The words “fat” and “bomb” conjure up a lot of mental imagery for me, so you can imagine how curious I was the first time I saw them used together as a noun. Was this a non-lethal deep-fried military weapon, or a sadistic prank in this seasons America’s Next Top Model?
To my great disappointment it turned out to be neither, but discovering the ketogenic diet this way provided a consolation prize for my curiosity.
If we haven’t met before, I’m Kym Campbell – the creator of the free 30 Day PCOS Diet Challenge. This is a live program that helps tens of thousands of women every year use evidence-based dietary changes to take back control of their PCOS. Being in this space means I meet a lot of well-read women that have either tried the keto diet for PCOS, or are thinking about doing so.
Lifelong battles with bodyweight are often the norm for women with PCOS so it comes as no surprise that we’re often drawn to this diet. This high fat, low carb approach can have rapid and profound weight loss effects, but that doesn’t mean it’s the right diet for you. Especially if you have PCOS. While ‘going keto’ can pour kerosene into your fat-burning machinery, this weight loss diet has several inconvenient downsides.
While a quick google search will tell you a hundred reasons why the ketogenic diet is great, here’s five reasons why you might want to think twice.
1. Most People Do A Keto Diet For PCOS Incorrectly
There’s no question amongst my friends and family that I’m a grade A perfectionist. This is seldom a good thing, especially the first three times I unsuccessfully tried making gluten free, dairy free, egg free, pancakes. Cooking frustrates the heck out of me at the best of times, and the horrific mess I made to create burnt-on-the-outside, uncooked-on-the inside blobs of goop sent me spinning like Taz in a looney tunes cartoon.
For many of the women I meet in my PCOS support group, managing both the keto diet and PCOS correctly is an even harder accomplishment.
A typical ketogenic diet has you eating around 75% of calories from fat, 20% from protein and about 5% from carbs. This is the equivalent of approximately 25 grams of carbs per day for women that aren’t super athletic.
By sticking to such a small amount of net carbohydrates, your body is tricked into ketosis – a metabolic starvation mode that gives this dietary approach its name. Rather than running on the normal glucose-based fuel cycle, like a high-tech hybrid, we start burning fat in the form of “ketone bodies” instead.
Well that’s the theory anyway.
Because compliance is so difficult, most attempts at getting into ketosis result in people unknowingly failing to achieve the pre-requisite metabolic state. Even if you can get there, it’s easy to fall out without realizing it thanks to all the barriers to successful keto dieting.
The first barrier to ketosis is the immediate side effects from carb withdrawal. It can take anywhere from two days to two weeks to enter ketosis and the transition period can be brutal. Discipline is everything, and you won’t want to be underestimating how much you’ll need. Known as the ‘keto flu’, you can expect to feel terrible for at least a couple of days when getting started. Symptoms include brain fog, headache, chills, sore throat, digestive issues, dizziness, insomnia, and irritability.
It’s like how you’d feel if you had a math exam in the morning, followed by a public speech in the afternoon – except this time it’s because your body thinks it’s starving.
Depending on how well you were eating before trying the keto diet for PCOS, these flu-like symptoms can last for weeks. It only takes one bad decision throughout this period and boom, you’re back to square one. Depending on your metabolic health, age, and activity levels, once you’re out of ketosis for just one day, it can take you weeks to get back to where you were.
Sure doesn’t sound like my idea of a good time…
Once you’re through the first phase and have reached ketosis, the strict macro nutrient requirements pose a threat to you staying there. Depending on your insulin sensitivity, inadvertently consuming too much protein can drop you out of ketosis.
The biggest barrier however, is the fundamental restriction on carbs. Fruit consumption needs to be highly restricted and you can only ever eat non-starchy vegetables (not that there’s anything unhealthy about eating lots of vegetables of course). Grains, legumes, and starchy vegetables are almost entirely off the menu meaning your ingredient options are drastically reduced. If you’re trying to follow both a keto diet and PCOS dietary principles like avoiding gluten and dairy, then you really need to be creative in the kitchen.
I’m not saying that you can’t go keto for PCOS and get great results from it, but unless you’re a super well-informed food accountant, that’s highly disciplined and pays for at-home blood ketone testing, it can be easy to slip out of ketosis without realizing it. For many women that have tried this approach, all these requirements are a little overwhelming and to me this makes it fairly impractical as a long-term weight loss solution.
2. A Keto Diet Makes It Harder To Quit Sugar
Back in the old days, when my PCOS was getting the better of me, if you gave me the choice between having my teeth pulled and taking away sugar, I would’ve thrown you a roll of dental floss and slid over to the nearest door handle.
It was my desire to start a family that eventually opened my mind to changing how I ate.
This is because all sources of sugar, regardless of where they come from are essentially just a mixture of fructose and glucose. While readily available sources of glucose promote fat accumulation and the kind of inflammation that causes all of your PCOS symptoms, fructose is even worse.
I know it’s hard to be mad, at such a sweet, sweet little molecule, but the fructose found in sugar gets processed only by the liver causing visceral fat, and a cascade of metabolic changes that’s been associated with reduced fertility, facial and body hair, adult acne, anxiety, depression, liver disease and much more (Johnson et al. 20171; Carvallo et al. 20172; Lustig 20133; Elliott et al. 20024).
Out of the tens of thousands of women from my free 30 Day PCOS Diet Challenge that I’ve helped through the sugar quitting process, I’ve never had a single report of someone not feeling better after successfully doing so for a couple of months. If you haven’t tried it before, then you’re really missing out.
If you have tried it though, and found it much too difficult, then you’re clearly 100% normal.
Quitting sugar is without question, an incredibly difficult step to take. It took me a good couple of years to really get my head around why this was so valuable, as well as figuring out just how to do it in practice. As someone that was comfortably above the third standard deviation in their class when it came to pounding sugary foods, I can really resonate with people that find this idea either scary, overwhelming, or seemingly impossible.
Research has clearly demonstrated a number of similarities between food addiction and drug use disorders (Pivarunas et al. 20155) with it well documented that sugar is more addictive than cocaine – well for rats anyway (Ahmed et al. 20136). A human trial is apparently too hard to get past the ethics committee review board, despite the number of willing volunteers.
There are many things you can do from behavioral to nutritional changes that can ease the discomfort of sugar withdrawals. Unfortunately for people on a keto PCOS diet though, one of these happens to be eating a small amount of low GI carbohydrate foods with every meal. This is something I introduce during my free 30 Day PCOS Diet Challenge as a helpful way to keep cravings to a minimum.
See where I’m going with this?
When you follow the ketogenic diet, you miss out on this valuable nutritional support. This means that not only is it more difficult to resist the temptation of that loud-mouth vending machine that keeps calling your name, but it also raises the stakes when you eventually cave to your instinctive desires. One survival Snickers later and not only are you unlikely to be satisfied, but you can also say goodbye to your ketogenic metabolism.
Keto and PCOS diets treat carbs slightly differently, but this difference really matters. Unlike the 25 g/day limit of the ketogenic diet, aiming for around 50 – 200 g/day of carbs is the sweet spot I recommend for women with PCOS that complete my diet and lifestyle programs. This leaves plenty of room for 1-2 servings of fruit as well as a small portion of gluten free grains, legumes, or starchy vegetables with every meal. This gives us the hormone balancing, and weight loss benefits of the ketogenic diet, but it’s much easier and more sustainable long term.
Jamie Bietzell, who was desperate to lose weight as she battled PCOS infertility, is a perfect case in point.
After failing to achieve meaningful long terms results with the ketogenic diet as well as many others, Jamie signed up for my free 30 Day PCOS Diet Challenge. Within three months of adopting the PCOS friendly diet I helped her implement during this live event, Jamie started getting a regular period for the first time in years. By eating a small amount of carbs with her meals she was able to completely quit sugar and after five months she had lost 50 pounds. She went from a size 22 jean to a size 18, her A1C levels fell out of the diabetic range, and her blood pressure measurements showed she was no longer hypertensive.
A few months later her four-year battle with infertility ended with a healthy, happy, natural pregnancy. Results like these show you don’t need to completely forgo carbs in order to transform your health and fertility.
Jamie gave birth on Christmas day, and she has kindly allowed me to share her celebratory announcement here.
Karina, is another great example of how a small amount of carbs can make all the different in quitting sugar. After taking part in my free 30 Day PCOS Diet Challenge, she was able to lose 60 pounds over a nine-month period by continuing to apply the things she learned. This was no easy feat for her as by all accounts Karina had a serious sugar addiction and she loved gluten-rich foods just as much – especially bread. But with the right information and support, a small amount of carbs, and some great determination, Karina was able to make an amazing health transformation that will serve her for the rest of her life.
3. It’s The Opposite Of A Healthy Relationship With Food
The relationship between PCOS and disordered eating is well established in the scientific literature. This is a problem I see women struggling with on a daily basis in my PCOS Support Group and seems to be particularly prevalent amongst frequent “failed” dieters.
A big part of the problem is that the hormone dysregulation that characterizes PCOS is associated with increased appetite, impaired impulse control, and feelings of body dissatisfaction. These physiological effects commonly lead to binge eating which in turn has been shown to make our PCOS symptoms worse (Paganini et al. 20187).
In an attempt to quantify these risks, researchers from the..
Metformin is one of the most commonly prescribed treatments for women with polycystic ovary syndrome (PCOS), but it’s not actually approved for this purpose, even if you’re pre-diabetic. There are good reasons for this as according to the latest scientific reviews, metformin is no longer considered a helpful drug if you’re trying to lose weight or get pregnant.
Let me explain.
In 2003 Dr Robert Barbieri, a highly cited leader in the field of Obstetrics, Gynecology and Reproductive Biology authored a guide to his colleagues on the use of metformin for the treatment of PCOS (Barbieri 20031). 15 years later, along with many other experts in the field, he is now saying that metformin should not be used under any circumstances as a first-line therapy for women with PCOS (Barbieri et al. 20182).
So why the change of heart?
Like all good scientists, it appears that Dr Barbieri updated his views as better information became available.
Given these latest recommendations, it appears from metformin’s continued use in treating PCOS, that as a community, we’re falling victim to a lengthy lag time between research findings and clinical practice (Morris et al. 20113). This a well understood problem that’s both affected me personally, as well as thousands of other women I meet during my free 30 Day PCOS Diet Challenge.
Many of the women I speak to during this live event have been given this drug either to help them lose weight, to lower the risk of type 2 diabetes, or to help them get pregnant. As you’re about to discover though, there are far better solutions to all of these problems that also happen to be free from the side effects of this outdated, ineffective drug.
