PCOS is a metabolic condition that comes with a host of symptoms. In fact, one of the biggest symptoms that women with PCOS contend with is weight gain. Furthermore, weight loss can be a struggle due to the hormonal environment. It can be difficult to figure out what to eat, how to eat, how to exercise, etc. There is so much information out there that it can be hard to determine which advice is true, and most beneficial. As a Naturopathic Doctor who looks at the body as a whole and is keen to spread the word about the unique intricacies of hormones, I’m here to break it down for you. Let’s bust some common myths about PCOS and Weight Loss.
Why do women with PCOS gain weight?
Women with PCOS are prone to gaining weight because of the unique hormonal environment that their body is exposed to. Ultimately, it all comes down to insulin. When we eat foods that contain glucose, insulin will bind to the cell’s receptor sites , which allows glucose to enter. This will be used to generate energy.
Insulin resistance is common with PCOS. This is when the cell becomes resistant to insulin, which in turn prevents it from binding to the receptor sites. This means that glucose cannot enter the cell. In turn, this results in higher insulin and glucose levels in the bloodstream. Higher insulin levels in the bloodstream can increase testosterone levels, contributing to a lot of the symptoms we see in PCOS. These include irregular menstrual cycles, acne, and increased hair growth.
Furthermore, higher levels of insulin and glucose in the bloodstream can result in inflammation, fatigue, increased hunger and most of all… weight gain.
What steps need to be taken to lose weight?
First things first, blood work should be completed to see the exact insulin and glucose levels. Then, a Naturopathic Doctor can guide you on how to eat for insulin resistance. We focus on which foods are best, how to build a meal with specific macronutrients, and then determine which supplements are required to support your cells’ function.
Myth #1: I need to be doing High Intensity Interval Training (HIIT) to lose weight
HIIT workout consists of short, high-intensity, anaerobic exercise followed by brief intervals of very low-intensity aerobic exercise. It’s a popular form of exercise for women with PCOS. Research notes that HIIT training can improve insulin resistance in women with PCOS. However, the question is: does it need to be high intensity or does moderate intensity have the same results?
A study published in the Frontiers of Physiology found that both HIIT and Continuous Moderate Intensity Exercise (CMIE) improved glucose levels in obese and overweight adults. (4) Additionally, a review by Harrison et al. looked at PCOS and moderate intensity exercise ranging from just aerobic, to aerobic with resistance, between 3-7 sessions a week and 30-55 minutes in length. It showed that regular moderate intensity exercise can help with ovulation, menstrual cycle regulation, weight loss, and insulin resistance. (2)
Keep in mind that if you’re getting burnt out after doing a workout, the intensity might be too much for you. This can spike your cortisol (stress hormone) levels and become counterproductive in helping with weight loss. As a result, I always recommend that if HIIT exercise is too much, then start with moderate intensity training. Moderate intensity exercise is defined as 60-90% of your maximum heart rate.
Myth #2: The Keto diet is the best way to lose weight for PCOS
The Ketogenic diet is all the rage right now. It was originally used as a treatment for epilepsy, and consists of high fat, high protein, and very low carbohydrates. There isn’t much research specifically on the Ketogenic diet and PCOS. One pilot study with only 11 women with PCOS showed that over a 24 week period, adherence to a low carbohydrate, ketogenic diet resulted in improvements in weight, reduction in free testosterone, LH/FSH ratio, and lower fasting insulin.
Even though the diet hasn’t been thoroughly investigated for PCOS, we know in theory, it can help PCOS symptoms. This is because it helps to improve insulin resistance, lowers inflammation, and can ultimately help with weight loss.
However, women with adrenal PCOS and hypothyroidism should be cautious with this diet. Our adrenal glands produce cortisol and adrenaline when we’re stressed, as well as androgen (testosterone) hormones such as DHEA, DHEA-S and androstenedione. Excess androgen hormones released by the adrenal glands can be one of the causes of PCOS.
In the research, we know that a diet very low in carbohydrates can increase cortisol levels. (3) Therefore, the Keto diet might not be the best solution for women with PCOS. Instead, it’s best to work with a healthcare provider who understands both the diet and PCOS in order to guide and support you.
Myth #3: Once the weight comes off, I can go back to my old way of eating. AND/OR I have to be strict with my diet forever.
It might seem daunting to deal with the idea that you have to change your whole diet forever. I often tell my patients that having PCOS and insulin resistance is a clue as to how to fuel your body appropriately. Once you start eating for your body, you’ll feel much better in terms of energy, and your body’s hormonal environment will change for the better. It is really all about learning what foods your body thrives on. Inflammatory foods such as dairy, gluten, and sugar might not be the best option long term, and can result in other conditions later on.
That being said, I often tell my patients that it’s okay to have that piece of cake, or indulge in some chocolate now and then. Eating a certain way doesn’t mean you can’t enjoy certain foods from time to time. These little indulgences won’t throw off all the hard PCOS weight loss work you’ve done: it’s all about balance!
Myth #4: Supplements don’t work for weight loss
When it comes to weight loss, it’s really important to identify what’s causing the weight gain in the first place. Once this is determined, specific supplements can be recommended. Often times in PCOS, insulin resistance can drive an increase in weight gain. One of the most researched supplements for insulin resistance is myo-inositol. A randomized, double-blind, placebo control trial with 92 women with PCOS showed that administrated myo-inositol resulted in significant weight loss. (1)
Myth #5: Pasta, grains, potatoes, and basically all carbs are bad for PCOS
Carbohydrates are not bad if you have PCOS. In fact, carbs have many nutrients such as B vitamins and minerals. It’s also important to note that carbohydrates aren’t only contained in grains, but are also within fruits, vegetables, and legumes. There are two important things to think about when consuming carbohydrates. First is the other foods that you pair them with, and second is the quantity you consume in each meal.
You want to limit your carb consumption in the morning, and increase the amount you eat as the day goes on. Additionally, always pair carbohydrates with protein and fats. This will slow down metabolization and prevent the body from creating blood sugar spikes. Also note that whole grain is better than white/processed carbohydrates, as whole grain products contain more nutritional value.
Key Takeaways from this article
- High intensity training is not necessary to lose weight
- The keto diet might not be the best diet for PCOS
- Once the weight is gone, balance is key, don’t revert to previous eating habits, but extreme diet control is not necessary for maintenance.
- Supplements can help with weight loss depending on the individual
- Not all carbs are bad for PCOS and some are even important. Also avoid carbs in the morning.
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- Gerli, S., Papaleo, E., Ferrari, A., & di Renzo, G. C. (2007). Randomized, double blind placebo-controlled trial: Effects of Myo-inositol on ovarian function and metabolic factors in women with PCOS. European Review for Medical and Pharmacological Sciences, 11(5), 347–354.
- Harrison, C. L., Lombard, C. B., Moran, L. J., & Teede, H. J. (2011). Exercise therapy in polycystic ovary syndrome: a systematic review. Human Reproduction Update, 17(2), 171–183. https://doi.org/10.1093/humupd/dmq045
- Mavropoulos, J. C., Yancy, W. S., Hepburn, J., & Westman, E. C. (2005). The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: A pilot study. Nutrition and Metabolism, 2. https://doi.org/10.1186/1743-7075-2-35
- Parker, L., Shaw, C. S., Banting, L., Levinger, I., Hill, K. M., McAinch, A. J., & Stepto, N. K. (2017). Acute low-volume high-intensity interval exercise and continuous moderate-intensity exercise elicit a similar improvement in 24-h glycemic control in overweight and obese adults. Frontiers in Physiology, 7(JAN). https://doi.org/10.3389/fphys.2016.00661