Polycystic Ovary Syndrome (PCOS) is an endocrine disorder that is said to affect 5-10% of women of reproductive age. Having PCOS can lead to metabolic challenges, including hormone imbalances and increased risk of insulin resistance. Women with PCOS may find that they gain weight and struggle to lose weight.
If you have PCOS and are wanting to lose weight, this can support some of the PCOS symptoms and reduce certain associated health risks. Here we will detail the best strategies to look after your health whilst aiding weight loss for those with PCOS.
What are the main symptoms of PCOS?
PCOS presents as a number of different symptoms – a diagnosis of PCOS requires at least 2 out of the following 3 characteristics:
– Irregular menstrual cycles
– Elevated male hormones (hyperandrogenism)
– Cysts on ovaries
Many, though not all women who are diagnosed with PCOS can face challenges linked to weight gain, particularly abdominal fat accumulation. This can contribute to insulin resistance, increasing the risk of type 2 diabetes and cardiovascular disease.
What is insulin resistance?
Insulin resistance (IR) is when the body does not respond to the hormone insulin as it should. Insulin is a hormone released by the pancreas, helping to regulate blood sugar levels. Normal action of insulin causes the body to remove sugar from the blood and into cells, to be used for energy. With IR, cells become less responsive to the action of insulin, meaning blood sugar levels remain elevated. This can lead to more insulin being released by the pancreas, in response to high blood sugar, that can lead to hyperinsulinemia, excess insulin in the blood. Over time, this will contribute to weight gain and increase risk of type 2 diabetes. This can also stimulate the production of androgen hormones such as testosterone, further worsening PCOS symptoms.
How can I lose weight with PCOS?
When focusing on weight loss linked to PCOS, there are a number of dietary, lifestyle and pharmacological recommendations that can be offered, which we explain here in detail.
Dietary interventions
Focus on a high fibre diet
Foods rich in fibre can reduce IR, as these foods help to slow digestion, reducing the rise in blood sugars. This allows less insulin to be produced and released, and overtime can support PCOS symptoms. High fibre foods include whole grains such as brown rice and quinoa, as well as beans and pulses, all fruits and vegetables, nuts and seeds.
Look for foods that have a low glycaemic index (GI) as this indicates the impact of the carbohydrates in the food on blood glucose levels. Lower GI foods lead to smaller increases in blood sugars. Research has shown a lower GI diet can improve insulin sensitivity and regulate menstrual cycle, to help reduce risk of co- morbidities of PCOS such as type 2 diabetes and obesity.
Regularly consume lean proteins
Along with fibre rich foods, lean proteins also support slower digestion, leading to smaller spikes of blood sugar and insulin levels. Lean proteins include chicken, fish, eggs, lean meats, tofu and pulses and beans. These foods can support insulin sensitivity and research has shown a diet rich in lean proteins can improve insulin resistance. Consume both protein rich and high fibre foods for the best benefit, when it comes to reducing overall insulin levels.
Focus on anti-inflammatory foods
Some symptoms of PCOS can be linked to inflammation from diet, stress and environment. The increase in inflammation can impact hormonal balance, increasing production of androgens. Foods that are known to be anti-inflammatory are encouraged in a PCOS diet, to help reduce the influence of inflammation on hormones, that can contribute to weight.
Anti-inflammatory foods include oily fish such as salmon and sardines, as the omega 3 fats they contain are highly anti-inflammatory. If you do not eat fish, walnuts and chia seeds are also a rich source of omega 3 fatty acids. Other great anti-inflammatory foods include green veggies such as kale and broccoli, colourful fruits like berries and kiwi, tomatoes and healthy fats like avocado and olive oil.
Exercise
Keeping active can support our health in many ways, though there is a clear link between certain exercises and supporting those with PCOS in the aid to weight loss.
Strength training
Regularly undertaking resistance training can enhance insulin sensitivity, meaning the body is better able to recognise the actions of insulin, helping to reduce overall blood sugar levels. Increasing muscle mass through regular strength training can also increase resting metabolic rate, supporting metabolism levels. Strength training can be done through body weight exercises, though intensity and weight loads will need to be increased over time.
If you are new to strength training, we recommend speaking to a professional such as a personal trainer with experience in supporting those with PCOS, to help create a realistic exercise plan that you can follow, within your lifestyle.
Aerobic exercise
Aside from strength training, adding in regular forms of aerobic exercise can also enhance insulin sensitivity, which can support fat loss. Aim for any activity that increases your heart rate and leaves you feeling slightly out of breath. This can include fast paced walking, swimming, cycling or team sports like tennis or basketball. Aim for at least 30 minutes a day and build up to a level that is sustainable and manageable across the week.
High intensity interval training (HIIT)
This type of exercise is a combination of short, very high intensity cardio, followed by a rest period. As an example, this could be 1 minute of fast running, followed by 1 minute of rest, repeated 10-15 times. Short bursts of HIIT style exercise have been shown to be positive for those with PCOS. In fact, research has shown HIIT can improve insulin resistance and body composition, but not all research has shown weight loss as an outcome. One study also showed that HIIT also reduced excess testosterone levels, which can improve overall PCOS symptoms.
Keep in mind that over exercising can be detrimental to the health and weight of those with PCOS. This can be linked to the hormone cortisol, which is released during stressful periods of time. Being overweight or having PCOS can lead to the increased production of cortisol hormone, and those who over exercise can unfortunately put extra stress on the body, which can increase cortisol levels.