So without further ado, here’s five reasons not to take metformin for PCOS.
1. The Metformin Weight Loss PCOS Myth
I love shopping at IKEA, but I always get my husband to assemble the parts. I’ve tried doing it myself in the past, but I get to the first picture where it shows the guy with the frowny face and the big question mark and I’m done.
Way too confusing!
So I’ll admit, there’s a lot of simple stuff that confuses the heck out of me, but understanding how metformin affects body weight isn’t one of them.
It’s clear from the latest systematic reviews that metformin doesn’t help with weight loss and only causes slight improvements in where your excess body fat is located (Morley et al. 20174). By looking only at a few isolated studies, it would be easy to come to a different conclusion. For example, some smaller (and older) metformin weight loss PCOS studies show a slight benefit from this drug. But the size of the effect is always small and is easily overshadowed by other interventions – especially dietary change (Nieuwenhuis-Ruifrok et al. 20095).
This is where meta-analyses are the best source of information because they combine the results from all relevant studies to see the overall affect. Any conclusions that can be drawn are the most scientifically robust. In the 2017 analysis by Morley and colleagues, which compared metformin therapy in women with PCOS with no treatment at all, there was a tiny improvement in waist to hip ratio, but the difference in body weight was nothing… zilch!
If there was one paper on metformin and PCOS that I wish doctors would read, this would be it. So many women are incorrectly prescribed metformin to help them lose weight, when the information available shows that it doesn’t actually help. It’s not even approved as a weight loss drug which has to make you wonder…
If you’re taking metformin for PCOS and were hoping to lose some weight, don’t let this news get you down. While this particular drug is clearly not the answer you’re looking for, the scientific community has shown us where to find a more comprehensive solution. One that targets the root problem of PCOS weight gain instead of using band-aid solutions like metformin.
Out of all the studies that explain the root cause of PCOS, the best one I’ve read to date is a double-blinded randomized controlled trial (the gold standard of high-quality research) conducted in 2012 by Indiana University and the Mayo Clinic (Gonzalez et al. 20126).
In this well-designed experiment, researchers took lean and otherwise healthy women, and effectively “gave them” PCOS for five days (I know… thanks for nothing right?). They did this by giving them the androgenic “male” sex hormones that are typically elevated in women with PCOS. What they showed was that these elevated androgens caused unhealthy changes to the subjects’ blood glucose regulation, just like in women with real PCOS. These previously healthy, uninflamed women had an increase in inflammatory biomarkers after taking the PCOS androgens but it was the consumption of glucose that caused the inflammation to take off. Remember that these were lean women with healthy levels of body fat.
What this tells us is that elevated androgens and diet-induced inflammation lie at the root cause of our PCOS symptoms independent of bodyweight. It also tells us that insulin resistance and subsequent weight gain are secondary effects caused by these underlying mechanisms (Gonzalez 20127).
As well as showing that metformin is not equipped to address the root cause of your insulin problems (see reason #2), this high-quality study also hints at the most effective way to lose weight with PCOS. Reducing inflammation through the foods you eat targets the root cause of your PCOS symptoms, including that stomach fat that just won’t budge.
Here are a couple of real-life examples that illustrate just how powerful dietary change can be for weight loss, even for some of the hardest PCOS cases.
When I first met Kendall, back in 2016, she was at the end of her tether after having gained a lot of weight in a few short years. At 260-odd pounds, she was determined to do whatever it took to get back to a healthy body weight. By sticking with the dietary fundamentals she learned during my free 30 Day PCOS Diet Challenge, Kendall began eating a low inflammation diet that treated her PCOS at the roots. She stuck with it and lost 100 pounds over the next three years, while at the same time eliminating all of her other PCOS symptoms.
Another previous Challenge participant, Karina K, had been battling with her weight for most her life. She also struggled with acne, low energy, and a temperamental mood – particularly in the evening when her sugar cravings were bad. During my free 30 Day PCOS Diet Challenge Karina was able to lose 12 pounds by sticking to the PCOS diet principles I outline here.
She was motivated by these early results so kept on going in the following months. Karina’s acne cleared up, her mood improved, and her energy levels went through the roof. She was able to sustain the positive changes she was making and within nine months she had reached her goal weight after losing more than 60 pounds. She didn’t need drugs, supplements, or meal replacement shakes. Just good old-fashioned healthy whole foods eaten in a way that paid respect to her diagnosis.
2. Metformin And PCOS: A Band-Aid Solution For Type 2 Diabetes
Back in the day when I was young and living on the cheap near the beach, I’d surf for days on a dinged-up surfboard that I’d “repaired” with duct tape. While I was (and still am) totally happy to patch up a hole in the rail so I can stay out in the water longer, I don’t recommend you take this approach for managing insulin resistance.
Unfortunately, this is exactly what’s happening when you use metformin to prevent diabetes.
As a proven insulin sensitizer, you’ll get no argument from me that metformin can reduce the chances of insulin resistance turning into full-blown type 2 diabetes. This is one of the most common answers we’re given when we ask our doctors, “so what does metformin do for PCOS again?” But this solution is a lot like saying my duct tape ding repairs make my board as good as new. In both cases, we’re failing to address the root cause of the problem.
As I mentioned above, in women with PCOS, insulin resistance is caused by a combination of our elevated androgens and the wrong kind of diet for our condition. Sure, there are definitely genetic and environmental factors that created this problem in the first place, but once you’re stuck with PCOS, then diet is the only causal mechanism you can actually do something about. This is why even if you’re eating “relatively healthy”, unless you’re specifically addressing diet-induced inflammation then you’re not going to regain control of your PCOS symptoms.
Because it only targets the secondary problem of insulin sensitivity, while making no difference to the what you’re actually eating, metformin is the quintessential band-aid PCOS solution.
The research says so too.
In an impressive study conducted by the Diabetes Prevention Program Research Group, 3234 people at risk for developing diabetes were assigned to either metformin therapy or an intensive, 24-week program focusing on diet and exercise (the lifestyle intervention group).
During a mean follow-up period of 2.8 years, metformin reduced the incidence of newly developed diabetes cases by 31% while people that had focused solely on their diet and exercise behavior reduced their risk by 58% (Knowler et al. 20028). There are two conclusions that can be drawn from this data. Firstly, to be fair, the benefits of metformin for PCOS can be seen in the 31% risk reduction compared to the control group who only received a placebo pill.
What’s of much more value however is that when compared to people that took metformin, the risk of diabetes halved for people who focused solely on eating better and doing more exercise.
It was also found in the drug arm of this trial, that the majority of the benefit achieved by metformin did not persist when the treatment was stopped (Knowler et al. 20039). Metformin only works as long as you’re taking it, which is great for Big Pharma, but not so good for you…
This study clearly illustrates the benefits of dietary intervention over metformin for diabetes prevention. And that’s saying nothing about the negative side effects of this drug which I discuss more below.
While these results driven studies give us the right answer, to understand why the right diet works so well, we need to look at the mechanisms involved. This is why I love the study by Gonzalez and colleagues so much (see Reason #1 above). As we now know from this high-quality study, and others like it, insulin resistance is caused by inflammatory processes that are primarily triggered by the foods you eat.
This means we can fight this disorder at the root cause both by avoiding pro-inflammatory foods and by eating more of the things that are rich in antioxidants. We can also take things a step further and restore our insulin sensitivity by giving our cells a break from spikes in our blood glucose levels.
We do this by being smart about carbs and the other foods we eat.
Using this approach, me and hundreds of other women I’ve met through my free 30 Day PCOS Diet Challenge have actually been able to reverse their insulin resistance and get their sensitivity back to normal. The ability of our body to heal itself despite years of mistreatment really is something to behold.
Here’s a couple of great examples you might find interesting.
Lisa Hiebner was diagnosed with PCOS and insulin resistance back in December 2017. As is still so common, her doctor put her on metformin and sent her on her way. Feeling deflated, she jumped on google that night where she read about my PCOS dietary recommendations and signed up for my free Challenge. Lisa committed to tightening up her diet by eliminating sugar, dairy, gluten, and soy from her meals.
Two months after she was given her prescription, Lisa had to stop taking metformin because it was constantly making her sick to the point where she was barely able to eat. While her doctor told her it would be a waste of time rechecking her blood work, when she retested in November 2018, not only had her insulin sensitivity returned to normal, but so too had her hormone levels, thyroid function, and previous vitamin deficiencies. This was all without the help of medication.
Lisa gave me permission to include her good news here which she posted in my PCOS Support Facebook Group not long after getting her test results back.
How I Lost 50 lbs and Fell Pregnant Naturally with PCOS
My husband and I started the journey to conceive our first little one in December of 2013. I had irregular cycles throughout most of that year, which at the time, I attributed to stress. After going nearly a year without a cycle, I was diagnosed with PCOS in 2014.
I was put on Metformin and it made me feel terrible, yet I put up with side effects for almost two years before stopping it because I was told it would help me get pregnant. We managed to conceive twice, with both ending in miscarriage at 6 weeks. I was devastated both times.
My last miscarriage was in August 2017, and it truly motivated me to work on my health before I tried again. I joined Kym’s free 30 Day PCOS Diet Challenge in November, and started applying what I learned. By January of 2018 I was getting a regular cycle, by April I had lost 50 pounds, and by July I was 13 weeks pregnant with our miracle!! No supplements, no treatments.
In the past I had a difficult time losing weight. I had tried Paleo, low carb, Weight Watchers, and Keto. None of these worked for me. I worked out at least 3 times a week, but I would stay at the same weight no matter how hard I tried.
As a result of taking part in Kym’s 30 Day Challenge I completely cut out refined carbs, sugar, and dairy. Quitting dairy was the kicker, as I LOVED yogurt and cheese but that change seemed to make all the difference.
My main motivation for weight loss was wanting to fall pregnant. It drove my journey. Every pound lost was another pound closer to the family I craved more than anything. My better health overall means so much to me, and I feel I received the best reward in getting the privilege to carry my son.
Dropping from a size 22 jean to a size 18 was pretty nice too of course. My A1C levels have dropped out of diabetic range, and my blood pressure is out of the hypertensive range. I sleep much better, and don’t feel as groggy during the day. My hair has also thickened up and I now have less unwanted hair on my chin and upper lip.
Once my baby is born, I hope to lose 75 pounds by 1 year postpartum and I plan to stick to the nutritional principles I learned during the 30 Day PCOS Diet Challenge to help me achieve this goal.
