This post was updated on December 7th, 2020
There are few things more demoralizing than regaining weight following a hard won diet.
Unfortunately, soul crushing frustration is almost an inevitable consequence for women with PCOS when they try to lose weight using traditional dieting techniques. People don’t fail diets – the diets fail them, and it’s a scientific fact that restricting calories is a terrible idea when you suffer from this disorder.
PCOS is a unique health condition that requires an equally unique approach to achieve effective and sustainable weight loss. Showing women how to do this the right way is exactly what my free 30 Day PCOS Diet Challenge is all about.
During this live event, thousands of women from around the world begin a path toward lifelong wellness in spite of living with a PCOS diagnosis. Using tailored PCOS recipes like those found in this free 3 Day PCOS Meal Plan, as well as evidence based nutritional video lessons and daily activities, I’ve had the fortune of watching thousands of women lose weight with PCOS without restricting calories.
This includes women like Kendall who lost over 100 pounds after following what she learned during my free Challenge. In this article you’ll find everything you need to know about how Kendall, and many others like her beat all the odds to achieve great health outcomes.
If you’re tired of brutal diets that you find impossible to stick to, and you’d rather follow practical dietary and lifestyle principles that are backed by real science rather than old-fashioned nonsense, then here’s 15 essential steps you should take to achieve a healthy body weight that is sustainable long term.
1. Avoid Restricting Calories
Even for women without PCOS, diets that seek to restrict your energy intake have been proven not to work. Back in 2007, researchers from UCLA systematically analyzed 31 diet studies to assess their effectiveness. The result: They found that only a tiny minority of dieters sustained their weight loss with the vast majority regaining more weight than they lost within a few years (Mann et al 20071).
Sadly, this is fairly old news, and yet restriction dieting is still seen as the only way to lose weight by many health professionals.
While short term weight loss of 5-10% within the first 6 months is fairly common, it’s been known for a long time now that long term relapse rates can be over 80% (Swanson & Dinello, 19702), with weight gain continuing to occur the longer you keep track of a previous diet participant (Hensrud et al. 19943).
Restriction dieting is actually one of the best predictors of future weight gain, which is why experts have recommended that weight-loss programs not be funded as a treatment for obesity. The benefits are too small and the potential harm is too large.
This was certainly the experience of Bianca, a previous participant in my free 30 Day PCOS Diet Challenge. After struggling with her weight her entire life and hitting 240 pounds in the weeks before we met, she had a surgeon lined up and had booked an appointment for a gastric sleeve. She just didn’t think it was possible to lose weight any other way.
Fortunately, she was willing to give her relationship with food one more try so she cancelled her appointment and signed up for the free Challenge in the second half of 2016 instead. By the end of the year Bianca had lost 30 pounds, and two years later had not only continued to approach her ideal body weight, but she’d actually managed to fall pregnant naturally despite her previous infertility.
There are some fairly good biological reasons why restriction diets don’t work as a weight loss treatment:
- We’ve evolved a sophisticated regulatory system that includes appetite hormones that tell us when we’re hungry. When you don’t eat enough in an attempt to lose weight, these hormones kick us in the guts in a bid to find satisfaction. Ignoring these powerful hunger cues takes enormous self-control which no one but the toughest disciplinarians amongst us can sustain long term.
- Brain chemicals like neuropeptide Y are secreted when they sense that you’re not getting enough calories (and carbohydrates). These increase your desire to binge and literally cause cravings for carbs and sweet foods. Good luck fighting those off in the late afternoon when work is getting stressful and that vending machine seems to be calling your name…
- Our bodies get stressed by caloric restriction diets and produce high levels of cortisol and adrenaline in response. These hormones slow down our metabolism and promote fat storage as a survival response. From a biological perspective, our bodies can’t tell the difference between dieting for your wedding and a cataclysmic famine.
Then there are some pretty intense psychological barriers too. Being “on a diet” feels terrible right? You feel deprived and depressed because you can’t have this, and you can’t have that. I don’t know anyone that would want to feel this way all the time, especially when just that one little candy bar looks so perfectly cute and innocent…
The take home point here is that if you want to lose weight and sustain it over the long term, then don’t bother with diets that limit your calories. You’re likely to do yourself more harm than good.
But if the most traditional tool for losing weight is off the table, where then does that leave us?
As I explain in my free 30 Day PCOS Diet Challenge, food is still the best PCOS weight loss treatment. But rather than starve participants thin, during this live event I show women how to eat in a way that works WITH your PCOS to achieve lasting weight loss.
To understand how this works, there are three things you need to know about PCOS and how this unique condition causes unfair weight gain. The first is that PCOS is characterized by abnormally high androgen levels and chronic low grade inflammation. The second is that insulin resistance is a common co-occurring disorder. And third, that elevated cortisol levels are a key cause of PCOS weight gain.
I know these can sound like fairly obscure and unrelated ideas, but understanding these three core concepts provides a massive advantage to anyone with PCOS that wants to lose weight for good.
To set you up for serious success, we are going to take a quick look at each of these concepts in the following 3 steps.
2. Take High Androgens & Inflammation Seriously
To understand how to lose weight with PCOS, you first need to have a working understanding of how PCOS weight gain happens in the first place.
Any women with PCOS who’s having trouble with weight loss is almost certain to have elevated levels of androgens (male sex hormones such as testosterone) and chronic low grade inflammation. This menacing pair are far more threatening to that button on your jeans than any amount of double chocolate ice-cream.
