*The following is not intended to be medical advice nor do we claim to be professionals in endocrinology. Our main goal with this article is to share with you the practical information that we have gathered through our own research and more importantly, by working with actual clients with PCOS. Please consult with your medical provider before implementing anything you read from this article.

Let’s dive in!

Polycystic Ovarian Syndrome (PCOS) is a condition in which two of the three following criteria must be met to receive a positive diagnosis.

• Anovulation or Amenorrhea-  Irregular menstruation or a chronic lack of menstruation altogether.
• Hyperandrogenemia- High levels of androgens such as testosterone in the bloodstream.
• Polycystic ovaries- Unexplained cysts on the ovaries.

From the above, patients can then be categorised into four subgroups based on their corresponding symptoms. 

Phenotype A meets all three criteria (oligomenorrhea, hyperandrogenism and polycystic ovaries).

Phenotype B features hyperandrogenism and menstrual irregularities only.

Phenotype C have normal ovulation but elevated androgen levels and polycystic ovaries. 

Phenotype D is the syndrome’s mildest form. Patients with this phenotype lack hormonal disturbances and the syndrome presents as menstrual irregularity with PCOS morphology.

Unfortunately, diagnosis and what actually causes PCOS in the first place still remains very controversial as assessment and management appear to be inconsistent amongst medical professionals. This can lead to many women remaining undiagnosed for years, leading to more serious metabolic conditions such as insulin resistance, high cholesterol, increased cardiovascular risk, impaired fertility, diabetes and endometrial cancer.

In fact, this study consisting of 1385 women with PCOS found that around 33% of them remained undiagnosed for over 2 years and had to go through three different medical providers before receiving proper treatment. 

PCOS & Weight Loss

Despite many of the myths surrounding PCOS, the one that most of our members and readers are concerned with would be the ability to lose weight. Yes, depending on the severity of your symptoms and where on the spectrum you fall between the phenotypes, weight loss may be slightly more challenging but it will never be the factor that is preventing weight loss.

Unfortunately, many women can fall into the trap of using their diagnosis as an excuse when in fact, their symptoms are vastly improved when they lose weight. This is because weight loss can:

• Improve the function of the ovaries which in turn reduces excess growth of facial/body hair.
• Restore regular menstruation.
• Improve chances of successful pregnancy.
• Bring down systemic (whole body) inflammation.
• Improve insulin sensitivity.

Still not convinced? Check out what RNT’er Komal had to say.

“When I first started my journey with creating good eating habits & weight training. I was in awe of the physical changes which drove my motivation. However that was just physical, the rest soon followed. Lowered thyroxine dosage, less tiredness, added glow to my skin, more agile as well as better cardiovascular performance. After my first round with RNT I also had a scan to confirm that I no longer had any signs of polycystic ovaries. This meant I’d reversed it without any medication or ops. Pure nutrition & training. I think that alone speaks volumes.”- Komal

Insulin Resistance

Before we go on, it’s important to have an understanding of what exactly insulin and insulin resistance is. The reason for this is that this appears to be the backbone of every major reported reason as to why losing weight is far more difficult when you have PCOS. 

Insulin is a hormone that is responsible for regulating the amount of glucose in our bloodstream at any one time. It does this by shuttling excess glucose into the liver, muscles and body fat stores as high blood glucose levels can be extremely damaging to the body. 

In healthy individuals, the appropriate amount of insulin is released in response to a meal to get the job done as efficiently as possible. The less insulin you need to produce, the more insulin sensitive your cells are making them very effective at “soaking” up the glucose. A good way to think about this is to picture the cells as opening the door for the glucose before it even has time to knock. 

When the cells of your body start to become less effective at taking up glucose, the pancreas responds by producing more and more insulin to get the job done. This would be akin to the glucose showing up to the cell (normal amount of insulin), ringing the doorbell with no answer (more insulin) and then banging on the door (even more insulin). This is because each cell has a finite capacity to store energy and if it’s full, it’s not going to open up it’s doors meaning new storage depots (fat cells) must be formed to accommodate the excess.