I felt like I would never lose weight and have a baby before I made the changes that have been so amazing for me and my husband. I now believe that with hard work and determination, anything is possible. So for all the other women with PCOS that know how hopeless things can feel, my message is to never give up. Have faith ladies, the changes you have to make are difficult, but so worth it.
Not that long ago, I was at breaking point with my PCOS.
After multiple failed attempts at IVF my lifelong dreams of motherhood were fraying at the seams. I had put up with excess stomach fat, acne, thinning hair, anxiety, depression, insomnia and more as a result of my PCOS, but infertility was the final straw that broke the camel’s back.
I was desperate, I was depressed, but I also had nothing to lose.
Beating PCOS became my number one priority and after transforming my diet and lifestyle using evidence based PCOS treatments, I’m now completely free from this disorder. After having also enjoyed a healthy, natural pregnancy, I’ve learned something truly remarkable.
While PCOS may not be “curable” in the traditional sense, by using the right diet and lifestyle interventions, this disorder can be managed to the point where you’re completely free of symptoms.
Since 2016 I’ve seen literally tens of thousands of women begin a similar transformation with the help of my free 30 Day PCOS Diet Challenge. These women have shown me that overcoming PCOS isn’t a privilege meant for just a lucky few. It’s actually available to anyone who’s willing to put in the work.
Amongst the PCOS medical community, it’s unanimously agreed that diet and lifestyle changes are the most effective treatments for PCOS. It’s just that most of this information sits in dusty old journals rather than making its way to the women that need it.
My mission is to change this paradigm with humble blogs like this one. Based on compelling scientific evidence and overwhelming real-life success stories, these seven steps can eliminate your symptoms by tackling PCOS at its roots.
1. Focus On The Root Problem, Not Band-Aid Solutions
The first time I spilled a drink on my new, secondhand couch I was furious. With a bit of quick thinking though, I gave the offended cushion a rub with a damp cloth and then flipped that puppy over.
As it turns out, you can get away with a lot of spills on your furniture, but when it comes to your personal health, you really want to treat your body better than a cheap couch you bought on Craigslist.
Unfortunately, quick fixes to cover the symptoms are normally the only thing offered for the treatment of PCOS. Pharmaceutical options generally only target one particular aspect of the disease and fail to consider the body as a whole. This over-simplified approach to PCOS treatment almost always has unintended consequences and rarely does little more than mask the problem.
Birth control for example, is the most commonly prescribed “band-aid” solution that many doctors use to regulate your period. But what they don’t tell you is that taking it long term puts you at risk of developing drug-induced thyroid problems. As I describe in this article on PCOS weight loss, women with PCOS are far more likely to have thyroid disorders and this has serious health consequences especially on your bodyweight (Yasar et al. 20161; Ulrich et al. 20182).
To me it seems plausible that extended use of birth control may be part of the problem. When you consider that the estrogen used in these drugs messes with the balance of several thyroid hormones (Grüning et al. 20073; Westhoff et al. 20134) while also causing depletions of important nutrients like magnesium, selenium, and zinc (Palmery et al. 20135) you’ve gotta wonder don’t you?
Metformin, another drug commonly prescribed to women with PCOS, also has some pretty major shortcomings with experts now discouraging its use for this disorder (Sam et al. 20176). The most up to date scientific reviews show that this drug is largely ineffective at controlling weight (Morley et al. 20177) and is less effective than diet and exercise for preventing type 2 diabetes (Knowler et al. 20028).
Like the majority of women with PCOS, birth control was the first thing I was offered as a teen when my periods wouldn’t come regularly. I was then given Retin-A for my acne, and not long after that I was put on antidepressants for insomnia and depression. Fast forward to my 30’s when I was struggling to fall pregnant, the answers came in the form of metformin, clomid, ovulation induction hormones, and IVF. Answers, that resulted in two painful miscarriages, lots of bruised and collapsed veins, but no baby.
With a bit better luck than what I had, conventional PCOS treatment drugs can be useful for fertility, but none of them solve the bigger problem. What I wish I’d known sooner is that I would’ve been far better off treating the underlying cause of my PCOS rather than just the symptoms.
Let me explain…
When it comes to PCOS there are two primary mechanisms driving all of your unwanted symptoms: high androgen levels and chronic low-grade inflammation. So unless the PCOS treatment you’re using is having a sustainable impact on these two key mechanisms, all you’re doing is a superficial fix of your presenting symptoms. With even a basic understanding of these complex mechanisms, it’s easy to see how diet and lifestyle changes are actually where I should’ve been focusing my attention from the start, instead of playing drug whack-a-mole with each of my symptoms.
So, hold onto your bonnet because I’m about to explain everything you need to know about the pathology of PCOS and why diet and lifestyle changes are the ultimate solution to this disorder.
In a nutshell, diet-induced inflammation causes our ovaries to overproduce androgens (like testosterone) and this is the primary driver of all of our symptoms (Gonzalez 201216; Gonzalez et al. 201217). PCOS infertility, unfair weight gain, unwanted hair, balding or thinning hair, oily skin, and adult acne – all of these can be traced back to diet-induced inflammation and excess androgens.
This is why dietary change treats your PCOS right at the root of the problem.
Insulin resistance and elevated cortisol levels are secondary effects caused by chronic inflammation and the worse these problems get, the more your PCOS gets out of control (Gonzalez 201216; Lindholm et al. 201118). This is why between 38% and 88% of women with PCOS struggle with their weight (Barber et al. 200819) and why roughly 30% of normal weight women with this disorder also have a problem with stomach fat (Carmina et al. 200720).
What this tells us is that diet and lifestyle interventions that promote better regulation of insulin and cortisol are ALSO going to deliver an effective PCOS natural treatment. For anyone looking for a genuine long-term solution to manage their PCOS symptoms understanding these facts are vital.
Karima Young, is a great example of what can be achieved when we focus on the root problem rather than band-aid solutions. Karima had spent over a year trying to conceive with the help of clomid when she first signed up for my free 30 Day PCOS Diet Challenge.
By the end of the 30 days she had noticed a dramatic improvement in her digestive health and symptoms and was keen to see how far she could take things. She stuck with the diet changes and a few months later she was able to fall pregnant naturally all on her own.
2. Support Your Microbiome & Heal Your Gut
The gut microbiome has to be one of most exciting fields in medical research at the moment with many of the latest discoveries holding particular relevance for women with PCOS.
While I know this can come as a surprise the first time you hear it, healing your gut is the best place to start. This is critical for overcoming the diet-induced inflammation at the heart of your symptoms.
Which begs the question – is it really you that wants that second piece of cake, or is it your gut bacteria?
Recent studies have shown a causal effect of gut populations on insulin resistance and obesity (Saad et al. 201629; Rabot et al. 201030) and they appear to mediate our mental health too, particularly when it comes to stress and depression (Kelly et al. 201631; Flowers et al. 201532). Since all of these problems are well known to occur more frequently in women with PCOS this is exactly the sort of research our community needs more of.
But wait there’s more!
In just the last few years, researchers have shown that women with PCOS have a lower diversity of healthy gut bacteria than our non-PCOS friends and that these differences correlate with how the disease is expressed (Torres et al. 201833; Liu et al. 201734). We can’t say for sure whether this is a cause or an effect but what’s clear from the latest research is that our microbiome is different and that this difference matters.
Here’s the good news though: It appears that the microbiota of women with PCOS can be altered significantly by the foods we eat (Prince et al. 201635), and that these changes can happen within days (Lawrence et al. 201436).
See where I’m going with this?
While scientists and clinicians are just beginning to imagine the massive potential of a gut driven, PCOS natural treatment protocol, we already know of several dietary changes that can have a positive impact. The first and most important of these is removing as much sugar from your diet as you can.
Before I continue, let me just say here that as a former sugarholic I never thought that I of all people would become “that person”. You know the one? The self-righteous type that gives trick-or-treaters a bag of mixed nuts? Back before I knew any better, I loved sweets so much that I once had a dream I was eating this gigantic s’more. When I woke up in the morning, there were graham cracker crumbs everywhere and my pillow was gone!
Ok, maybe that last bit’s made-up, but I really truly was sufficiently addicted to sugar that I couldn’t be trusted to hold the bag of marshmallows. What I know now though is that sugar is super-bad for your PCOS, and that a lot of the harm it does is via changes to your microbiome.
Dietary fructose, which makes up approximately 50% of all common sugars, has been shown to adversely affect our microbiome in multiple negative ways (Magnusson et al. 201537; Vos 201438; Neuschwander-Tetri 201339). Too much glucose on the other hand, which makes up the rest of the sugar molecule, can cause a sudden spike of insulin.
Given its constituent components (glucose and fructose), sugar is unrivalled as enemy number one on my foods to avoid list. What this means is that if you can successfully free yourself from this addictive substance you’re basically killing multiple PCOS blackbirds with one proverbial stone.
As a recovered sugarholic who literally took years to break a lifelong habit, I know as well as anyone how daunting and unlikely this sounds. This is why I made quitting sugar a major cornerstone of my free 30 Day PCOS Diet Challenge. To help make this process easier, not only do I provide recipes and meal plans that alleviate cravings, but we also spend time exploring some of the emotional and psychological barriers to success.
Hey, if I can do it despite being on a Lucky-Charms-only diet for most of my life, then I’m 100% confident that you can do it too.
Another big way that a PCOS friendly diet can help improve gut health is that it normally includes a lot of prebiotic foods. Prebiotics are foods that feed your healthy gut bacteria and they’re found in abundance in certain vegetables like garlic, onions, and cabbage, as well as many legumes, fruit, nuts and seeds (Monash University 201640).
Probiotic supplements can be especially useful if you’ve recently finished a course of antibiotics or if you’ve been under a lot of stress (these both have adverse effects on your gut bacteria). There are also a number of promising high-quality studies showing positive results when using probiotic supplements to treat insulin resistance (Kim et al. 201841). While it’s still early days, high dose strains of certain Lactobacillus, Bifidobacterium, and Streptococcus seem to be particularly beneficial.
Moving beyond our microbiome, another big step that can help heal your gut is avoiding foods that are known to be inflammatory. Sugar, vegetable oils, dairy, and gluten are the most common culprits in this regard. While sugar and vegetable oils are generally bad for everyone, the thing that makes gluten and dairy particularly pernicious is that it’s super common to have a subclinical intolerance to them and not be aware of it.