Mind & body exercise
Although exercises like yoga and Pilates are less intense, research has shown that these exercises can help with stress and anxiety management, reducing overall stress levels on the body. We know from research that overweight women with PCOS have a higher level of depression than non-overweight women with PCOS. So, practicing mindful exercises can help to reduce stress and support mental wellbeing.
Find a balance of exercising that works for you, ideally a mix of all the above. Too much HIIT can increase stress on the body due to the very high intensity nature of the exercise. Low intensity exercises like walking can reduce cortisol levels, which an further reduce insulin resistance over time, and some strength training can also enhance insulin sensitivity.
Medications and supplements
Certain medications and supplements may improve weight loss due to their actions on insulin and appetite signals.
Metformin
Metformin is a common drug used to improve the insulin sensitivity of cells in the body. This allows the cells to take in the glucose from the blood, reducing the resistance of the action of insulin. This has been shown to promote wight loss, reduce androgen levels and even restore ovulation in women in PCOS.
GLP-1 Receptor agonists
These medications, sometimes known as Ozempic or Wegovy, have been designed to improve insulin resistance, reduce risk of developing type 2 diabetes, and increase chances of weight loss. They mimic the action of the glucagon-like peptide-1 hormone, which leads to a reduction in appetite. These medications can be fantastic for women with PCOS who struggle with appetite and hunger levels, though it is important to work alongside a dietitian whilst on these medications, to support the creation of healthier habits and lifestyle changes. This will reduce the likelihood of weight regain, once the medication is stopped.
Vitamin D
Supplementation of Vitamin D is encouraged, as low levels are linked to increased risk of insulin resistance. Aim for between 25-75 µg per day, unless advised otherwise by a medical professional.
Inositol
Inositol’s are a type of sugar alcohol that can enhance glucose transport inside of the cells. It is actually made by our kidneys, liver and brain, in small doses each day. We can also obtain inositol’s through the diet e.g, through nuts, oats and beans, though supplementation of inositol at a higher dose is often recommended for women with PCOS. A combination of Myo-inositol and D-chiro-inositol have been shown to be effective in improving insulin sensitivity in women with PCOS. Guidance recommends 2-4g of myo-inositol with 50-100mg of D-chiro-inositol per day, in the ratio of 40:1.
Berberine
Berberine is derived from a plant and has been associated with many potential health benefits. Research has been promising to show that berberine can improve ovulation, reduce fasting plasma glucose and insulin levels, as well as improving insulin resistance. It may also be greater than metformin for improving body composition and lipid profile. Although there is no consensus on the dosage of berberine for PCOS, most studies have safely used a dose of 500mcg divided into 2-3 servings with meals across the day.
How do I balance my meals to optimise weight loss with PCOS?
Following a certain structure for main meals and snacks can help to encourage sustainable and safe weight loss for women with PCOS.
Focus on building a meal that includes:
Complex carbohydrates
This includes carbohydrates with a low glycaemic index, to support healthy blood sugar levels, reducing spikes in insulin levels. This covers wholegrains such as brown rice, wholewheat cous-cous and buckwheat, as well as potato and sweet potato ideally with the skin on for added fibre.
Fruits and non-starchy vegetables will be a source of carbohydrate, and due to their high fibre levels, can help us feel satisfied for longer.
Legumes and pulses contain carbohydrates, so it is important to keep these portions in mind when balancing a meal.
Lean proteins
Protein is an important part of each meal and snack, as it supports the feeling of satisfaction and also helps to slow down digestion of foods, meaning a smaller spike in glucose. Regular protein intake supports the production and maintenance of lean muscle mass.
Good quality proteins include lean poultry, fish, shellfish, eggs, unprocessed soy products such as tofu and tempeh, as well as legumes and beans.
As mentioned above, beans and legumes provide a source of carbohydrates, so it is important to be aware of portion sizes alongside other carbohydrate sources.
Healthy fats
Including a regular intake of healthy fats is crucial for hormonal health, as well as satisfaction and supporting vitamin absorption. Emphasise the intake of unsaturated fats, which are health promoting.
This includes avocados, nuts and seeds, olives, olive oil and oily fish. It can feel tempting to cut out fats in the attempt to lose weight, however a low fat diet has not been to be more effective for weight loss compared to other weight loss strategies. And depriving your diet of fats can leave you feeling unsatisfied, which can increase consumption of additional foods.
Keep in mind portions and moderation, as fats are higher in calories than protein and carbohydrates, and an excess may contribute to hindered weight loss. Speak to a registered dietitian to understand your tailored requirements for fat intake.
What other factors support weight loss with PCOS?
Sleep
Sticking to a regular sleeping routine is crucial for supporting hormonal balance, rest and weight management. Sleep deprivation, even if mild, can negatively impact recovery and also increase stress on the body, which can hinder weight loss. Insufficient sleep can lead to an increase in the hunger hormone called ghrelin, and reduce our satiety hormones, such as leptin. This can lead to an increase in cravings, particularly higher calorie foods. Not only is appetite influenced, but poor sleep can worsen insulin resistance.
Aim for a minimum of 7 hours quality sleep per night, even on weekends. If you struggle with sleep quality, it’s important to seek support from a professional.
Stress management
We all know that high levels of stress can negatively impact health. It’s been shown that high levels of stress can worsen PCOS symptoms, linked to weight gain. If the stress hormone known as cortisol is chronically raised, this can contribute to insulin resistance and promote fat storage around the abdominal area.
Stress management techniques can include meditation and yoga, as well as general exercise, therapy and making time for hobbies you enjoy.
Reach out to our PCOS dietitian today to receive personalised and evidence based support for your PCOS requirements and weight loss.