The more fat we gain (especially around the organs), the more insulin the pancreas needs to produce. Do this for a long enough time, and the pancreas eventually cannot keep up with the resistance of the cells leading to chronically high blood glucose levels which ultimately lead to type 2 diabetes. 

How Does This Relate To PCOS?

Up to 80% of women with PCOS have insulin resistance and are seven times more likely to develop diabetes in comparison to women without the condition. Reversing this should be one of the top priorities in managing your health but it’s important to remember that it’s NOT the factor preventing you from losing weight.

It’s the result of eating too many calories, not exercising enough, not getting enough quality sleep and not prioritizing your self care in general.

Let’s dive deeper.

What About My Metabolism?

There is no evidence to show that the resting metabolic rate of women with PCOS differs from women without the condition. Granted, this is only one aspect of metabolism but any differences you would see are going to be extremely negligible that have more to do with behaviour. For example, research has found a correlation between a higher prevalence of binge eating with women with PCOS while also noticing that women who have bulimia nervosa are more likely to have polycystic ovaries.

Increased appetite, poorer impulse control and overall body dissatisfaction seems to be the underlying mechanisms of action here. From a hormonal perspective, being insulin resistant along with having higher than normal androgens can impact appetite in a negative way, leading to overconsumption but as we will discuss later, good nutritional and lifestyle habits can go a very long way.

Also, it’s important to note that not all women who have PCOS are overweight. Despite being far less common, there is a “lean subtype” where these women have all the same metabolic markers (including insulin resistance) yet manage to keep their BMI under 25.

This demonstrates that as long as you are able to sustain a caloric deficit through diet, exercise and lifestyle interventions, any minor fluctuations in metabolism mean nothing in the grand scheme of things. 

We understand that this can be much easier said than done but the bottom line is that your metabolism isn’t the linchpin that is preventing you from getting in shape. A lot of the time, many women feel embarrassed to admit that they are binge eating or overeating in general but if you’re not sharing this information with either yourself or a professional, you are going to continue spinning your wheels. 

If you are looking to learn more about overcoming binge eating along with some of the strategies we use, check out Bijal’s transformation.

Do I Have To Eliminate All Carbohydrates?

Absolutely not. 

Fundamentally, a lower carbohydrate approach does appear to be better suited for many women with PCOS but this does not mean completely avoiding them altogether. In fact, by focusing on more complex carbohydrates such as fruits, vegetables, potatoes, oatmeal, beans and lentils, you can still enjoy a moderate amount of carbohydrates while still dropping weight.

Why? The above carbohydrate sources contain fibre which we know helps control blood sugar by slowing down the absorption of glucose into the blood. By combining those foods with a protein source along with some healthy fats, you will be able to manage your blood sugar levels to a great degree leading to higher levels of sustained energy, satiety and appetite regulation.

When all of the above is in check, the ability to stay in a calorie deficit becomes much easier without unnecessary restriction. 

Coach Sanjeeta went through her entire transformation while also dealing with PCOS. There was never a point where she had to eliminate carbohydrates and in fact, her staple (and favourite) meal was a bowl of oats every evening!

Glycemic Index & Glycemic Load

We have previously discussed the glycemic index (GI) on how in the context of a healthy meal containing protein, fibre and healthy fats, a “high GI” carbohydrate source such as bread or white rice has virtually no negative impact on your body composition or blood sugar regulation. 

In the context of someone with PCOS, this does become more important which is why opting for lower GI carbohydrate sources (as mentioned in the previous section) are going to be a better choice. 

There is another caveat here that is worth addressing too and that is the total amount of carbohydrates someone is consuming or, the “glycemic load”. Oats and sweet potatoes may be a great option from a GI perspective but if you eat too much in one sitting, you may run into some problems.

To work out the glycemic load (GL) of a food you want to use the below formula:

(GI x g of carbs) / 100.

Let’s use 100g of sweet potato as an example.

GI= 62

Carbohydrates= 20g

62 x 20/100 = 12.4

A good rule of thumb would be to aim for a GL score of anything <20 meaning 100g of sweet potato would be perfectly fine. 