Inflammation triggers our ovaries to over-produce androgens (Gonzalez 20124), while our excess androgens promote further inflammation in a vicious loop (Gonzalez et al. 20125). This problem is made worse if you’re overweight (Lindholm et al. 20116), but you don’t need to be overweight for inflammation and elevated androgens to be a negatively affecting you. These are actually some of the defining aspects of a PCOS diagnosis as they occur in women of normal body weight too (Gonzalez et al. 20117).
Since elevated androgen levels and chronic inflammation are the root cause of our PCOS, addressing these issues through better food and lifestyle choices is the most effective way to not only lose weight, but to also improve fertility, reduce acne, and get rid of unwanted hair.
Everything included in the steps below has to be about addressing these two problems, and this is why my next point is especially important.
3. Be Aware Of How Insulin Resistance Causes PCOS Weight Gain
Insulin resistance is a common feature of PCOS affecting between 50 – 70% of women depending on who you ask. If high androgen levels and inflammation are the head honchos at the PCOS weight gain factory, insulin resistance is the work-horse because it causes our bodies to store, rather than burn, energy.
Insulin resistance, along with its partner in crime cortisol, is responsible for the excess body fat that accumulates around our waist and is so powerful that roughly 30% of normal weight women with PCOS also struggle with stomach fat (Carmina et al. 20078).
I can attest to this as someone with the leaner type of PCOS. While I never had any issues with body weight in the past, even as a teenager I struggled with excess stomach fat. I can remember missing out on pool parties because I was afraid of people seeing me in a swimsuit.
For some weird reason, the link between PCOS, insulin resistance, and weight gain seems to have passed over the heads of many health professionals. It’s heart-breaking to meet so many women through my free 30 Day PCOS Diet Challenge that have been berated for not being able to lose weight with dieting.
The reality is though, that without the right information and support just eating less and doing more exercise simply doesn’t help you overcome PCOS weight gain.
Insulin is the hormone that tells your body to store glucose as fat. The higher your insulin levels, the more body fat you’re likely to accumulate independent of your caloric intake. This relationship has been demonstrated in studies that look at weight changes in diabetic patients when they begin receiving insulin shots to manage their blood glucose levels (Henry et al. 199380). This type of “insulin therapy” typically results in weight changes of 7 – 20 pounds (3 – 9 kg) within just a year (Brown et al. 201781).
The take home point here is that if weight loss is something you’re serious about, then decreasing insulin resistance, rather than limiting calories, is a great way to achieve your health goals.
But this is also why insulin resistance really sucks for women with PCOS.
When we eat, our blood glucose levels rise as the foods get broken down by our gut. Insulin is then produced to transport the glucose out of our blood and into our various cells. When we’re insulin resistant this process doesn’t happen efficiently which then causes us to have high insulin levels across the day, ultimately leading to more body fat accumulation.
Once you understand this mechanism, the next step is to make diet and lifestyle changes that lower your insulin levels. This is a key part of many of the powerful PCOS weight loss steps that I talk about below.
4. Manage Your Cortisol Levels
So far I’ve explained how high androgens, chronic inflammation, and insulin resistance are the key causes of PCOS weight gain. But there’s just one piece missing to complete the puzzle and that piece is cortisol.
Cortisol is commonly referred to as the stress hormone, and in collaboration with the other causes I’ve mentioned already, this powerful steroid has a massive effect on our body weight. Particularly when it comes to stomach fat.
Coming back to my own experience with having excess stomach fat despite being otherwise fairly slim, I now realize that this phenomenon was largely driven by high cortisol levels. This also explains why I used to always feel stressed and anxious all the time. I experienced this again recently after the birth of my son where the stress and anxiety of having a baby packed the pounds back onto my stomach.
Cortisol is produced by the adrenal glands in response to a stressor and from a biochemical perspective our bodies care little whether that stress is caused by a tiger chasing you or is based on the psychological demands of a normal busy life.
Repeated elevation of cortisol has three pathways for making you gain weight when you have PCOS:
- Promoting fat storage around the mid-section.
- Increasing your blood glucose levels which raises insulin (see step 3 above)
- Increasing cravings particularly for sugar and carbs which raises your insulin further!
Cortisol also has the unfortunate feature of creating a positive feedback loop in relation to body fat. Not only does cortisol cause stomach fat accumulation, but the more abdominal fat you accumulate the more cortisol you produce. This is because fat tissues release proinflammatory compounds that promote insulin resistance and stimulate the production of more cortisol (Makki et al. 201382).
This is why I say that a good PCOS weight loss plan has to include the management of cortisol levels, which you’ll see me mention throughout many of the following weight loss steps below.
Possibly one of the best examples I’ve seen where managing cortisol levels really makes a difference was with a woman named Hanna. As an active athlete and dancer, Hanna had always been thin, but she still struggled with excess stomach fat like I did.
During my free 30 Day PCOS Diet Challenge, Hanna followed my anti-inflammatory, insulin conscious meal plans (like the one included in this free 3 Day PCOS Meal Plan). She then continued her progress during my 10 Week Program and completed the exercise module included within it – the perfect combination for reducing cortisol levels.
While falling pregnant naturally a few weeks after the program had ended was by far her biggest accomplishment (she’d previously never gotten her period), she also managed to lose all her excess stomach fat and build great functional muscle tone.
5. Get In Synch With Your Fullness Hormones
One of the biggest concerns I hear from people when I tell them they don’t need to watch how much they eat is that they’re worried they’ll eat too much instead.
This just simply isn’t a real risk when you eat healthy whole foods and follow the right PCOS diet.
Every time I run my free 30 Day PCOS Diet Challenge I become more convinced of this fact as I hear from numerous women saying they’re finding my serving sizes too large, only to hear from them a few weeks later telling me how much weight they’ve lost.
