PCOS- What works?

I strongly advise you to go ahead and get tested now. Most doctors will want you to start taking a birth control pill or progesterone in order to get your hormones into balance. This is very important for health reasons -- women with PCOS have higher risk for uterine cancer, high cholesterol, stroke, heart attack, and type II diabetes due to how out of balance our hormones are. Taking a birth control pill or progsterone to help put things back in balance can reduce your risk. And it can help reduce the hair growth, which is a huge plus in my opinion.

Keep in mind that just because a doctor wants you to take a med, you don't have to do it. So if your doctor wants to prescribe metformin (which is common for PCOS) or some other medication for metabolism, you don't have to actually do it until you decide that you want to. You could continue on with trying to lose weight without medication as you have been. But even if you decide against a med like this, I still think it's really important to address the hormone issues in order to reduce your risk of other health problems.

As for losing with PCOS, it would help you if you knew for sure whether you are insulin resistant. Women with insulin resistance struggle more and sometimes have to try things like reducing carbs in order to lose. Most absolutely have to exercise in some way and cannot lose easily just by cutting calories. I'm incredibly lucky to not be insulin resistant and I find that the best way for me to lose weight is to make sure that I'm eating enough and getting plenty of exercise. Otherwise I eat a balanced diet of all things in moderation and try to take it easy on processed sugars. The truth is that many women with PCOS do have special considerations when trying to lose weight. It is a health condition that impacts that simple calorie in/ calorie out equation that everyone so loves to throw around on this website because of the major role that hormones play in everything from fat burning and sugar transport to hunger signalling. You need to see a doctor to assess how severe your PCOS and/or insulin resistance is and do what you can to improve your health condition first and then start worrying about the best way to lose weight with it.

PaleoPath4Lyf, you don't need to be disrespectful. Your quote "Your not an Endocrinologist so stop trying to simplify what you have no clue about" is a prime example.

People do not have to have a MD/DO degree in order to be well informed regarding medical topics or to discuss them here in a public forum. The forums aren't to be used for giving official medical advice, but that doesn't prevent people from talking about their own viewpoints or experiences. You are welcome to disagree, but you shouldn't attempt to shut others out or kill the discussion.

It's OK to talk about PCOS from *all* perspectives - and that should *include* those who also have diabetes or insulin resistance, as well as those who do not or no longer do.

I'd like to politely remind folks that Diabetes Mellitus is not actually included in the diagnostic criteria for PCOS. It's a separate diagnosis. Some PCOS women have DM, but many do not. I've pasted the most recent medical definition for PCOS below. (I used Rotterdam, 2003, because it's a wider definition than NIH.)

In 2003 a consensus workshop sponsored by ESHRE/ASRM in Rotterdam indicated PCOS to be present if any 2 out of 3 criteria are met:
1.oligoovulation and/or anovulation
2.excess androgen activity
3.polycystic ovaries (by gynecologic ultrasound)

Please take note of what's NOT listed - insufficient pancreatic function/activity. Diabetes, insulin sensitivity, insulin resistance, and metabolic syndrome are separate conditions. Yes, they are *often* present in women with PCOS. PCOS women *may* develop insulin resistance. They *may* develop diabetes. They *may* develop heart disease. Or they *may* not. Yes, the likelihood is there. Yes, we should be very concerned. And yes, we should do something...

We should also acknowledge that there isn't a ONE-SIZE-FITS-ALL solution to such a multi-faceted problem like PCOS. We also need to remember that even the scientific/medical community hasn't fully figured out PCOS yet.

Maybe he shares a profile with his wife? lol :bigsmile:

LOL, nope. I most definitely don't have PCOS ... nor does my wife. The only annoying thing she has to deal with is 3 kids and me.

The only thing that has ever worked for me & I was diagnosed almost 25 years ago now, has been super low carb. No SUgar! and exercise & lots of it. sucks, but it works.

Weight loss happens at a calorie deficit. PCOS or insulin resistance does not make one an alien:
calories burned > calories in means weight loss
It is impossible to not lose weight when at a deficit, regardless of whether you are eating 50% carbs or 20% carbs, PCOS or not.