If you were to double the amount to 200g though, this would bump the score to 24.8 putting you above the recommended score.

If you’re not keen on geeking out on specific numbers, using your plate as a reference can be a really simple way to make sure you’re managing your intake effectively.

• ¼ of your plate contains a lean protein source.
• ½ of your plate contains a heap of vegetables with a moderate amount of /healthy fats.
• The remaining ¼ can be made up of a high fibre starch.

  

Overall, the main goal here is to not only control the quality of carbohydrates consumed but also the quantity. For most, this means having 1-2 meals per day with the above “plate” while the others should look more like this:

Dairy

We will briefly touch on dairy and its impact on acne as it’s another hotly debated topic. 

Dairy products have been shown to stimulate IGF- 1 (insulin like growth factor) which in turn, increases insulin levels. Skim and whole milk have also been shown to have a 3-6 fold higher glycemic load in comparison to other carbohydrate sources, but not cheese. 

Interestingly enough, there hasn’t been that much research examining the link between dairy and PCOS but from what we do know, some women can tolerate dairy just fine.

This study showed that when incorporating a DASH (Dietary Approaches to Stop Hypertension) diet approach to 48 women with PCOS, there was a noticeable improvement in symptoms across the board ranging from weight loss, improved insulin resistance and inflammatory markers. A DASH diet is rich in fish, poultry, fruits, vegetables, wholegrains, and low-fat dairy produce.

In the context of an overall healthy diet that incorporates all of the factors we have discussed today, including 1-2 servings of dairy each day coming from sources such as yoghurt, hard cheese or whole milk can be fine for many women.

As always though, find what works best for you and if you notice issues when consuming dairy products despite doing everything right, it may not be on the cards for you.

PCOS & Exercise

Outside of the standard guidelines for activity, there is nothing an individual with PCOS needs to do differently whatsoever.

Weight training is fantastic for reversing insulin resistance as it promotes “non insulin mediated” transport of glucose into the cell. This means your muscles can soak up glucose without the need of insulin at all. Moderate to intense cardiovascular work can have a similar impact so pick a form of exercise you really enjoy. The more you move, the better.

Walking is great for stress management and reducing cortisol which in turn, helps manage blood sugar more effectively too. Cortisol’s main job is to raise blood glucose levels so if you are consistently stressed out, not sleeping enough or not moving enough then you are only going to be making your situation much harder. 

Another great way to manage blood sugar levels would be to incorporate a 10 minute walk after each meal. Make it a habit to go for a little walk after each meal or better yet, go with a friend!

Supplements?

If you implement everything we have discussed today so far, you will be putting yourself in a very advantageous position in managing PCOS. Nothing will ever be able to beat a solid nutrition, training and lifestyle plan but there is some promising research on a specific supplement that may be a fantastic “cherry on top” of the proverbial cake.

This supplement is “inositol” and it has been shown to:

• Promote female fertility
• Improve insulin sensitivity
• Reduce anxiety/ panic attacks
• Improve symptoms of depression
• Help control binge eating tendencies

If this was something you were interested in, speak to your medical provider first as they will be able to give you further guidance on adequate dosages for your specific situation.

Putting It Altogether

Being diagnosed with PCOS doesn’t mean that you cannot get into shape. As you may have realised, getting into shape is actually the best thing you CAN do for managing your PCOS.

It can make certain aspects of your journey more difficult but not for the reasons you may think. With proper guidance, a willingness to learn about your body along with taking 100% ownership of your situation, there is absolutely no reason that you cannot get into the shape of your life.

• Your hormones are a little messed up. That is fine, you can still lose weight.
• Your metabolism is fine for the most part. It will not prevent you from losing weight.
• You can eat carbohydrates. Just the right ones in the right amounts.
• You might be able to eat dairy. You may not. Find what works.
• Move as much as you can. Exercise is a god send for you.
• Consider inositol supplementation.
• See your friends and loved ones. Don’t be a recluse.
• Prioritise your sleep. You will find it much easier to stick to things when you’re well rested.