It’s not that I’m making people eat more calories with my recipes. They often don’t. The reason they feel so satisfied after making one of my meals is that the ingredients I use collaborate closely with our diverse set of fullness hormones. Here’s a few examples that describe what I mean:
- Leptin is a satiety hormone that reduces appetite and makes you feel full. By making yourself satisfying recipes like those I use in this free 3 Day PCOS Meal Plan you increase your sensitivity to leptin by avoiding inflammatory foods especially sugar and trans fats, and by adding anti-inflammatory foods like salmon and walnuts instead (Sureda et al. 201883).
- Cholecystokinin (CCK) is another satiety hormone that has been shown to reduce food intake in both lean and overweight people (Perry and Wang 201210). Food that increases CCK includes protein (Foltz et al. 200811), healthy fats (McLaughlin et al. 199812), and beans (Bourdon et al. 200113).
- Ghrelin is a hunger hormone that tells your brain when it’s time to eat. The less ghrelin in your system, the less you feel like eating. There are two main ways in which you can promote this natural calorie control phenomenon with better food choices: you can avoid sugar which acts to increase ghrelin levels (Teff at al. 200414; Ma et al. 201315), and you can eat foods that provide adequate protein which helps suppress this hormone (Blom et al. 200616; Lejeune et al. 200617; Gannon et al. 201118).
- Cortisol levels are also reduced by providing a balanced diet that doesn’t restrict your calories and as I mentioned in Step 4, less cortisol means less cravings for sugar and carbs.
- Neuropeptide Y stimulates appetite particularly for carbohydrates as I mentioned earlier in Step 1. Two of the best ways to lower Neuropeptide Y are to eat enough protein (White et al. 199419), and to feed healthy gut bacteria with prebiotic foods (Holzer and Farzi 201520).
- Glucagon-Like Peptide-1 (GLP-1) is a hormone produced in your gut that keeps blood glucose levels stable and helps you feel full. Increasing GLP-1 is understood to be one of the mechanisms by which gastric bypass surgery works so well for weight loss (Osto et al. 201521). Any easier way to increase GLP-1 though is to eat plenty of fish (Madani et al. 201522) and leafy greens like spinach and kale (Montelius et al. 201423). Taking every opportunity to reduce inflammation (Gagnon et al 201524) and promoting a healthy gut microbiome with probiotics (Yadav et al. 201325) have also been shown to help.
- Peptide YY is another gut hormone that controls appetite and reduces food intake (Arora et al. 200626). Recipes like those included in my free 3 Day PCOS Meal Plan increase peptide YY by providing appropriate amounts of carbohydrates, protein, and fiber from whole food sources.
As you’ll soon see, a lot of the remaining steps below are all about putting this useful theory into practice and why you’ll find all of the above-mentioned foods in my popular free PCOS Diet Cheat Sheet and this free 3 Day PCOS Meal Plan.
6. Ditch The Sugar
I’m all about reducing body fat in a healthy sustainable manner, but nothing helps you lose weight with PCOS faster than quitting sugar. During my free 30 Day PCOS Diet Challenge it’s not uncommon for people to lose 10 – 15 pounds within a few short weeks with high achievers like Ashley losing more than 20 pounds in 30 days.
But just telling someone to quit sugar is not as straight forward as it may seem so if you’ll bear with me, I’ll give you the quick explanation on how to do it correctly.
Fructose and glucose are the two simple sugars that make up just about every kind of sugary food. Eating significant amounts of glucose is unhelpful for both PCOS and weight loss because your body needs to produce more insulin in order to process it. The glucose found in sugar also helps cortisol sabotage the hard work you’ve been doing at the gym by promoting the accumulation of visceral fat (Gyllenhammer et al. 201484).
But while glucose is unhelpful, fructose is simply harmful. Unlike glucose which is used by every cell in your body, fructose can only be metabolized via the liver leading some experts to call it alcohol without the buzz (Lustig 201327).
Once in the liver, intermediate fructose metabolites overwhelm the cells energy centers leading to the creation of excess liver fat and the development of insulin resistance. This not only exacerbates our already elevated risk of many chronic diseases, but it also makes all of our PCOS symptoms worse.
From atherosclerosis to the inability to form a healthy zygote with your partner, fructose causes the A-Z of PCOS symptoms and is the mother load of bad ideas when it comes to food choices.
So how do we go about quitting sugar? Here are a few simple tips that can make a big difference to your long term success:
- Get really good at spotting all the different sources of sugar in your diet. I discuss this in detail in my foods to avoid blog where I also provide a helpful checklist of the most common problem foods.
- Remember that even natural sweeteners like honey, maple syrup, and coconut sugar are best avoided because they still contain 50% fructose despite being marketed as “healthier”.
- When absolutely needed, choose glucose only sweeteners like brown rice syrup or dextrose. Pure stevia is another suitable alternative as this herb derived sweetener has a slightly positive effect on your blood glucose levels and appears to be generally safe (Carrera-Lanestosa et al. 201728; Mathur et al. 201729).
- Minimize the risk of cravings by following the right PCOS diet. This should include plenty of healthy proteins and fats that leave you full and not reaching for that candy bar.
- Avoid all sources of dietary fructose beyond what you’ll find in 1-2 modest servings of fruit each day.
While I know how impossible this might sound at first, there really is light at the end of the tunnel. Once you’ve avoided sugar for a few months, your taste buds change so much that you’ll find foods you used to love become too sweet and you no longer want them.
A woman named Karina, who I had the pleasure of working with in early 2017 is a great example of someone who had dramatic weight loss results from quitting sugar.
When we first met, Karina was struggling with PCOS and at her all time highest weight. She had tried dieting on many occasions but it never took her long to fall back into old habits and regain any weight that she managed to lose. She had bad acne, her hair was thinning, she had a lot of male hair growth, and she hardly ever got her period.