FYI weight-loss happens at a caloric deficit, yes... and with the weight-loss comes improvements in insulin-resistance... That's true.

It's important to note, however, that 20-25% of women with PCOS are lean, and don't need weight-loss. The majority of them still have some level of insulin-resistance and can have problems with glycemic control. Current research shows that insulin resistance and hyperinsulinaemia appear to be linked to PCOS independently of obesity. http://www.nature.com/ejcn/journal/v67/n8/full/ejcn2013116a.html

Regardless of whether someone with PCOS is lean or overweight, glycemic-control is considerably improved with a low-carb/high-fat/moderate-protein diet. Hyperglycaemia that's experienced UNTIL the insulin-resistance is improved can be damaging the body in many ways.

Weight loss results in controlling PCOS, exercise results in controlling PCOS. Whether a low carb diet will help with the insulin resistance itself is up for debate and probably research (lots of conflicting info out there, most drs do not demand a low carb diet for this).

Actually, there is no conflicting research on whether a VLCKD helps PCOS suffers. All currently-available research concludes it does.

FYI physicians don't "demand it" for the simple reason that it's not currently an established primary-care protocol for PCOS. Just like a VLCKD diet is not yet an established primary-care protocol for diabetes mellitus. Though in both cases the research is clear that they are beneficial - and any physician that cares to invest the time to research the diet will come to the same conclusion. The problem is that unlike my own case (I work in research - and was on disability when I did my own research), most don't have the time.

My medical school spent about 25 hours on nutrition, and most still teach the prevailing wisdom of the lipid-hypothesis and diet-heart hypothesis ... Even though no research has ever proven either hypothesis, and considerable research concludes the opposite.

I am pleased to see that strength training is seen as beneficial with pcos weight loss, this is an aspect I hadn't really considered as impacting. Personally I find that I do best when I have a 500 cal defecit with 4 meals a day and exercise to boost my metabolism. To me exercise is key. But I also urge you to get tested. You can reduce symptoms and hormonal imbalances to an extent with weight loss, but it is not easy and is not a cure all. The long term repurcussions are not ideal, so the sooner you get proactive about your health and weight the better. I had symptoms sine my late teens when I was a healthy weight and these continue to the present day, to an extent, but I have been helped by taking metformin. You will find a solution that suits you, but you need a diagnosis first. Be sure to get an understanding and informed healthcare provider.
Good luck with the weight loss. :-)

What works for women with PCOS is low carb, higher fat, and moderate protein diet. Have reversed all symptoms with this diet. While monitoring calorie intake is important, a PCOS patient has to consider macronutrients as well. What works for normal women will NOT usually work for those with this condition.

Also, I recommend weight lifting.

Weight loss happens at a calorie deficit. PCOS or insulin resistance does not make one an alien:
calories burned > calories in means weight loss
It is impossible to not lose weight when at a deficit, regardless of whether you are eating 50% carbs or 20% carbs, PCOS or not.
Weight loss results in controlling PCOS, exercise results in controlling PCOS. Whether a low carb diet will help with the insulin resistance itself is up for debate and probably research (lots of conflicting info out there, most drs do not demand a low carb diet for this).

This is actually not true. Having IR makes it extremely difficult to lose weight. I have it myself and my endocrinologist has told me time after time that I most likely will not lose much weight unless I am eating 500-800 calories a day. Which is something he would never recommend for me because I only have 40 lbs to lose.

He is right. I didn't lose weight eating 1200 calories and I didn't lose weight eating 1750-1840 calories (recommended for my weight/height). The only time I lose weight is when I am eating less than 800 calories a day due to being sick and unable to tolerate much food.

Well, this may not be true for *your* individual situation, FatFreeFrolic. Generally, PCOS + IR women don't require such severe calorie restriction to see weight loss. It sounds like you have a pretty serious degree of insulin resistance, and I definitely do not envy you. Sub-800 calories has gotta be really, really tough. I'm sorry to hear that you are dealing with this.

