I’m going to try not to over complicate this however polycystic ovarian syndrome is a complex syndrome that can be a nightmare for the women who suffer with it. So what exactly is PCOS and what can we do about it?

PCOS has three defining characteristics:

• Hyperandrogenism –  The excessive presence of the male sex hormones testosterone, androsterone and androstenedione in women, and the effects that they have on the female body.
• Polycystic Ovaries – cysts present on the ovaries.
• Anovulation – Anovulation happens when an egg (ovum) doesn’t release from your ovary during your menstrual cycle. An egg is needed to have a pregnancy.

At least two of these characteristics need to be present to be diagnosed with PCOS:

• Hyperandrogenism + Polycystic Ovaries = Ovulatory PCOS
• Polycystic Ovaries + Anovulation = Non-Hirsute PCOS
• Anovulation + Hyperandrogenism = Classic PCOS

So what do women experience with PCOS?

• Reproductive problems – menstrual dysfunction and higher levels of male hormones leading to infertility & or increased pregnancy complications.
• Metabolic issues – insulin resistance, an increased risk factor for cardiovascular disease and type 2 diabetes as well as persistent weight gain.
• Psychological effects – anxiety, depression and reduced quality of life.

Well this all sounds pretty grim doesn’t it. However, as difficult as it may be, there are ways to combat this syndrome to improve symptoms. Let’s not go looking for some complicated answer, let’s keep it simple, well sort of. A large percentage of women that suffer with PCOS really struggle to lose weight. Weight loss can have a significant effect on reducing risk of cardiovascular disease, T2 diabetes and insulin resistance. There is such a thing as ‘lean PCOS’ which means without the presence of excessive weight. You can have lean PCOS and still be insulin resistant. So the weight loss advice may not be relevant but the rest of the advice will be as we still want to reduce insulin resistance.

There are two approaches to weight loss that I would not recommend for PCOS sufferers. Keto, as it can increase insulin resistance (IR) and If it fits your macros (basically eat whatever you want as long as it is within your carb, fat and protein allowance) this would make it difficult to reduce IR.

Of course there is no one size fits all diet for PCOS, however there have been some studies showing greater improvements in weight loss with certain diets. It will take a dedicated period of experimentation and recording to see which method works best for you. If you have been dieting and stressing for months or years, you may not be in a position to start this psychologically demanding phase.

Here are some diet options to experiment with that have research to suggest they help ~ Moran et al 2013

• High protein – PCOS sufferers are metabolically inflexible, meaning they struggle to switch fuel sources (fats, carbs, protein) at night they burn protein rather than using the bodies fat stores which has an implication for muscle loss. Ensuring a high protein diet will help with this. Some fasted training could also be beneficial to improve metabolic flexibility, improving the bodies ability to appropriately select fuel sources. (note I didn’t say fasted cardio but fasted training. Fasted cardio has no significant benefit for weight loss)
• High Monounsaturated fatty acid diet – research has shown greater weight loss.
• Low GI – A low GI diet showed greater reduction in insulin resistance, improved menstrual regulation and improved quality of life.
• Intermittent fasting – shown to have positive effects on reducing insulin resistance.

Now here is the horrible truth of why it is such a struggle to lose weight with PCOS, not impossible but a struggle. The BMR (calories burned at rest) of a PCOS sufferer can be as much as 20% less than a non sufferer. This means that to be in calorie deficit to lose weight you may need to minus an extra 20% from your calorie allowance in order to actually be in a deficit. And if this isn’t bad enough some suffer with impaired appetite control meaning you may feel hungry more often. If this is the case a high protein diet may be the way to go, as protein is the most satiating macronutrient, which leaves you feeling fuller for longer. ~ Georgopoulos et al 2009

What else can we do to help?

• Resistance training or HiiT – research has shown that these forms of exercise have a positive effect on insulin sensitivity. Women can benefit from strength training in a number of different ways, including maintaining healthy bone density, a healthy weight and mental health so if PCOS is an issue for you, it’s even more important that you are including some resistance training.
• Fruits like kiwi, apple, grapefruits, berries and cherries, avocado, pears, and peaches are high in antioxidants, vitamins, and minerals. They have a low to moderate glycemic index and are more suitable for weight loss, stabilising blood sugar levels, and improving the symptoms of PCOS.
• Supplements – Omega 3 is shown to have distinct metabolic and endocrine effects in PCOS. Taking a daily vitamin D supplement with 600 IU may help some PCOS problems such as infertility, weight gain, and anxiety. 250mg a day of carnitine can help with weight loss.
• Inositols is showing promising results in research for PCOS. Inositols are a kind of sugar the body makes. They help balance chemicals that control your blood sugar and fertility. They also affect your metabolism, which is the process of turning the food you eat into energy.

PCOS can be a difficult syndrome to manage but once you have spent some time establishing what works best for you, it’s possible to see significant improvements. Whether it’s to lose weight or start resistance training consistency is of paramount importance. Spend some time experimenting and recording or enlist the help of a well read specialist who can be specific to your case.

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