The number one reason for this was she suffered intense sugar cravings that she simply couldn’t reason with. None of this was Karina’s fault. If anything should be apparent from my earlier explanation, Karina’s food choices were predominantly influenced by the powerful hormones that control our cravings.
When she started my free 30 Day PCOS Diet Challenge she was 187 pounds. And then she discovered how to work with her PCOS.
Karina began eating a diet rich in whole foods and vegetables like the meals provided in my free 3 Day Meal Plan and this gave her the opportunity to quit sugar without suffering from withdrawals. She lost 12 pounds in one month, and nine months later she was down 60 – just two pounds short of her goal weight. She actually said to me that she doesn’t really think about sweets anymore because she’s no longer getting cravings. Amazing!
Maybe this is the first time you’ve really considered quitting sugar seriously? If it is, and your nervous then let me assure you that if committed addicts like Karina and me can do it, you can too.
7. Eat Carbohydrates Wisely
All carbohydrate foods are broken down by digestion into the simple sugar glucose. Given that glucose is both a key ingredient in PCOS inflammation (see Step 2 above), and also directly increases insulin levels (Step 3) any good PCOS diet plan for weight loss is going to pay attention to this food group.
It doesn’t take much of a search when trying to learn how to lose weight with PCOS naturally to discover that low carb diets are a great idea. But this popular idea can lead to adverse outcomes if you’re not careful with some of the most common mistakes I see people make including:
- Reducing your carbohydrate intake too low which then triggers intense carb cravings (see Step 5) or flu-like symptoms.
- Not getting enough dietary fiber leading to poor gut health, and discomfort.
- Re-directing your restriction diet mentality to a subset of foods in the form of ‘macro counting’. This promotes and sustains an unhealthy relationship with food, rather than dealing with our emotional connection to food or learning to trust our bodies more (see Step 5).
When it comes to carbs, my advice for anyone wanting a healthy, simple, and sustainable PCOS diet plan for weight loss is to eat low carb, and slow carb, from whole food sources.
As I describe in more detail here, eating low carb to me means getting around 20 – 30% of your energy intake from carbohydrate sources, while slow carbs are foods that have less impact on your blood glucose levels (aka. “Low GI”). The whole food sources constraint means we’re choosing foods that are perfectly packaged with the full array of nutrients, just as nature intended.
When put into practice my low carb, slow carb, whole food sources principle means every meal has either:
- 3 – 8 oz (85 – 230 g) of starchy vegetables like sweet potato, yam, taro, corn, parsnip and squash. The serving size depends a little on how starchy the vegetable is.
- 3 oz (85 g) per meal of gluten free grains like quinoa, buckwheat, and black rice.
- Or approximately 5 oz (140 g) per meal of beans, lentils or peas.
For a comprehensive list of my recommended low GI carbohydrate foods make sure to download this free PCOS Diet Cheat Sheet.
8. Make Peace With Fat
If there’s one thing that mainstream “nutrition experts” have clearly gotten wrong it’s the view that people need to eat less fat.
Wholefood sources of fat – even saturated fats, do not make you fat.
They do not give you heart disease (Siri-Tarino et. al 201030), and they should be embraced as part of any healthy and sustainable PCOS weight loss diet.
Anyone who tells you otherwise, regardless of their qualifications, is simply not keeping up with the scientific research. Even the creators of the dietary guidelines are wrestling with how to roll back decades of bad advice as Nina Teicholz so eloquently describes here.
Fatty cuts of meat, oily fish, butter, and anything made from coconuts should all be eaten liberally without self-consciousness or concern about your weight. These foods are actually good for your PCOS and can help you weight (see my PCOS Diet Cheat Sheet for a list of healthy fats and oils).
Here are a few of my favorite reasons why:
- The medium chain triglycerides (found predominantly in coconut oil) help us lose weight particularly from around our stomach and thighs (St-Onge and Jones 200285; Mumme and Stonehouse 201531).
- Certain fats found in beef and butter are good for your arteries (Mooney and McCarthy 201232), help with glucose tolerance and insulin action (Ryder et al. 200133; Castro-Webb et al. 201234), and reduce body fat (Blankson et al. 200035; Kennedy et al. 201036).
- Saturated fats improve your cholesterol as countless studies have shown (Fattore et al. 201437, Schwingshackl and Hoffmann 201438; Dreon et al. 199839).
- Eating fats with carbs lowers the glycemic index. The presence of fat slows the rise in your blood glucose levels after a meal, which means less insulin, and less fat storage.
- Fatty food is super-duper filling. This is because of the effect fat has on our fullness hormones leptin and CCK (see Step 5). If you find yourself snacking a lot in the morning, try having steak and eggs for breakfast and then see how you feel.
- Eating a high fat diet is the best way to quit sugar. Again this comes back to our satiety hormones. If we can apply this logic and have more fat throughout the day, then it’s far less likely you’ll think about sweets.
- Cooking with lots of butter, ghee, or lard makes eating vegetables easier which most of us need to do more of to lose weight healthily. We all know vegetables are good for us, but getting them down can feel like a chore if they’re bland and boring. Nothing helped me go from a vegetable hater to an ardent fan more than discovering how much better they taste when cooked in plenty of fat.
This is why both my free 30 Day PCOS Diet Challenge as well as my free 3 Day PCOS Meal Plan include plenty of healthy fats in all of the recipes. Fat is your friend, and the sooner the two of you can get your relationship back in order the better off you’ll be. Plain and simple.