I noticed I had to drop my calorie intake lower and lower and lower to lose weight and I had difficulty functioning below 1100 cals/day (sustained). I had really great results when I added both steady state and then HIIT cardio. We're talking 1-3 hr workouts 3-4x week at a moderate-to-high intensity (as close to my anaerobic threshold (AT) as I could bear - I was working on endurance). I could eat more (not a ton) *and* was seeing weight loss. I had to be careful with nutrient timing before/during/after exercise to avoid extreme blood glucose peaks/troughs, but it helped me get back to eating more calories (for me, 1500 on average) and not feeling like a zombie. Something to consider if you are looking for options that might help you "escape" the hell that is <800 cal/day. (I know it might not work as well for everybody, but I thought I'd share.) Good luck!!!

Edited to add who I was primarily addressing. Sorry.

Hello all!
I hope not to sound silly on this topic as I have yet to be officially tested for it, but I was wondering what women with PCOS have done to break through and lose weight. I have delayed the testing as I've been afraid to hear it...

Just wanted to mention to the OP that I was tested via ultrasound after consultation with my OB/GYN. I was imaged in a prenatal ultrasound room and it was kinda peaceful. (Nothing like what I was expecting... I had so much anxiety by the time I finally got tested that I think I was expecting something out of a torture chamber. Ah, anxiety!) Knowing is so much better than not knowing. If you already suspect you have PCOS, then getting an answer might feel like a weight being lifted off your shoulders! Knowledge is both freeing and empowering. Good luck. :flowerforyou:

I totally agree. Knowddge is power!

PaleoPath4Lyf, you don't need to be disrespectful. Your quote "Your not an Endocrinologist so stop trying to simplify what you have no clue about" is a prime example.

People do not have to have a MD/DO degree in order to be well informed regarding medical topics or to discuss them here in a public forum. The forums aren't to be used for giving official medical advice, but that doesn't prevent people from talking about their own viewpoints or experiences. You are welcome to disagree, but you shouldn't attempt to shut others out or kill the discussion.

It's OK to talk about PCOS from *all* perspectives - and that should *include* those who also have diabetes or insulin resistance, as well as those who do not or no longer do.

I'd like to politely remind folks that Diabetes Mellitus is not actually included in the diagnostic criteria for PCOS. It's a separate diagnosis. Some PCOS women have DM, but many do not. I've pasted the most recent medical definition for PCOS below. (I used Rotterdam, 2003, because it's a wider definition than NIH.)

In 2003 a consensus workshop sponsored by ESHRE/ASRM in Rotterdam indicated PCOS to be present if any 2 out of 3 criteria are met:
1.oligoovulation and/or anovulation
2.excess androgen activity
3.polycystic ovaries (by gynecologic ultrasound)

Please take note of what's NOT listed - insufficient pancreatic function/activity. Diabetes, insulin sensitivity, insulin resistance, and metabolic syndrome are separate conditions. Yes, they are *often* present in women with PCOS. PCOS women *may* develop insulin resistance. They *may* develop diabetes. They *may* develop heart disease. Or they *may* not. Yes, the likelihood is there. Yes, we should be very concerned. And yes, we should do something...

We should also acknowledge that there isn't a ONE-SIZE-FITS-ALL solution to such a multi-faceted problem like PCOS. We also need to remember that even the scientific/medical community hasn't fully figured out PCOS yet.

Excess androgen activity has a hell of a lot to do with blood glucose disorders and metabolic issues. They go hand in hand. Majority of women with PCOS benefit from blood sugar control. That's why the first line medications that are used to treat it (besides BCs) is usually an oral diabetes medication such as metformin.

What works for women with PCOS is low carb, higher fat, and moderate protein diet. Have reversed all symptoms with this diet. While monitoring calorie intake is important, a PCOS patient has to consider macronutrients as well. What works for normal women will NOT usually work for those with this condition.

Also, I recommend weight lifting.

Weight loss happens at a calorie deficit. PCOS or insulin resistance does not make one an alien:
calories burned > calories in means weight loss
It is impossible to not lose weight when at a deficit, regardless of whether you are eating 50% carbs or 20% carbs, PCOS or not.
Weight loss results in controlling PCOS, exercise results in controlling PCOS. Whether a low carb diet will help with the insulin resistance itself is up for debate and probably research (lots of conflicting info out there, most drs do not demand a low carb diet for this).