The biggest problem with most blogs about PCOS supplements is that they’re only written by people trying to sell them. Even if you have the best of intentions, you simply can’t be unbiased if it affects your pockets.
This blog is different.
I have no affiliates to any supplement suppliers and I have no intention of ever selling them.
But I do have a lot to say on the topic. Especially after having recently reviewed over 900 scientific papers that studied PCOS related supplements when creating my Beat PCOS Supplement Guide.
When you take a proper look at the supplements that really have good scientific data in their corner, the list of contenders looks vastly different to what you’d expect. For a start, the list is pretty short and for many of the symptoms we’d like to treat, there just aren’t good supplements that provide a meaningful effect.
For supplement promoters this can be an inconvenient truth, but for the women that take them this can make all the difference between finding a genuine treatment or wasting your money.
As the creator of the free 30 Day PCOS Diet Challenge, my priorities lie in service to the inspiring women who want to take back control of their health using evidence based lifestyle interventions. So my interest is in providing the best information possible to help you beat this highly treatable disorder based on quality science.
Determining Your Personal Nutrient Status
After having met literally tens of thousands of women with PCOS it’s become clear to me that supplements are of interest for two reasons. You either want a natural alternative to pharmacological drugs, or you’re concerned about a potential nutrient deficiency.
In the list below you’ll find the small number of PCOS supplements where high quality scientific studies have found a notable or strong effect. These PCOS supplements don’t just have one or two animal trials showing a “statistically significant result” (the hurdle rate for publication). They actually have multiple, randomized controlled human studies showing the sort of effect you could really notice if you take them.
In this comprehensive free guide, I share the most common PCOS related nutrient inadequacies and have identified those that result from the drugs we’re usually prescribed. Birth control, metformin, antidepressants, and many more all cause nutrient depletions that even most doctors don’t know to look for.
I’ve also included a recommended resource that describes a step by step process to determining your own personal nutrient status. This includes the exact name of all the tests you need, links to the labs, and 70 pages of detailed notes explaining how to interpret the findings.
So here’s a list of the 11 most proven PCOS supplements according to the evidence.
If you haven’t heard of inositol before, they’re a group of nine naturally occurring vitamin-like compounds that are present to varying degrees in many foods. Myo-inositol, D-chiro-inositol, or a combination of the two are the most commonly used types of inositol when it comes to taking supplements.
Structurally speaking, they’re somewhat similar to glucose, and the various things they do at a cellular level means they can have a significant effect on several PCOS related symptoms.
When researching for my Beat PCOS Supplements Guide, I looked at nearly 30 scientific studies that specifically looked at the effects of inositol supplements on various PCOS related symptoms. The take home from this analysis was that while the marketing hype can seem a bit overzealous, inositol supplements really can hold their own when it comes to certain PCOS symptoms.
If you really want the lowdown on this highly popular PCOS supplement, then my full blog post on inositol for PCOS is well worth a read. Here are the key points I think everyone needs to know though.
Myo-inositol is clearly a pretty good idea for anyone with PCOS that’s trying to conceive as this supplement has been shown to reduce AMH levels and the size of polycystic ovaries better than birth control (Ozay et al. 20161). It’s also been shown to increase egg quality and reduce the risk of ovarian hyperstimulation in women undergoing fertility treatment (Papaleo et al. 20092; Ciotta et al. 20113).
If your doctor prescribes metformin to help you get pregnant, you’re actually better off taking myo-inositol instead. In a carefully controlled trial, researchers demonstrated this point when women with PCOS who took myo-inositol supplements achieved a natural pregnancy rate of 30% during a six month period, compared to just 18% of women that were prescribed metformin (Raffone et al. 20104).
Inositol supplements can also be great for anxiety with several studies showing they can reduce panic attacks, sometimes even better than medication (Palatnik et al. 20015). Inositol can help with unwanted hair and acne too, but don’t expect amazing results. The best research to date shows a “statistically significant” improvement in these symptoms for some, but not all women with PCOS (Minozzi et al. 20086; Zacche et al. 20097). The thing to keep in mind of course is that statistical significance can mean a pretty small improvement in real-life terms so this is more of a side-benefit than a PCOS acne supplement.
The one area where the marketing of inositol diverges the most from scientific fact is in claims about weight loss. Despite what you may read elsewhere, inositol does not help you to lose weight in a meaningful way. The blockbuster study quoted by promoters of the product Ovasitol, does not support this health claim (Nordio and Proietti 20128), and neither do many others (Gerli et al. 20079; Genazzani et al. 201410; Santamaria et al. 201211).
If weight loss is one of your main health goals right now, then you’ll be far better off joining my free 30 Day PCOS Diet Challenge rather than taking inositol. During this live event I typically see women lose 10 – 15 pounds in just 30 days, with high achievers like Erina, Kendall, and April going on to lose more than 50 pounds using the simple strategies I share during this free program.
Zinc is one of the essential 24 micronutrients needed for survival and thanks to its antioxidant and enzyme regulating behavior, supplementing with this mineral can affect several PCOS related symptoms such as ovulation, acne, weight management, insulin sensitivity and the regulation of blood glucose levels.
This is a nutrient you don’t want to be short on and as I explain in my free PCOS Nutrient Inadequacies Guide, there’s plenty of reasons to suspect you might be – especially if you’re on birth control.
Zinc might seem like an unusual choice for a PCOS supplements list, but it made it through my science filter because of its proven efficacy in fighting treatment-resistant depression (Ranjbar et al 201412; Siwek et al. 200913).
Depression is well known to be a REALLY common problem for women with PCOS (Barry et al. 201114; Jedel et al. 201015), so if this is a problem for you, then you’re definitely not alone.
As someone that’s battled with depression for most of my adult life, this PCOS symptom also happens to be particularly close to my heart. Even today as I’m creeping my way towards freedom from SSRIs, monitoring and adjusting my zinc levels has made a massive difference to my daily wellbeing.
I couldn’t be sincerer when I say that if you’re struggling with depression, then you need to get your zinc levels tested.
As you’ll learn from the recommended resource included in my free PCOS Nutrient Inadequacies Guide, you need to make sure to test for zinc plasma and NOT serum. Ignore the “normal ranges” as these are usually too broad and know that the sweet spot for good health is likely to be between 100-120 micrograms per litre.
If your levels are less than 70 μg/L, then you should definitely be considering supplementing with either zinc acetate, zinc gluconate, zinc sulfate, zinc citrate, or zinc monomethionine. Don’t use zinc oxide or zinc picolinate as these are not absorbed as well by your body. Note that 70 μg/L is within the “normal range” but concentrations less than this indicate you’re actually on the low side.
If you go down this pathway, then you should also be considering a copper supplement too as zinc needs to be kept in balance with copper. Your zinc to copper ratio should be kept between 8:1 and 12:1. Talk to your doctor of course, as hopefully they can provide some guidance with this.
Curcumin is the yellow pigment found in turmeric and it’s a hot topic thanks to its anti-inflammatory and anti-depressant effects.
Chronic low grade inflammation is one of the distinctive characteristics of a PCOS diagnosis and is responsible for many of our unwanted symptoms. From unfair weight gain and cardiovascular disease risks, to infertility, hirsutism, and acne, inflammation plays a key role throughout.
There’s no doubt that the foods we eat can fuel or extinguish the fires of inflammation, and a curcumin supplement can help tip the balance in your favor. The thing about curcumin supplements though, is that taking them effectively is vastly different to what most people assume.
If you jump online, or talk to your slightly eccentric, Aunt Selma, you’ll hear that consuming large amounts of turmeric will help you live to 100. The reality though is that your gut has a lot of trouble absorbing the curcumin found in turmeric and the same can be said for the majority of cheaper supplements.
While curcumin can be a safe and effective supplement, if you want to experience the “proven benefits”, then you’ll need to be taking one of the more expensive brands that use proprietary technology to increase bioavailability.
4. Fish Oil
When people talk about fish oil, what they really mean is a concentrated supplement containing two particular omega-3 fatty acids – EPA and DHA. These are the super healthy..
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.
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 with 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 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 it’s actually one of the defining aspects of a PCOS diagnosis as it occurs 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 well documented in countless studies that show reducing insulin, rather than limiting calories, is the key to weight loss (Holman et al. 20079).
This is 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 causing us to have high insulin levels across the day and this means more body fat.
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 thanks to the release of inflammatory compounds from fatty cell tissues that make our PCOS worse while also calling for more cortisol.
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.
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.
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..
If you’re wondering how to get pregnant with PCOS, then you’ve come to the right place.
In 2016, I overcame what I’d come to believe was incurable PCOS infertility, and I’ve since then had the pleasure of seeing thousands of other women take control of their reproductive health and fall pregnant too.
As someone that’s been through the full list of fertility treatments before finally falling pregnant naturally, this article provides a comprehensive overview of both the lifestyle changes and the medical interventions that can help you achieve a healthy happy pregnancy.
With the information you’ll find here in these 11 “must know” principles, you’ll be able to make the best fertility choices for your particular circumstances.
Can You Get Pregnant With PCOS?
While PCOS can cause infertility due to ovulation and egg quality issues, PCOS is also one of the most treatable causes of infertility. Given the number of options available, both natural and medical, your chances of getting pregnant despite a PCOS diagnosis are very good.
1. Getting Pregnant With PCOS Requires First Understanding How PCOS Affects Fertility
When I first started having trouble falling pregnant, I had no idea what I was dealing with and this made the problem a hundred times scarier. It now seems obvious that the first place I should’ve started is understanding the cause of my problem better.
For women under 38 years of age, more than 9% of IVF cycles conducted in the US are primarily undertaken because of PCOS (SART online1). This is more than twice as common as endometriosis and it’s widely understood that ovulatory disorders in general, and PCOS more specifically, is the number one cause of infertility.
PCOS affects fertility in a number of ways. The most obvious one of course is that most women with PCOS don’t get regular periods, with this one being my biggest clue leading up to my own diagnosis.
Like the majority of women with this disorder, I was put on birth control as a teen because I only had a period about once or twice a year. While this got rid of the symptom, it did nothing to actually address the underlying problem which is why I often refer to birth control as a band-aid solution for women with PCOS.
Irregular periods are a rite of passage for most women with PCOS because of the way this disorder affects our hormones. At the heart of the matter is our unusually high levels of androgenic hormones like testosterone, and chronic low grade inflammation. These two mechanism are the primary cause of ovarian dysfunction and give us two ways we can improve our fertility through lifestyle interventions.