9. Eat Plenty Of Fish, Meat And Eggs
While I’ll possibly never fully grasp the molecular biology behind it, it’s well known amongst biochemists that when we have inadequate nutrition, the energy status of our cells switches to promote fat storage. These switches work off nutrients and not calories which means you can be eating plenty of calories and gaining weight but still be undernourished.
When you get into the intracellular processes at play, nutrition is a ridiculously complicated field that gets more confusing the more I try to learn about it. At the end of the day though, the practical advice of every expert I follow always seems to be that if we want to be adequately nourished in order to lose weight, then we should eat plenty of whole foods, particularly fish, meat, and eggs.
The advantage of animal derived foods is that they’re super nutrient dense and not only provide us with the right combination of all the essential amino acids, but they also deliver a wide range of micronutrients that signal to our cells that all is well. This means that rather than worrying if they’ll have enough resources to make it through the day, our cellular fat storage processes can relax in the knowledge that they have everything they need to keep our various organs functioning properly.
I know that plant based diets are popular amongst many PCOS circles, but as I explain here, I don’t think these are optimal for anyone wanting to achieve meaningful PCOS weight loss.
If you’re like me, and you feel bad about eating animal derived foods (I was once a vegetarian for this very reason), then choosing the best quality sources you can afford may provide some consolation. While the ethics of “happy meat” is a bit of a slam-dunk, there seems to be consistent evidence showing its better nutritionally too.
For example, on a gram for gram basis, grass fed beef has been shown to be much higher in omega 3 fats and conjugated linoleic acid (CLA) than its grain fed counter parts (Daley et al. 201041). While the antioxidant properties of omega 3 fats seem to be fairly universally appreciated, what few people seem to be aware of is that CLA is the ultimate weight loss fat.
This fat, which comes primarily from beef, lamb, butter, and ghee has been well documented to improve body composition (Blankson et al. 200042; Kennedy et al. 201043). CLA is such a great weight loss agent that people try (somewhat unsuccessfully) to use it as a weight loss supplement. As irony would have it, CLA’s effects seem to work best when eaten as a whole food rather than taken as a pill…
Several studies suggest that grass fed beef also has higher amounts of vitamin A and E, as well as cancer fight antioxidants such as glutathione (Descalzo et al. 200744) and superoxide dismutase (Gatellier et al. 200445).
These are the kind of facts that you can really use to convince your family to switch to a PCOS friendly diet with you. When they start to object to you changing the menu, just tell them that Prime Rib counts as a health food now!
10. Heal Your Gut For Long Term PCOS Weight Loss
Everyone’s gut is populated by a ridiculous number of bacterial cells that together make up our microbiome. There are so many of those little-guys in there that if I had a dollar for each of mine, I could pay off the US national debt and still afford a long overdue cut and color.
As the gatekeepers of our digestive system the microbiome has a massive influence on our body composition. While researchers have only recently begun to unravel the mysteries of the microbiome so far we know that it affects how much we eat (Fetissov et al. 200846), our metabolism and fat storage mechanisms (Ramakrishna 201347; Backhed 201148; Backhed et al. 200449), and even the way in which we absorb nutrients (Jumpertz et al. 201150).
It’s also now known that the bacteria in our gut has a causal effect on both insulin resistance and obesity (Saad et al. 201651; Rabot et al. 201052) which is particularly salient for women with PCOS, especially those that are struggling with their weight.
Supporting our microbiome is one of the simplest ways we can treat our PCOS diagnosis and here’s a few simple ways we can achieve this:
- Quit sugar. Our microbiome was never designed to run on a high sugar diet so it’s no surprise that reducing our sugar intake can improve the balance of these microbes.
- Eat more prebiotic foods. Prebiotics are foods that feed our microbiome and include things like Jerusalem artichokes, garlic, onion, leek, shallots, spring onion, asparagus, beetroot, fennel bulb, green peas, snow peas, sweet corn, and savoy cabbage (Monash University 201653).
- Make probiotic foods a regular habit. Probiotic foods are foods that actually contain live strains of healthy gut bacteria. They also make for great snacks in many cases. Some of my favorites include things like coconut yogurt, pickles, sauerkraut, miso, and tempeh.
- Consider taking probiotic supplements. While the research is still in its infancy, there are a lot of promising studies showing the efficacy of probiotic supplements for the treatment of insulin resistance (Kim et al. 201854). For women wanting to lose weight with PCOS and especially those that have trouble with their digestive systems, I recommend considering probiotic products such as VSL#3, Visibiome, and Custom Probiotics. I have no affiliation with these brands but I recommend them because they are exceptionally potent, they’ve had independent studies that have assessed their effectiveness, and I’ve personally had great results with them too. Most over-the-counter probiotics only have tens of billions of bacteria per dose and are far less likely to be beneficial compared to these products which count their microbes by the hundreds of billions. They might cost more, but they’re definitely worth it in my experience.
- Be judicious with antibiotics. Antibiotics are designed to kill bacteria and they do so indiscriminately. This means the good guys get taken out, as well as those that may be making you sick. Obviously if you really need them then you really need them, but I always recommend avoiding antibiotics as much as is humanly possible.
- Stress less. Both acute and chronic stress are well known to affect various functions of our gastrointestinal tracts (Konturek et al. 201155) – this will seem fairly obvious if you’ve ever experienced nervous “butterflies” or anxiety-induced nausea. As our knowledge base grows, it’s becoming increasingly clear that the neurotransmitters and hormones produced under stress have a direct effect on microbiota and that these changes in turn adversely affect health (Lyte et al. 201156; Bailey et al. 201157; Bailey et al. 201058).
Achieving improvements in gut health is an easy win that a lot of women comment on during my free 30 Day PCOS Diet Challenge. Not only does this help with weight loss, but women also report sleeping better, and feeling happier. These results make perfect sense in light of the close relationship between our microbiome and the gut-brain axis.