Low carb diets helping with insulin resistance is not something up for debate, it's a scientific fact, and any doctor that deals heavily in related disorders will normally recommend a lower-carb approach.

There are some manifestations of PCOS that are not comorbid with metabolic syndrome.Such people can lose weight with a 50% carbohydrate diet or whatever. I'm NOT going to say that calories do not matter - because, in the end, calories do matter - but they are NOT the ONLY THING THAT MATTERS when dealing with this condition. Why in the **** would I want to give my hormonally messed up body the absolute WORST macro nutrient (worst meaning the one it can't handle well) to lose weight? I'm not going to struggle with a 50% carbohydrate diet for a year to lose a measly 20 pounds again, that's completely unnecessary. Biology isn't physics.

Why I do not like giving (or reading) advice for anything other than "do things in moderation, talk to your dr" on the internet:

Scenario A: Woman goes to dr, has blood tests, confirmed prediabetic or diabetic, is given a nutrition and exercise plan, might or might not be low carb or low calorie or whatever, made for her needs, follows the plan made for her, goes on to live happily ever after.
Scenario B: Woman googles PCOS, self diagnoses with insulin resistance. Receives advice to go low carb, with no plan, ends up with a 10% carb, 60% animla fat diet she made up herself with the help of internet strangers. Woman in fact does not have insulin resistance, but has a kidney issue she forgot to mention to dr google, and she is damaging her kidneys even more.

Not saying of course that this is the scenario with the OP, but we are not her drs. We know nothing about her health, she did not even say she has PCOS. Even if she does have it, my dr's instructions, for my PCOS, are adapted to me, and are completely different than the instructions that poster X or Y got from their dr.

As on to whether a really low carb diet is controversial or not, there you go:

http://www.diabetes.org.uk/About_us/What-we-say/Food-nutrition-lifestyle/Low-carbohydrate-diets-for-people-with-Type-2-diabetes/

"Evidence exists suggesting that low-carbohydrate diets can lead to improvements in HbA1c and reductions in body weight in the short term (less than one year).
Weight loss from a low-carbohydrate diet may be due to a reduced calorie intake and not specifically as a result of the carbohydrate reduction associated with this diet.
Despite the short-term benefit there is a lack of evidence related to long-term safety and benefit of following this diet."

http://www.washingtonpost.com/lifestyle/wellness/qanda-i-have-prediabetes-what-should-i-eat/2013/11/05/70a3e868-4192-11e3-a751-f032898f2dbc_story.html

"The DPP encouraged participants to first get a handle on their fat consumption as a direct route to reducing total calories. How to do that? One way is to focus on how you prepare food. For example, limit the butter or oil used to saute vegetables, mash potatoes or scramble eggs. Next limit the fats and oils added to foods before eating, including butter, margarine, cream cheese, sour cream and salad dressing.
The next focus if need be? Further reduce total calories by looking at the types and amounts of carbohydrates you eat. “People think Americans eat vast amounts of carbohydrates. We don’t,” Davidson says. We get a bit less than half our calories from carbohydrates — though for many people that’s within the context of too many calories."

http://prevention.stanford.edu/word-pdf/Pre-Diabetes Recommendations.pdf
"1. Don’t eat too much carbohydrate at one meal or snack. Combine a carbohydrate
food with lean protein and unsaturated fat for “balanced” meals and snacks.
2. Try a lower carbohydrate breakfast. In place of fruit juice with toast and jam,
eat a slice of whole grain bread with peanut butter or with an egg white omelet.
3. Choose high fiber, unrefined, whole grain carbohydrates (for example, whole
wheat bread in place of white bread). You still must watch your portion sizes.
4. Eat a heart-healthy diet low in saturated fat, trans fat and cholesterol. Foods
high in unsaturated fats (e.g. olive oil, canola oil, nuts, avocado, fatty fish) can
be included. But remember that high-fat foods are high in calories."