By eating pro-inflammatory foods like vegetable oils and sugar, we’re essentially adding further fuel to an existing fire so it makes sense that eliminating these foods is a simple way to boost your chances of getting pregnant.
Our chronic inflammation is also closely linked to the way our cells respond to glucose. Regardless of whether you’re thin, or you experience the more classical symptoms of PCOS that lead to unfair weight gain, the majority of PCOS sufferers will have a dysregulated insulin response within their ovaries, and often throughout their bodies too.
Since insulin is one of many important hormones that controls our cellular processes, when insulin is unbalanced, many other hormones go out of synch too. Most significantly for our periods is the fact that excess insulin causes our ovaries to overproduce androgens which ultimately cause our eggs to stop maturing before they get a chance to ovulate.
It’s a bit of a circular loop: PCOS means high androgens and chronic inflammation which in turn leads to insulin issues. When our insulin functioning gets bad enough, it then returns the favor by promoting more androgens and further inflammation.
But PCOS infertility runs much deeper than just affecting ovulation.
In order to get pregnant with PCOS not only do you need to ovulate, but you also need to ovulate good quality eggs. This is one of the key reasons why ovulation induction drugs or injectable hormone products are not a complete solution to PCOS infertility.
While the mechanisms explaining this phenomenon go well beyond my scientific literacy, it seems pretty clear from the literature that in addition to preventing regular ovulation, the hormone imbalances of PCOS have a detrimental effect on the ability of our eggs to perform their reproductive functions (Palomba et al. 20172).
As a further kick in the guts to anyone who manages to ovulate a healthy egg while trying to conceive, having a PCOS diagnosis means you’re also more likely to miscarry. This has been shown to be true even when the other major variables like age, body weight, and embryo genetics are controlled for (Luo et al. 20173).
As anyone who’s experienced miscarriage before can tell you, the results can be devastating. With the two I experienced, it took me months to get over the shock and distress I went through.
And while not specifically a barrier to having a baby, the reality of getting pregnant with PCOS means you also have elevated risks for pregnancy complications like pre-eclampsia, and you’ll need to be especially vigilant about gestational diabetes given our three-fold risk of this disorder (Yao et al. 20174).
2. Don’t Underestimate Diet And Lifestyle Changes
Many fertility doctors and OBGYN’s will tell you that a PCOS diagnosis means you’ll only ever be able to get pregnant with the help of fertility treatments. This could not be farther from the truth.
There’s a huge amount of compelling evidence that shows for many women, the right lifestyle modifications may be all that’s needed to achieve a healthy PCOS pregnancy.
Besides the link to a list of scientific studies above let me back this up with some specific examples:
If you’re trying to conceive, you have PCOS, and you also happen to be overweight, it’s likely that you would’ve been advised that losing weight before conceiving is a good idea right? While this advice can often be poorly delivered by an insensitive health care professional (often with little support on how to achieve this), there’s good consensus with this view amongst experts (Tarlatzis et al. 20085).
Excess weight has been shown to adversely affect the reproductive outcomes of a PCOS diagnosis (Baghdadi et al. 20126; Joham et al. 20147) so getting to a healthy preconception body weight can really boost your fertility.
The benefits of using lifestyle interventions in addition to seeking fertility treatments can best be seen though with a recent study which showed that taking a four month break to improve your diet and lifestyle before starting fertility treatments greatly improves your chances of success (Legro et al. 20168).
To give you a feel for the results that can be achieved, in this one particular study, ovulation rates improved by around 50%, while live births more than doubled as a result of lifestyle modifications prior to fertility treatment.
This is why I say it doesn’t matter if you’re planning on undertaking medical fertility treatments or not. By being intentional about what you eat, the exercise you do, and how you cope with stress, you’re setting yourself up for success irrespective of whatever else you are doing – which many women from my free 30 Day PCOS Diet Challenge can attest to.
The benefits of a PCOS friendly lifestyle goes well beyond just getting pregnant. Eating in a way that supports your PCOS reduces the risk of miscarriage and pregnancy complications, improves breastfeeding, and provides lifelong health benefits to both you and your baby. As long as you’re sustaining this healthy way of living, you’ve effectively solved the underlying cause of your infertility.
The downside of using lifestyle interventions to treat PCOS infertility however, is that it can take longer. It takes time for your body to heal and for the effort to convert into real results so plenty of patience is clearly a key factor for success here (definitely not my strong suit).
I can clearly remember that gut-wrenching desperation I felt once I’d decided I was ready to be a mom, so I completely understand the desire to “just get on with it” and the justifications for heading straight to the fertility clinic.
This is largely why I sought fertility treatments for my PCOS in the first place as the dietary changes I had begun to make only a few months earlier still didn’t seem to be working. My lack of understanding meant I completely underestimated just how powerful lifestyle changes could be.
While it took me two years before I started having a regular period, once I got there, I was able to fall pregnant naturally very quickly.
As I found out, sometimes it pays to take a longer term view as this would’ve saved me and my husband tens of thousands of dollars and untold stress over what ended up becoming many unnecessary fertility treatments.
Not to mention a lot of bruised and collapsed veins!
3. Know When Fertility Treatments Are Needed For PCOS
To be fair and balanced here, there’s no doubt that fertility treatments certainly have their place and we’re lucky to have this option. The key is knowing when they’re necessary and when they’re not.
If there’s a male factor fertility issue or another complication beyond PCOS, medical intervention may be well warranted.
Fertility treatments may also be a good option if you’re in your late 30’s and are concerned about the time that may be needed to heal your PCOS through diet and lifestyle changes alone. As a 1981 baby that still feels like a spring chicken, I absolutely hate saying that your late 30’s are “old” but unfortunately our biology takes no prisoners.
The effect of age on egg quality can be seen in studies that look at the percentage of embryos produced via IVF that have the correct number of chromosomes. Embryos with the wrong number of chromosomes almost always either fail to implant in your uterus or they result in early miscarriage so chromosome count is an excellent indicator of egg quality.
As the figure below shows, egg quality peaks in your late twenties, and then begins a speedier decline after your mid-thirties. Unfortunately the reality is that this has a direct effect on your chance of getting pregnant with PCOS.
Figure 1. Percentage of embryos produced by women that have the correct number of chromosomes i.e. “good quality” eggs. (Franasiak et al. 20149).
What this means for our “natural” fertility is that for the average woman, things start to get pretty difficult once you hit 40 as can be seen in the next figure. These results used the genealogical data from women and their husbands born between 1840 and 1859 which is useful for seeing how fertile we’d be if it weren’t for all the advances in the medical technology that we benefit from today.
Figure 2. Changes in relative “natural” fertility rates with age from historical population data (Menken et al. 198610)
The ability to extend the age at which we can start or grow our families is one of the greatest gifts of advanced reproductive technology, but even with the best clinics, age can be a major barrier. While the media loves to cover celebrities having children in their 50’s, the reality for women wanting to use their own eggs is that even with IVF, once you pass 45 years of age, your cumulative success rates are likely to be less than 20% after three attempted cycles.
While I hate being so blunt, the take home message here is that if you’ve hit your forties, it’d be prudent to pursue IVF regardless of how PCOS friendly you’re living.
4. Understand What Fertility Treatments Can’t Do For PCOS
The downside of fertility treatments is that they do nothing to address your underlying PCOS diagnosis – they’re more of a clever way to get around the problem for the purposes of having children. Just like how taking the pill “solves” irregular periods, fertility treatments are another band-aid solution that may help you get pregnant in the short-term but do not benefit your pregnancy or your health beyond that.
This comes back to what I said in Step 2. Working on your diet and lifestyle in addition to fertility treatments not only improves your chances of success, but it also means that when you do get pregnant, you’ll be more likely to have a healthy pregnancy. It’ll also improve breastfeeding, and you’ll support the epigenetic switches that promote the long-term health of your baby.
The risk of your PCOS getting worse after pregnancy is also a major concern that I see regularly through my PCOS support group.
This is why I get so many mom’s taking part in my free 30 Day PCOS Diet Challenge. Because it’s also not uncommon for unwanted hair, and acne to get worse, and many women will struggle with their weight even more following childbirth.
Women that don’t get the help and support they need to adopt a PCOS friendly lifestyle, will also often find themselves back to square one when they’re ready to have another baby.
5. Be An Informed Fertility Patient If You Need Treatment
Thankfully for the families in need, reproductive technology has advanced a long way beyond telling people to “just relax and it will happen”. This was always a pet peeve of mine during my four and a half years of trying to conceive.
When I first went to get fertility treatments I really didn’t understand what my options were. I was at the mercy of the doctors I would see, and looking back now, I don’t necessarily think they were as up to speed with the science as I would’ve preferred. I don’t want to be disparaging towards doctors, but the reality is that the man or woman who came last in their class at medical school is still called a doctor so I firmly believe in the principle of being your own health advocate. The best weapon that an informed patient can wield is good information obtained through self-education.
Here’s the basics of the standard PCOS fertility treatment options:
The first cabs off the rank for most fertility specialists that treat women with PCOS are metformin and..
As the creator of the free 30 Day PCOS Diet Challenge – a live program for women wanting to beat PCOS with evidence based nutritional changes, I’ve reluctantly found myself in the thick of questions about PCOS supplements.
While I don’t think it’s necessary for everyone to become an expert, it is important to be an informed consumer so you don’t get mislead by clever marketing and industry hype.
So in this short article I am going to share with you the 5 things I believe every woman with PCOS needs to be aware of and what to do instead when considering supplements.
1. Don’t Trust An Unregulated Industry
The US Food and Drug Administration (FDA), will tell you that dietary supplements are intended to supplement your diet and that they’re not drugs that are supposed to treat diseases like PCOS. A genuine bureaucrat might also give you a wink since this half-hearted statement is both understandably valid while also being completely unhelpful.
Of course supplements can help treat diseases like PCOS and the good ones are like drugs, it’s just that the FDA doesn’t regulate them that way. What this means for you is that you have unlimited access to medications that have limited scrutiny concerning safety and efficacy.
This is both and good and bad right?
It’s good if you’re well informed and are guided by a highly skilled medical professional, but it’s bad if you’re desperate to “try anything” in an attempt to get your PCOS symptoms under control.
The lack of regulation in the supplements industry means consumers are accepting more risks than when they buy pharmaceuticals. These risks include:
A product being dangerous or harmful.
Taking supplements that have an adverse effect on other medications (or supplements) you’re taking.