11. Know Which Foods To Avoid
If you’ve gotten this far through the list, then you’ll be down with the idea of reducing inflammation to achieve meaningful weight loss.
So what’s the easiest way to have a profound effect on this primary mechanism of PCOS weight gain? Eliminate the foods to avoid I describe in detail here.
- Sugar. Any food that contains significant amount of fructose is like rocket propellant when it comes to fueling fat storage.
- Refined Carbohydrates. These break down quickly into glucose causing your blood sugar and insulin levels to spike which in turn leads to body fat accumulation.
- Vegetable Oils. These oils have no relationship to real vegetables and contain high amounts of pro-inflammatory omega 6 fatty acids.
- Industrial Trans Fats. Found in processed foods like frostings, microwave popcorn, packaged pies, frozen pizzas, margarines and coffee creamers, industrial trans fats are so bad for you even the recalcitrant FDA has agreed they are no longer “generally recognized as safe”. Despite this recent move by the FDA which went into effect in June of 2018, industrial trans fats can still be used as “food additives” so it pays to be vigilant and always check ingredients list for “partially hydrogenated oils”.
- Gluten. This common group of proteins are used in so many foods it’s almost impossible to avoid it without intentionally doing so. It’s also one of the foods you’re most likely to have an undiagnosed intolerance to so going gluten free can make a massive difference to both your PCOS symptoms generally, as well as your body weight more specifically.
- Dairy. Like gluten, many women with PCOS have a dairy intolerance that hasn’t been diagnosed yet. Quitting all sources of dairy apart from butter is a powerful way to reduce systemic inflammation and improve your body composition. Butter is the only dairy food that’s okay to eat as it’s almost 100% fat (excluding the water content) and it doesn’t contain any of the problematic sugar and proteins found in milk.
- Other Food Intolerances. While this comes down to your unique circumstances, there are many other foods that can cause sub-clinical sensitivities that promote inflammation and drive fat storage. Common examples include eggs, peanuts, tree nuts, fish and shellfish.
- Soy Products. Yes, there’s evidence suggesting soy is anti-inflammatory, but in my view it should generally stay off the shopping list because of the adverse effects it can have on our estrogen functioning (which promotes fat storage). I make an exception here for fermented soy products.
- Processed Meats. While they’re unlikely to be a primary problem food, I recommend avoiding processed meats because of the other junk that goes into making them. Sugar, dairy proteins, MSG and nitrites etc. None of these additives makes losing weight easier.
- Caffeine. Caffeine goes against the grain of many of the strategies described throughout this article. It increases cortisol and insulin levels, can disrupt sleep, and may harm your gut. Not really the friend you need when you’re trying to lose weight with PCOS…
- Alcohol. Most women with PCOS underestimate the harmful effects of alcohol which are made worse by our increased rates of non-alcoholic fatty liver disease (Vassilatou 201459; Kelley et al. 201460). Even small amounts of alcohol consumption can be more harmful for women like us and we all know that drinking less is a simple way to lose weight.
If you can afford to see a Functional Medicine doctor or Naturopathic doctor (which I highly recommend), then they’re likely to give you this list of foods to avoid even before they’ve seen your test results. A well-informed doctor like the types I just mentioned will normally have you eliminate these problem foods as a first line therapy for most chronic illnesses because doing so is incredibly effective and it costs so little to implement.
This list of foods to avoid is one of the practical applications of Steps 2, 3, and 4 above. Once you understand the mechanisms that cause women with PCOS to gain weight faster than other people, the argument for replacing processed foods with whole food alternatives becomes even more compelling.
12. Learn How To Manage Your Stress Levels
Reducing and managing stress can sound like one of the least scientific ways to lose weight with PCOS. That’s until you understand that chronic psychological stress is one of the best ways to elevate your cortisol levels and destroy your gut health.
The more we’re exposed to cortisol, the more likely we are to store fat around our mid-section, and to experience sugar cravings that can quickly unravel any positive dietary progress we’ve been making.
As I witnessed after the birth of my son, the cortisol weight-gain connection is strong. Not only did I start gaining weight rapidly due to sleepless nights and the usual first-time-mom anxieties, but I also quickly saw my ever slim hubby packing on the pounds despite our PCOS friendly diet remaining unchanged. Turns out that kids are responsible for the infamous Dad-bod’ after all…
In all seriousness though, after doing a less than pleasant retest of his microbiome (he’d done one a few years earlier), it turned out that the stress of a newborn had dramatically reduced some of the healthier strains of bacteria in his gut. After nine months of taking some potent probiotics, continuing to eat well, and getting a little more sleep, his abs are now slowly re-emerging from their cushy hideout.
While I know my husband’s “baby gut” sounds pretty unrelated to PCOS weight gain, I’ve found this an interesting case study of how stress affects our gut which in turn leads to stomach fat accumulation even if you don’t suffer from insulin resistance. This problem is even worse if you’re dealing with weight gain caused by PCOS.
Within the scientific literature it has also unfortunately been shown that women with PCOS are both more likely to suffer adverse effects as a consequence of stress (Cooney et al. 201787; Barry et al. 201161) while also being less well-equipped to cope when confronted by stressful situations (Benson et al. 200963).
So what can we do about it?
Well, when it comes to stress and anxiety management, I tend to think about it in two ways – direct, and indirect.
Direct methods include things like removing stressful triggers in your life, cognitive behavioral therapy, relaxation exercises, mindfulness meditation, and self-compassion exercises such as those described by Dr Kristin Neff.
Indirect approaches focus primarily on fostering a more kind and compassionate relationship with yourself.
