vitamin B12. Supplementing with these nutrients can ensure the body maintains optimal levels for metabolic health.

• Use quality supplements. With nutrition and lifestyle foundations in place, supplements offer targeted support to support nutrient levels, metabolism, mitochondria (cellular energy production), inflammation reduction, and other mechanisms involved with weight. Supplementation requires a personalized approach and working closely with your TārāMD team. Some research-backed options to consider include:
  • Inositol
  • NAC – n-acetyl cysteine
  • ALA – alpha lipoic acid
  • CoQ10 – coenzyme Q10
  • Vitamin B12 and folate
  • Vitamin D, vitamin E, vitamin K
  • Bioflavonoids
  • Calcium, zinc, selenium, chromium
  • Omega-3s
  • Melatonin
  • Probiotics
  • Cinnamon
  • Berberine
  • Turmeric

Weight loss is challenging in general, but particularly so with women with PCOS. The metabolic and hormonal dysfunction of PCOS requires an integrative approach to address each woman’s root causes. There isn’t one strategy or diet to follow; instead, the answer is personalized care and drawing from the integrative toolkit.

References

1. Alesi, S., Ee, C., Moran, L. J., Rao, V., & Mousa, A. (2022). Nutritional Supplements and Complementary Therapies in Polycystic Ovary Syndrome.Advances in nutrition (Bethesda, Md.), 13(4), 1243–1266.
2. Gu, Y., Zhou, G., Zhou, F., Wu, Q., Ma, C., Zhang, Y., Ding, J., & Hua, K. (2022). Life Modifications and PCOS: Old Story But New Tales.Frontiers in endocrinology, 13, 808898.
3. Barrea, L., Verde, L., Camajani, E., Cernea, S., Frias-Toral, E., Lamabadusuriya, D., Ceriani, F., Savastano, S., Colao, A., & Muscogiuri, G. (2023). Ketogenic Diet as Medical Prescription in Women with Polycystic Ovary Syndrome (PCOS).Current nutrition reports, 12(1), 56–64.
4. Barrea, L., Arnone, A., Annunziata, G., Muscogiuri, G., Laudisio, D., Salzano, C., Pugliese, G., Colao, A., & Savastano, S. (2019). Adherence to the Mediterranean Diet, Dietary Patterns and Body Composition in Women with Polycystic Ovary Syndrome (PCOS).Nutrients, 11(10), 2278.
5. Szczuko, M., Kikut, J., Szczuko, U., Szydłowska, I., Nawrocka-Rutkowska, J., Ziętek, M., Verbanac, D., & Saso, L. (2021). Nutrition Strategy and Life Style in Polycystic Ovary Syndrome-Narrative Review.Nutrients, 13(7), 2452.
6. Cowan, S., Lim, S., Alycia, C., Pirotta, S., Thomson, R., Gibson-Helm, M., Blackmore, R., Naderpoor, N., Bennett, C., Ee, C., Rao, V., Mousa, A., Alesi, S., & Moran, L. (2023). Lifestyle management in polycystic ovary syndrome - beyond diet and physical activity.BMC endocrine disorders, 23(1), 14.