Buying products whose active ingredients are either of poor quality or are in lower amounts than stated on the label (this problem is far more widespread than we’d like to believe).
Being exposed to contaminated product due to ill-managed manufacturing practices.
If something is potent enough to make a genuine difference to your symptoms, then it’s also powerful enough to do you harm. And despite all the scientifically presented marketing hype, the majority of supplements are far less effective than they’re cracked up to be.
2. Critically Assess Health Claims Before Taking A PCOS Supplement
Want to know the easiest way to sound evidence based in the supplements business? Quote a study that supports your product.
When researching for my PCOS Supplements Guide here’s the questions I constantly kept asking myself whenever I saw a health claim with a scientific reference attached:
Who did this study and where was it published? One of the oldest tricks in the book for supplement manufacturers is to commission a “study” with a marketing company that looks like a science establishment. You specify the results you want, and they’ll create the supporting evidence. What you want to see instead is a peer reviewed scientific paper published in a legitimate publication. One of the easiest ways to determine how credible the publication is, is to look up its Journal Impact Factor. A ranking of 4 and above puts it in the top 10% in terms of its scientific reputation, while if it doesn’t have a score that should probably be a red flag.
Was the study done in a lab, tested on rats, or were real humans involved? This is sort of the pathway of progress for anyone trying to make a health claim. Good quality evidence comes from human trials that are preferably randomized and double blinded (which means neither the patient nor the researcher knows which is the placebo and which is the supplement until after the results are in).
How much difference was observed? It’s one thing for a PCOS supplement to “have an effect”, it’s quite another for that effect to be meaningful in real life. For example, myo-inositol is a popular PCOS supplement that has been shown in some trials (but not all) to help with weight loss. People promoting inositol products love this health claim…
But out of all the high quality studies I looked at when writing my Beat PCOS Supplements Guide, the best I could find showed an average weight loss of just 2 pounds over 3 months (Gerli et al 20071). While I’m not saying inositol isn’t great for PCOS, to me the weight loss aspects are hardly worth getting excited about. Especially when you compare this to the weight loss results achieved during my free 30 Day PCOS Diet Challenge. It’s not uncommon to see women lose 5-15 pounds within just 1 month – and that’s without restriction dieting!
Have the results been replicated? One study doesn’t make a conclusive finding. If a PCOS supplement is really as good as the marketing people tell you, then the benefits will show up time and time again whenever it gets studied.
A good example of this is Berberine, which has been shown in many high quality studies to have a strong effect on blood glucose levels in women with metabolic syndrome (a condition that occurs in the majority of women with PCOS). The same can’t be said for the inositol and weight loss health claim I mentioned above with several studies showing this supplement to have no significant effect on body weight (Nordio and Proietti 20122; Genazzani et al. 20143; Santamaria et al. 20124).
3. Don’t Be Blasé About Safety and Side Effects
I don’t know about you, but I can always hear my teenage self say “yeah, yeah, whatever” whenever I read a safety warning on a supplement label. Perhaps it’s my natural tendency to rebel against authority, but they often seem so exaggerated and unlikely.
I mean come on… do I really need to inform my doctor I’ve taken some vitamin C?
The problem with becoming de-sensitized to safety warnings is that when it comes to some supplements, it’s easy to become dangerously cavalier. Just because you can order it over the internet without a prescription, doesn’t mean it’s safe.
There’s multiple degrees of safety and side effects worth keeping in mind with PCOS supplements.
First there’s the products that are known to be harmful. I came across several examples of these when researching for my PCOS Supplements Guide. One of these was ephedrine which has been well proven to have a notable effect on weight management. This is why it’s used in many “diet pills” that you can still order online despite it being banned in the US after several deaths and other serious adverse effects were reported.
Chromium is another supplement that’s often marketed heavily toward women trying to lose weight. What no supplement company will tell you though is that there’s concern in the scientific community that this product causes cancer (Wu et al. 20165). To me there’s far better ways to achieve effective and sustainable weight loss.
The next level down, is the risk of interactions with other drugs you’re taking. While a given PCOS supplement may be relatively safe when taken on its own, if it messes with the effects of other medications you could easily land yourself in trouble. Berberine is a great example of this.
Berberine is one of the few PCOS supplements that’s been shown to have a similar level of efficacy to pharmaceutical drugs like metformin (Dong et al. 20126).
This is pretty exciting news for anyone that’s sick of metformin’s side effects, but berberine is also known to interact with antibiotics in a way that can lead to heart problems (Zhi et al. 20157). There’s evidence suggesting it may limit the effects of metformin (Kwon et al. 20158) and it’s unsafe during pregnancy so you need to be very careful when considering this supplement, especially if you’re trying to conceive.
Once you’re satisfied your chosen supplement doesn’t cause harm, and it won’t affect your other medications, there’s still the risk of unwanted consequences.
For example, during my free 30 Day PCOS Diet Challenge I often see women within the Challenge Facebook Group recommending magnesium and zinc to help with various symptoms. But it’s amazing how something as innocuous as these minerals, can actually be bad for you in certain circumstances. This is because of how minerals are balanced in our bodies with the levels of one, affecting another.
For example, if you take too much magnesium you can mess up your calcium balance, while too much zinc might lower your copper or iron.
4. Don’t Underestimate Food For Nutrition
While it’s a little too cute for my liking, the FDA’s advice that dietary supplements are only meant to supplement your diet points to a fundamental belief that I share. While supplements have played an important role in my own recovery from PCOS and natural pregnancy, I think it’s uncontroversial to say that if we eat better, we’ll have far less need for supplements.
It’s easy to underestimate just how powerful the right diet can be when it comes to treating PCOS.
The thing about food is that you have to eat it anyway, so choosing the right things to nourish yourself with provides a long term sustainable solution that goes well beyond the benefits of any supplement regime.
Food is always the best source of nutrition. It’s entirely safe and amazingly effective.
5. Know Where to Get Help
Clearly there’s a lot to think about when considering PCOS supplements, which is why I always recommend getting professional help rather than taking matters into your own hands.
In my experience a functional medicine practitioner or naturopathic doctor is almost always going to be the best person to see when it comes to treating PCOS with supplements.
Unlike conventional physicians who need you gone in 15 minutes, these highly qualified doctors take the time and effort to understand your unique situation and the underlying issues. This can be a totally mind-blowing experience if all you’ve ever been used to in the past is band-aid solutions like the pill. A functional medicine doctor can order the right tests, monitor dosages and progress, as well as recommend their most trusted supplement brands.
The interesting thing about functional medicine, is that despite also being trained in conventional medicine, they always start with dietary changes.
So while you’ll always get the best results with personalized advice, you can get yourself 90% of the way by switching to a PCOS friendly diet first. Given that great health care is expensive, teaching yourself how to treat PCOS using food as medicine can save you thousands of dollars in the long run.
1Gerli, S.; Papaleo, E.; Ferrari, A.; et al. Randomized, double blind placebo-controlled trial: effects of myo-inositol on ovarian function and metabolic factors in women with PCOS. EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES, 2007.
2Nordio M; Proietti, E. The combined therapy with myo-inositol and D-chiro-inositol reduces the risk of metabolic disease in PCOS overweight patients compared to myo-inositol supplementation alone. EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES, 2012.
3Genazzani, Alessandro D.; Santagni, Susanna; Ricchieri, Federica; et al. Myo-inositol modulates insulin and luteinizing hormone secretion in normal weight patients with polycystic ovary syndrome. JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH, 2014.
4Santamaria, A.; Giordano, D.; Corrado, F.; et al. One-year effects of myo-inositol supplementation in postmenopausal women with metabolic syndrome. CLIMACTERIC, 2012.
5Wu, Lindsay E.; Levina, Aviva; Harris, Hugh H.; et al. Carcinogenic Chromium(VI) Compounds Formed by Intracellular Oxidation of Chromium(III) Dietary Supplements by Adipocytes. ANGEWANDTE CHEMIE-INTERNATIONAL EDITION, 2016.
6Dong, H; Wang, N; Zhao, L; Lu, F. Berberine in the treatment of type 2 diabetes mellitus: a systemic review and meta-analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE, 2012.
7Zhi, Duo; Feng, Pan-Feng; Sun, Jia-Liang; et al. The enhancement of cardiac toxicity by concomitant administration of Berberine and macrolides. EUROPEAN JOURNAL OF PHARMACEUTICAL SCIENCES, 2015.
8Kwon, Mihwa; Choi, Young A.; Choi, Min-Koo; et al. Organic cation transporter-mediated drug-drug..
With medical science and the internet being what they are today, you’d think it’d be easy to find out what the best diet for PCOS is. But when I first looked for answers all those years back, I found so much conflicting information that it became completely overwhelming. It was worse than the time I googled “what should I buy my mother in-law for Christmas”.
Should I be eating a plant based diet, or am I supposed to go keto? But how can a ketogenic diet be better when everyone tells me I need to avoid fat? And how the heck am I supposed to “just lose weight” when every diet I’ve tried in the past eventually made me heavier?
After years of research and having to learn everything the hard way, the goal of this article is to make the process as easy and simple as possible for you.
If you’re looking for evidence based answers to what you should be eating, then look no further.
The Link Between Diet And Your PCOS Symptoms
To understand how these 13 food principles work, there are just two things you need to know about PCOS.
While medical journals routinely state that the exact cause of PCOS is yet to be identified, from a practical, what-can-I-do-about-it perspective we know it’s two main mechanisms: high androgen levels (testosterone being the most famous androgen), and chronic low grade inflammation.
It doesn’t matter if you have lean type PCOS and you’re relatively slim, or your PCOS is expressed with the more classical phenotype where you gain weight easily, these two things are responsible for all those awful symptoms we have to deal with every day.
Once you understand these two main mechanisms, the 13 steps outlined below make a lot more sense. It also becomes apparent why the same PCOS diet plan that works for women wanting to lose weight, also works just as well for someone with lean type PCOS that is struggling to fall pregnant.
Making dietary changes can be about as fun as having your bikini line waxed after six months in the wilderness, but if you’re anything like me, then understanding the WHY behind what you’re doing makes it a lot easier to get motivated about doing it.
My free 3 Day PCOS Meal Plan is a good example of this, where I don’t just provide PCOS friendly recipes and say “here, eat this” but instead I share the thinking behind why you’d want to make these food choices. It’s a lot more useful that way right?
My intention with this article is to use the same helpful approach to set you up for long term success.
