Losing weight is a challenge that many women with PCOS face at some point in their lives. If this is you, then you are probably already aware that you can’t just do what an average person would do to lose weight; it often doesn’t work (even if you’ve tried, and tried and tried!). We have one main hormone to blame for this struggle, and it is that same hormone that will trigger our androgenic symptoms such as acne, hair growth, and irregular cycles. The culprit here is none other than the metabolic hormone – insulin. All women with PCOS – not just overweight women- have been shown to have changes in insulin sensitivity (1) and high levels of insulin will stimulate the ovaries to produce androgens, such as testosterone. Once elevated, the androgens impact menstrual regularity and contribute to acne, hair loss and hirsutism. To treat the cause of these unwanted symptoms, and to effectively lose weight, we need to identify and treat the underlying insulin resistance.
This sounds straight forward, however, as many of us have experienced, it is not quite so easy to do.
Even when following a whole foods diet and taking supplements, many women with PCOS find that their weight still won’t budge. This becomes particularly disheartening to the many patients I see who are exercising regularly, tracking their calories, avoiding sugar, and putting in lots of hard work!
So, what do you need to do differently?
Timing Our Meals
For successful weight loss in PCOS, not only do we need to be exercising and eating the right foods, but also the timing of our meals is probably the most overlooked factor. Research has shown that taking in the majority of our calories at breakfast was able to not only improve markers of insulin sensitivity, but also reduce the high androgen levels and improve ovulation in women with PCOS (2). This study tells us that we have to flip our caloric intake around – instead of ingesting the majority of our calories with our dinner; we want to actually take them in during the morning.
We should aim for a breakfast that is around 700 kcal for this to be effective. This is a lot, I know! What I often recommend to patients is that they split up these calories into 2 morning meals, especially if they are not very hungry first thing when they wake. I’ve been using a calorie structure of 700-500-200 recently in the clinic with many women, with excellent results. That’s 700 calories for breakfast, 500 for lunch, and 200 for dinner. This is actually quite the opposite of what we normally eat, however it really helps to regulate our leptin and insulin levels and as such can break plateaus in weight loss for women with PCOS beautifully.
It is important to also assess the composition of our meals. Women with PCOS do well on a lower glycemic index diet (3), which is one that won’t spike your blood sugar levels, so taking the time to plan out recipes and snacks is imperative. Your meal should revolve around a high quality protein source, contain lots of non-starchy vegetables and healthy fats.
Several studies have highlighted the therapeutic value of foods that are high in healthy fats – such as fish (3), almonds and walnuts (4) – as being key to balancing insulin and improving inflammatory markers in PCOS. Since nuts have a high caloric density, they are a great option to incorporate during the morning meals.
Taking the right supplements can also be key to improving insulin sensitivity, and studies support the use of chromium, vitamin D and Omega-3 in PCOS (3).
Incorporating these specific foods and supplements, and following this pattern of caloric intake improves insulin resistance and treats the underlying hormonal dysregulation of PCOS. I see this every day in clinical practice.
It’s not easy to break out of a pattern that we are used to (admit it, how many of you are actually skipping breakfast?). However, once we are able to introduce a change, the benefits should be immediate. When insulin and glucose levels are balanced, we feel much more energetic, have significantly fewer food cravings and have a better ability to think clearly and make healthy food choices.
Women following this diet are thrilled to finally be able to achieve weight loss at a healthy rate, but further, they are not feeling hungry, nor are they craving certain foods as before. For many of us, managing the cravings is a big part of the battle. The whole reason to reset glycemic balance is to move away from the idea of a short term “diet” or intervention, but rather to move towards a new and sustainable lifestyle – one in which you can both look and feel your best.
Don’t give up! Incorporating this new paradigm of meal composition and meal timing can significantly shift the underlying hormones in PCOS.
- Morales AJ1, Laughlin GA, Bützow T, Maheshwari H, Baumann G, Yen SS. Insulin, somatotropic, and luteinizing hormone axes in lean and obese women with polycystic ovary syndrome: common and distinct features. J Clin Endocrinol Metab. 1996;81(8):2854-64.
- Jakubowicz D, Barnea M, Wainstein J, Froy O. Effects of caloric intake timing on insulin resistance and hyperandrogenism in lean women with polycystic ovary syndrome. Clin Sci. 2013;125(9):423-32.
- Rondanelli M, Perna S, Faliva M, Monteferrario F, Repaci E, Allieri F. Focus on metabolic and nutritional correlates of polycystic ovary syndrome and update on nutritional management of these critical phenomena. Arch Gynecol Obstet. 2014;290(6):1079-92.
- Kalgaonkar S, Almario RU, Guirusinghe D, Garamendi EM, Buchan W, Kim K, Karakas SE. Differential effects of walnuts vs almonds on improving metabolic and endocrine parameters in PCOS. Eur J Clin Nutr. 2011; 65 (3):386-93.