As friends, girlfriends, wives, moms, and sisters we often set high expectations for ourselves that we can’t possibly sustain. Learning to be more realistic with our expectations, and being kinder to our human failings is one of the best ways we can lower our stress levels.
13. Get Enough Sleep
Here’s a PCOS weight loss strategy I’m sure you’re going to love.
Not only is getting enough sleep one of the best ways to improve your resilience to stress, but after dietary changes, sleep is the second most powerful lifestyle intervention for managing your body weight.
If this sounds far-fetched, then here’s a short selection of findings from the scientific literature:
- Poor sleep is well understood to cause greater hunger and more disinhibited eating with studies showing a clear link between poor sleep quality and weight gain (Blumfield et al. 201864).
- If you’ve ever done an all-nighter before, then it’ll come as little surprise that not getting enough sleep makes you naturally crave sugar, while a good night’s sleep reduces the onset of cravings (Smith et al. 201665; Al Khatib et al. 201866).
- Recurrent nights of insufficient sleep has been shown to increase insulin resistance in healthy adults (Van Cauter 201167; Nedeltcheva et al. 200968) while obstructive sleep apnea (which adversely affects sleep) is a known determinant of insulin resistance and type 2 diabetes in women with PCOS (Tasali et al. 200869).
- Inadequate sleep increases inflammation which not only makes your PCOS worse and drives weight gain, but also increases your risk of cardiovascular disease and type 2 diabetes (Irwin et al. 201670).
- Even short term sleep restriction has been shown to make you less likely to engage in physical activity which tips your energy homeostasis towards weight gain (Schmid et al. 200971).
What all these studies indicate is that even mild sleep deprivation over a long period will contribute to significant weight gain. Lack of sleep messes with the hormones that control appetite, satiety, and fat accumulation and decreases both our willpower and our better judgement when it comes to food and physical activity.
Nearly a third of Americans get six hours of sleep or less per night (Krueger and Friedman 200972) which is far greater than the tiny percentage of people that have a genetic polymorphism that lets them function properly with this much sleep. For the vast majority of us, we should be getting at least 7 – 8.5 hours of sleep per night, especially if you’re trying to lose weight.
If you’re thinking this might be easier said than done, then you may have a point as part of having a PCOS diagnosis means you’re also twice as likely to suffer from sleep disturbances (Moran et al. 201573).
The good news though is that improvements in sleep quality is one of the most common things I hear about from women taking part in my free 30 Day PCOS Diet Challenge. My theory is that this is mostly due to people quitting sugar, but all the beneficial nutrition from my PCOS friendly recipes has to be making a big difference too.
Besides improving your diet there’s other simple steps you can take to improve your chances of a good night’s rest. These include:
- Going to be bed before 10 pm. This helps you fall asleep faster as this is when your cortisol levels are at their lowest.
- Avoiding blue light from screens. The light produced by your TV, phone, tablet, or computer suppresses the secretion of melatonin and interrupts your circadian rhythm.
- For over-active minds, guided relaxation exercises, sleep meditations, or boring yourself to sleep with the Wall Street Journal audible version is an unstoppable ticket to lala-land.
So if it’s getting late and you’re still reading this blog on your phone, it’s time to go bed now. You can read the rest in the morning.
14. Make Exercise A Habit
When it comes to prioritizing the different ways we can treat PCOS weight gain there’s no doubt that dietary change is the most effective approach with sleep coming in a close second. For people looking at a more complete lifestyle transformation though, regular exercise is a simple no-brainer.
The thing that I like the best about exercise is the positive effect it has on our psyche. Working out is empowering. It makes us feel great about ourselves, and boosts our emotional health with far greater effect than any antidepressant or anxiolytic medication.
Exercise improves happiness and who doesn’t want more of that?
When it comes to PCOS, exercise is well known to be an effective lifestyle treatment. While high intensity interval training is now well understood to be a time-efficient strategy to decrease fat from the stomach (Maillard et al. 201874) recent pilot studies have specifically shown that this kind of exercise can improve insulin resistance and body composition in women with PCOS (Almenning et al. 201575).
Researchers have also found that progressive resistance training is highly effective in improving PCOS symptoms (Cheema et al. 201476), with the main mechanism being the way this kind of training makes our muscles more sensitive to insulin and more tolerant to glucose.
There’s no doubt that the research is still in its infancy as large scale trials identifying the best exercise protocols for PCOS are yet to be conducted. But you really don’t need to wait. If you want to lose weight with PCOS fast and keep it off forever then there’s no question that getting active is a great idea, however you chose to do it.
Creating new exercise habits seem to be a common theme with many of the success stories that graduate from my full 10 Week Program. Sarah adopted a sustainable gym routine to help her steadily lose 30 pounds over a 12 month period while Bianca K. who I mentioned at the top of this article, uses yoga and weight training to sustain her PCOS friendly lifestyle.
15. Get Your Thyroid Checked… The Right Way
27% of women with PCOS suffer from thyroid disorders compared to just 8% in the normal population (Garelli et al. 201377). This is extremely important because just like PCOS, having an underactive thyroid can cause unexplained weight gain, heavy or irregular periods, infertility, thinning hair, dry skin, insomnia, fatigue, muscle and joint pain, depressed moods and more.
It’s no co-incidence that these mutually exclusive disorders have so much in common as both are primarily an autoimmune disease. For most people with hypothyroidism it’s their immune system that’s the problem.
While thyroid issues like Hashimoto’s should be excluded by physicians when diagnosing PCOS, the unfortunate reality is that a LOT of women fall through the cracks and suffer the consequences of undiagnosed, or subclinical hypothyroidism.