How The Right PCOS Diet Plan Can Improve Androgen Levels
Androgens like testosterone are the puppeteers responsible for the majority of our PCOS symptoms.
They interact with all our other hormones to impact our fertility, to cause unfair weight gain, to promote adult acne, and to give us not enough hair in the right places, while providing extra in the wrong places. High androgen levels are pretty much the bane of our existence.
Androgen levels work in unison with your insulin levels. When insulin goes up, so too does testosterone.
Insulin also happens to be the hormone that makes our bodies store body fat, which is why a lot of women with PCOS find it nearly impossible to lose weight, while other’s often accumulate excess stomach fat despite being otherwise thin.
Putting two and two together here, since our insulin levels are controlled by what we eat, if we can implement the right diet for PCOS and eat in a way that keeps our insulin levels lower, all our PCOS symptoms will be improved.
I’ve been amazed by how quickly this effect can be seen when hearing from women who do my free 30 Day PCOS Diet Challenge. It’s not uncommon for people to see early results within just a few weeks of changing their diet, which is pretty remarkable.
Inflammation And The Best Diet For PCOS
While I might get lucky once in a while, it’s pretty safe to say that most people who find my blog aren’t that interested in biochemistry. But it’s still very important – especially if you want to understand how food affects PCOS.
In the hopes of finding a happy medium, here’s the less boring, simplified explanation of the PCOS-inflammation connection:
Chronic low-grade inflammation is an inherent part of a PCOS diagnosis which means our immune systems are constantly on amber alert. While inflammation is good if you happen to be injured, when it happens all the time it leads to many of the serious long term health risks that are associated with PCOS. Things we don’t want to think about normally like heart disease, liver disease and cancer etc.
At a more everyday level, inflammation makes a major contribution to many of the daily health issues so common amongst our PCOS community. Things like bloating, sinus congestion, low energy, brain fog, sore joints, insomnia, anxiety and depression.
Given this unfortunate starting point, it makes perfect sense that when choosing what to eat, women with PCOS need to avoid pro-inflammatory foods, and eat more of the things that are rich in natural antioxidants instead.
It’s as simple as that.
As you’ll see throughout the 13 steps below, managing insulin levels and avoiding inflammatory foods are the two foundational ideas behind each of these principles.
So let’s get into it!
1. Avoid Fad Diets
Almost without exception, all of the success stories from my free 30 Day PCOS Diet Challenge come from women that have tried a lot of other diets before finally discovering that a PCOS diet is a unique beast.
While we can draw on the healthy influences of the Mediterranean Diet, Whole30, and Paleo recipes, none of these are perfectly synonymous with the type of diet that works best for PCOS.
Restriction Diets Don’t Work For PCOS
The most important misconception I want you to forget is this seemingly universal belief that you need to restrict your calories if you want to lose weight.
If you understand that body fat accumulates because of poor insulin regulation and NOT because of excess energy in your diet, then it should be pretty obvious that restriction dieting is a fool’s errand.
Since PCOS is the cause of weight gain, reducing your calories is a bit like putting your dirty socks in the dishwasher. You’re simply using the wrong tool for the job. Anyone who tells you otherwise is not keeping up with our current understanding of how PCOS works.
My biggest problem with restriction dieting though is the fact that they’ve been shown not to work time and time again, yet they continue to be the only way we’re told we can lose weight.
The most famous study showing the ineffectiveness of restriction diets reviewed 31 long term weight loss studies and found that between one to two thirds of dieters regained more weight after they finished their diet than what they lost while on it (Mann et al. 20071). Based on the hundreds of people I hear from at the start of my free 30 Day PCOS Diet Challenge, I’d say the percentage is closer to 99%!
So I’ll say it again: The best diet for PCOS does not require caloric restriction. Traditional dieting techniques don’t work over the long term.
Why I Don’t Recommend A Ketogenic Diet For Women With PCOS
While it’d be unfair to call it a “fad”, the ketogenic diet seems to be a popular diet for women with PCOS that I don’t think is optimal. This approach can certainly be effective, but here’s why I don’t think it’s the best diet for PCOS.
Ketogenic diets require that you consume very small amounts of carbohydrates – like 20 grams per day small. When you do this for several days, there’s not enough glucose in your system to keep you functioning so your metabolism switches to consuming fats instead. This metabolic state mimics starvation and is known as ketosis.
Going into ketosis is a pretty amazing way to lose a lot of weight quickly, and this type of diet has been widely proven as an effective PCOS therapy (Paoli et al. 20132). These health benefits, however, are largely a result of improvements in insulin regulation, and these same benefits can be achieved without “going keto” as I’ll talk about more in Step 5.
The reasons I don’t recommend ketogenic diets for women with PCOS include:
The ketogenic diet feels like a diet. For women wanting a long-term sustainable cure for their PCOS, being “on a diet” for the rest of your life is hardly an acceptable solution. The food restrictions required to keep your body in ketosis can mean some careful math before taking every bite, which is why most people can’t sustain this long term. No one likes to be ON a diet, you just to HAVE one that works for you.
The ketogenic diet can be unhealthy. Without wanting to discredit all those well-read and disciplined keto’ disciples out there, it’s not uncommon to develop mineral and vitamin deficiencies when this diet is not performed correctly. Researchers have warned of the potentially serious health risks of a ketogenic diet (Czyzewska-Majchrzak et al. 20143) showing it’s not all upside when denying yourself carbs.
The ketogenic diet may not be so good for trying to get pregnant. A ketogenic diet on its own is not specific about the sources of dietary fat, leading some researchers to claim it can be harmful for fertility (Kulak and Polotsky 20134).
The ketogenic diet can cause thyroid malfunction. Given that hypothyroidism can be a common problem for women with PCOS, recent reports documenting the adverse effects of a ketogenic diet on thyroid function should be cause for reconsideration (Kose et al. 20175).
The side effects can suck. Many women report some pretty uncomfortable side effects from this diet. While constipation can be an ongoing problem if you don’t eat enough leafy green vegetables, there’s no avoiding the flu like symptoms when your body makes the switch into ketosis.
Why I Don’t Recommend A Plant Based Diet For Women With PCOS
I also get a lot of questions from the women who do my free 30 Day PCOS Diet Challenge asking if a plant based diet is best for PCOS. This is another legitimate approach that can certainly be effective, but after spending a lot of time looking into it further, I now think that vegetarianism is far less than optimal for women with PCOS.
I totally appreciate the appeal of a plant based diet from an ethical stand point. I used to be a vegetarian for this very reason which made it harder to accept that the best diet for PCOS includes eating animal protein.
So it’s in spite of my personal bias towards the wellbeing of animals that I reluctantly acknowledge these three important facts:
Eating fish, meat, and eggs is a guaranteed way to ensure you’re getting adequate amounts of all nine essential amino acids. Sure you can do this by eating a wide range of different plant based foods every day, but you need to be exceptionally skilled at it to avoid an amino acid inadequacy while also keeping your carb intake low (see Step 5 below). Of the many vegetarians I know personally, none of them seem to succeed at this.
Animal sources of protein are all highly bioavailable and the same can’t be said for most plant derived alternatives. It’s one thing for a food to contain an essential amino acid, it’s quite another for that molecule to be readily absorbed and used in your body. Pea protein isolate may be a rare exception here.
To be fair to all the women with PCOS that have achieved great results when switching to a plant based diet, I’m not saying it can’t be done. It’s just that it’s not optimal.
I’ve heard plenty of success stories from women who’ve switch to a plant based diet and I think a lot of this has to do with the fact that they’re swapping out pro-inflammatory processed foods for healthy whole foods. This is great as it’s exactly what Step 2 is all about. It’s just that a plant based diet is even better when you also include fish, meat, and eggs while you’re at it.
2. Swap Processed Foods For Nutrient Dense Whole Foods
Principle 2 has to be the least surprising idea here, but there’s more to this general public health recommendation when it comes to PCOS.
The problem with processed foods and PCOS is threefold. The first problem is that if you’re eating processed foods, you’re not eating all the good things that can help heal your PCOS. And as a general rule, processed foods contain pro-inflammatory ingredients that make your symptoms worse. The worst of these are vegetable oils, which I talk about more in Step 8, and sugar which happens to be the next step in your polycystic ovarian syndrome diet induction.
There are also a bunch of compounds in processed foods that people have good reason to be concerned about. These include suspected carcinogens like chemical food coloring, potassium bromate, butylated hydroxytoluene (E321), and its close cousin butylated hydroxyanisole (E320).
To me processed foods are things made in factories, where engineers and food scientists collaborate to produce highly marketable products that play on our evolutionary weak-points. The priorities in this process are cost and convenience rather than health and wellbeing which is kind of counterproductive to using food as medicine.
If it comes in a package and you don’t recognize all of the ingredients then I’d call this a processed food.
Whole foods by comparison, are foods your granny and great granny would recognize so these should be easy to identify.
3. Exclude Sugar From Your Polycystic Ovary Syndrome Diet
At the risk of becoming your least favorite person, the reality of polycystic ovarian syndrome is that quitting sugar is the most powerful step you can take to overcome your diagnosis.
When I first learned this, I freaked out. If there were sugar eating Olympics, I’d have taken the podium every year. If you’ve ever seen the Coney Island hot dog eating contest, that’s how I used to plough through Reece’s peanut butter cups and ice cream… okay maybe that’s a slight exaggeration but the point is I get-it if you think this sounds ghastly or impossible.
But there’s just nothing good that can be said about sugar when it comes to PCOS. It causes your body to store rather than burn fat, promotes unwanted facial hair, acne, and male-pattern baldness, and it makes you feel like crap emotionally.
If you’re trying to get pregnant, sugar consumption is really working against you as it’s known to adversely affect egg quality, increase miscarriage rates, and reduce libido.
So who wants sugar now??
Of course you still do…
It would be completely naive to presume that knowing something is bad for us is enough to stop us eating it. After the long struggle I fought to break my own sugar addiction I’d never make this mistake and I certainly could never judge anyone for finding this step the hardest.
Research has clearly demonstrated a number of similarities between food addiction and drug use disorders (Pivarunas and Conner 201510) with it well documented that sugar is more addictive than cocaine (Ahmed et al. 201311).
Responding to the social, psychological, and biological challenges of quitting sugar really was a key driver for me when I developed my free 30 Day PCOS Diet Challenge. During this immersive experience I seek to nourish and satisfy any potential cravings, ensuring participants are well supported during the first few weeks of this difficult step.
While I could literally write about this all day (if only someone else would do the housework), the take home..