Taking medications like birth control is a major risk factor for drug-induced thyroid problems because the oral estrogens used in these drugs lowers the free thyroid hormones available for your body. (Grüning et al. 200786). They also deplete selenium, zinc, and the amino acid tyrosine which are all needed for proper thyroid function (Palmery et al. 201387).
According to Dr Izabella Wentz in her book “The Root Cause”, the effect that birth control has on our hormones and immune system can actually be a trigger for thyroid dysfunction. This was pretty shocking news to me given that “the pill” is the first thing most of us are prescribed when we had period problems in our teens.
Fluoride containing drugs can also be a major trigger as fluoride is a known thyroid toxin (Prystupa 201188). Examples include the most commonly prescribed drugs used for acid reflux, anxiety and depression, yeast infections, UTI, and for lowering cholesterol levels.
You can find a full list of fluoride containing drugs here.
When you look into it, the list of drugs that interfere with your thyroid seems almost endless. At the end of the day, if you’ve been taking medications for a long time, then there’s a good chance that they’re messing with your thyroid. And if you’re trying to lose weight, then this is an important health indicator worth getting checked.
I really wish I had known this years ago, as the hypothyroidism I developed in my early thirties is almost certainly a result of a decade of antidepressant use.
Once in a while I’ll be working with someone who struggles to lose weight despite admirable compliance with the PCOS weight loss steps outlined above. This can be an exceptionally frustrating experience but it’s almost exclusively a result of an undetected thyroid disorder. This also explains why other women can take longer to see the benefits of a PCOS friendly lifestyle.
And here’s the biggest thing to keep in mind: Even if you’ve been told that your thyroid function is fine by your doctor there’s a good chance they’re wrong.
When most doctors test your thyroid they’ll order a panel that includes TSH and T4 only. The first problem with these markers is that the “normal” ranges used to identify illness are not developed based on what’s considered healthy, but instead represent a normal distribution of all the people that have been tested before you. The shortcoming of this approach of course is that healthy people generally don’t get their thyroid tested so you’re comparing yourself to other unwell individuals.
Perhaps the bigger problem though is that there are several types of thyroid disorders than can’t be detected using only the standard TSH and T4 tests. In his free ebook Thyroid Disorders, the well-known Functional Medicine Practitioner, Chris Kresser, describes five of these thyroid patterns.
The one most relevant to women with PCOS though is caused by elevated androgen levels (the primary cause of PCOS, as I described in Step 2) and insulin resistance. With this pattern, TSH and T4 are usually in the normal range and it’s only by testing three other markers that a diagnosis can be made. These three markers are T3, T3 uptake, and thyroid binding globulin (TBG).
My advice is to discuss testing for all of these markers with your doctor before concluding that your thyroid function is normal.
Even then though, there are several ways which you can still have thyroid issues while still passing these tests. Understanding how to correctly diagnose and treat thyroid disorders is a massive topic I won’t get into further now, but if you want to learn more then I highly recommend downloading a copy of Thyroid Disorders by Chris Kresser. This short free ebook is a patient-centric educational resource that can help you guide your physician in the right direction.
While thyroid disorders can be super complicated, what I can say for sure is that the best solution in all cases of hypothyroidism is to follow a PCOS friendly lifestyle. The steps that have been shown to make the biggest difference include eliminating gluten entirely from your diet, avoiding inflammatory foods especially vegetable oils and sugar, regulating your blood glucose levels through strategic consumption of carbohydrate foods, promoting a healthy gut microbiome, and reducing stress.
If you’ve read this article in full then hopefully these ideas might be sounding familiar to you? Thyroid dysfunction really is the twin sister of PCOS so what’s good for one, is also good for the other.
The Best Next Steps To Take
When it comes to losing weight with PCOS the power of our beliefs cannot be overstated.
I’ve seen so many inspirational success stories in just the past few years that I really want to impress on you just how transformational the 15 steps above can be. Not only can you overcome PCOS weight gain and achieve your ideal body weight, but these same principles can help you treat all your other PCOS symptoms too. Because you’re addressing your high androgen levels and chronic inflammation with all these strategies, things like acne, hirsutism, and fertility are all going to be significantly improved as well.
If you’re ready to get started on this amazing new lifestyle, the biggest lever you can pull is the food you choose to eat.
The easiest way to take action right now is to download yourself a copy of my free 3 Day PCOS Meal Plan. If you’re up for a more comprehensive experience that includes group support, then I highly recommend joining my next free 30 Day PCOS Diet Challenge.
It doesn’t matter how overweight you think you are, how long you’ve been dieting for, or how hopeless your situation may seem, if you apply these PCOS weight loss principles then I promise you’re going to see results.
Unfair weight gain has to be one of the most predictable and treatable PCOS symptoms out there so don’t put up with it for another day. Today’s your day, so start over and finally give yourself the health you deserve.
Kym Campbell is a Health Coach and PCOS expert with a strong passion for using evidence-based lifestyle interventions to manage this disorder. Kym combines rigorous scientific analysis with the advice from leading clinicians to disseminate the most helpful PCOS patient-centric information you can find online. You can read more about Kym and her team here.
This blog post has been critically reviewed to ensure accurate interpretation and presentation of the scientific literature by Dr. Jessica A McCoy, Ph.D. Dr McCoy has a master’s degree in cellular and molecular biology, and a doctorate in reproductive biology and environmental health. She currently serves as a University professor at the College of Charleston, South Carolina.
This blog post has also been medically reviewed and approved by Dr. Sarah Lee, M.D. Dr. Lee is a board-certified Physician practicing with Intermountain Healthcare in Utah. She obtained a Bachelor of Science in Biology from the University of Texas at Austin before earning her Doctor of Medicine from UT Health San Antonio.
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