You wouldn’t trust a fox to take care of your hen house, but it’s easy to make this mistake when it comes to supplements.
Reliable information on any PCOS supplement is a hard thing to find given the number of websites that write about the virtues of a product but then also sell it on their website. Inositol supplements are no exception to this common conflict of interest, and setting the record straight on these matters was my biggest motivation for creating a PCOS Supplements Guide that critically reviews the scientific evidence.
As I explain in this article, if you look a little deeper into the science behind inositol supplements there are a lot of fairly misleading truth claims made, especially when it comes to the heavily promoted product Ovasitol, and inositol’s effect on fertility and weight loss.
Having met literally tens of thousands of women with PCOS through my free 30 Day PCOS Diet Challenge, I completely understand why supplements in general, and inositol more specifically, are so popular amongst women who appreciate natural remedies for PCOS.
But if you’re going to consider taking supplements as part of your PCOS treatment regime then let me help you do so with the most accurate and reliable information possible.
After first busting two of the most common myths deceptively touted by the supplements industry, I’m then going to share with you a comprehensive critical review of inositol supplements for various different PCOS symptoms.
This article also considers safety and side effects and includes some helpful tips on how much inositol to take for PCOS.
Inositol And PCOS: The Basics
Inositol is a term used to describe a family of nine naturally occurring, vitamin-like compounds that play a vital role in how all our cells function. While our bodies can synthesize inositol naturally, most of what we need comes from the foods we eat.
In women with PCOS, the cellular processes that use inositol fail to function correctly. This upsets our insulin regulation which then leads to the widespread hormone imbalances that eventually present themselves as all of the typical PCOS symptoms we hate.
Researchers have shown that taking inositol supplements can have a positive effect on this faulty cell functioning. Improvements have been observed in both insulin sensitivity and free testosterone levels providing a clear mechanism to the health and fertility benefits that many people have experienced.
In this article when I refer to “inositol supplements” I’m generally talking about products that contain either myo-inositol, D-chiro-inositol, or a combination of the two. These are the two types of inositol compounds most commonly used as nutritional supplements.
While myo-inositol on its own is the most widely studied form of this supplement for women with PCOS, new products that combine both myo and D-chiro forms of inositol have been promoted heavily since about 2013 as I discuss more below.
1. Myth 1 Busted: Taking Myo-Inositol For Weight Loss
The first thing I want to point out is that if you suffer from PCOS, then inositol supplements are unlikely to help you much with weight loss. If this contradicts what you may have read elsewhere then this is because when I looked at all the studies on myo-inositol for PCOS, and the combination inositol supplements that contain both myo-inositol and D-chiro-inositol, I considered not just whether these products lead to weight loss or not, but also how much women lose depending on their diagnosis. This was the approach I used when reviewing all the different compounds included in my PCOS Supplements Guide.
Ovasitol, and its competitor product Inofolic Combi are marketed as the best PCOS inositol supplements because they contain both myo-inositol and D-chiro-inositol in a ratio of 40:1. But here’s a key fact that I’ve taken straight out of the SAME blockbuster study that almost all experts and marketing machines quote when talking about the virtues of these products:
No change in hip to waist ratio or BMI was detected in the patients that were assigned either myo-inositol on its own, or the combined 40:1 inositol supplement during this highly cited trial (Nordio and Proietti 20121).
These women were all overweight to start with too meaning it should have been fairly easy for the inositol supplements to help them loose weight if it was actually going to work.
These women took the supplements for a 6 month period which for you or I would cost around $180.
This finding is consistent with many other studies that have shown very modest weight loss at best when giving women with PCOS inositol supplements.
For example, during a 3 month trial of myo-inositol, women who were moderately overweight lost approximately two pounds on average, while women that were severely obese didn’t lose any weight at all (Gerli et al. 20072).
Two pounds is a statistically significant amount, but it’s not exactly a life changing result is it?
If you ask me simply putting the words myo inositol and weight loss together to grab a headline is a bit misleading.
None of this is to say that there aren’t some great health benefits from taking inositol supplements (see below), it’s just that they’re probably not going to help with weight loss if this is one of the main reasons you’re considering them.
2. Myth 2 Busted: You Don’t Necessarily Need Ovasitol If You Have PCOS
If there was a prize for the PCOS supplement that generated the most conversation during my free live 30 Day PCOS Diet Challenge hands-down it would go to Ovasitol. But just because it’s popular, it doesn’t necessarily mean that everyone with PCOS needs it.
I’ve already mentioned the magic 40:1 ratio of myo-inositol and D-chiro-inositol used by some of the market leading inositol supplement providers, but how rigorous are their claims to having the most effective blend of ingredients?
But then I realized that all of these experts rely on just two randomized controlled trials for evidence (Nordio and Proietti 20121; Colazingari et al. 20138). Both of these studies used very small sample sizes (50 and 100 women respectively) leaving it completely undisputed that further research is needed before anyone can have much confidence in the results.
While it seems highly likely that a combination of both myo-inositol and D-chiro-inositol is the best way to take these supplements for PCOS, the jury is definitely still out when it comes to the 40:1 ratio claims.
According to a team of independent experts, “The ratio chosen [40:1] seems arbitrary” (Sortino et al. 20179). They explain that while the ratio may be 40:1 in the ovaries, the combination of the two forms of inositol is very different in our blood and that any supplement taken needs to go into our blood before it gets to our ovaries.
These researchers also point out that based on the results of lab studies looking at how myo-inositol and D-chiro inositol ratios are balanced in the ovary tissue of women with PCOS (Heimark et al. 201410), it’s possible that using an overwhelming amount of myo-inositol over D-chiro-inositol in a 40:1 ratio could “exert paradoxical effects”.
They go on to say that “without further scientific evidence, the 40:1 ratio has no reason to be considered preferable to other available formulations”.
The take home message from all of these details is that it’s still very early days in the research into using inositol supplements for the treatment of PCOS. If you’re buying Ovasitol or its competitor product Inofolic Combi (which is only available in Europe, I believe) then you’re really ahead of what the science can be sure of.
To me it seems pretty clear that while things may change with further research, at this point in time, the truth claims made by people promoting these products are more of a marketing artifact than a scientific conclusion.
3. Inositol For Women With PCOS Who Are Trying To Get Pregnant
As someone who struggled for years with PCOS related infertility, I can completely relate to the burning desire to do everything in your power to maximize your chances of success. And inositol supplements may be a helpful step along the way.
According to the experts, approximately 75% of women with PCOS have clinically evident menstrual problems and a further 20% of women have ovulatory problems that are harder to detect unless your doctor really knows what they’re doing (Azziz et al. 200611).
Put mildly, if you have PCOS and you didn’t have trouble falling pregnant, then you’re darn lucky…
Combating the ovulatory disorders that lead to infertility is one of the areas where inositol supplements show the most promise for women with PCOS.
When it comes to using inositol supplements to enhance your fertility you essentially have three options:
Take myo-inositol on its own
Take D-chiro-inositol in its own
Take a combination of myo-inositol and D-chiro-inositol.
Here’s what the science says about each of these options:
4. Myo-Inositol, PCOS & Fertility Treatments
When it comes to fertility, a supplement that consists of 2000 mg of myo-inositol plus 200 μg of folic acid taken twice daily for at least 3 months has shown some pretty impressive results. This supplement has been shown to:
Reduce AMH levels and the size of polycystic ovaries better than birth control (Ozay et al. 201612).
These benefits can correlate to real results for women trying to conceive.
In a study of overweight women with PCOS that were given myo-inositol + folic acid during IVF, 32% of women had a successful pregnancy within the 12 month study period, compared to just 12% of women who only took a straight folic acid supplement without the inositol (Artini et al. 201315).
These really positive results have been repeated by other researchers that used a similar supplement regime to treat women undergoing intrauterine insemination (IUI) rather than IVF. In a recent study of IUI patients with PCOS, pregnancy rates were improved by approximately 50% (regardless of whether or not they had insulin resistance) after taking myo-inositol for just 3 months beforehand (Ozay et al. 201716).
The take home from this is that if you’re being prescribed recombinant follicle stimulating hormone (r-FSH) as part of an ovulation induction cycle (either with IVF or IUI), then make sure you’re fertility doctor also puts you on myo-inositol.
This one’s a no-brainer as far as I can see.
5. Beware Of Myo-Inositol Products That Contain Folic Acid
It’s worth paying attention here to the fact that one of the most widely used myo-inositol products also includes folic acid.
Inofolic by LOLI Pharma (not to be confused with their other product Inofolic Combi) is often the product of choice for researchers studying the effects of myo-inositol on women trying to conceive. If you’re ever in the market for this supplement keep in mind that that this product goes by the name Pregnitude in the US and Canada (it’s the exact same drug, just a different brand name).
Inofolic (Pregnitude) is certainly a good quality product as independent analysis has shown this brand actually contains the dose rates of active ingredients stated on the label. The same cannot be said for some of their competitors where myo-inositol concentrations were found to be 25% less than the labelling amount (Papaelo et al. 201117).
While folic acid is generally considered essential for anyone that’s trying to conceive or already pregnant, a common genetic disorder known as the MTHFR gene mutation can mean that folic acid can potentially be harmful to both you and your baby.
Rather than taking folic acid supplements, women with this gene mutation instead need to take the active form of folate, known as methyl folate or 5-MTHF.
If you are going to take folic acid it’s important that you get tested for this gene mutation. And if you have it make sure to find a competent doctor that can supervise your 5-MTHF dosage rates as these need to be monitored to avoid adverse side effects.
I don’t want to get too far off topic here, but if you’re interested in learning more I discuss this further in my PCOS Supplements Guide.
The key thing to take note of here is that if you’re considering myo-inositol to assist with your fertility, it’s also worth taking the time to figure out the source of supplementary folate that is most appropriate for you personally.
For many people folic acid will be fine, in which case products like Inofolic (Pregnitude) are going to be a good option. But for women that test positive for the MTHFR gene mutation, you’ll want to avoid this product brand and stick with a pure myo-inositol supplement and take 5-MTHF as well.
6. If You Have PCOS Myo-Inositol Is Better Than Metformin For Fertility
The same combined myo-inositol / folic acid supplements were also found to be better than metformin at restoring ovulation and achieving a natural pregnancy. In a study that put these two treatments in a head to head battle, metformin achieved an 18% pregnancy rate over a 6 month period compared to 30% of women who managed to fall pregnant naturally just by taking the myo-inositol / folic acid supplements (Raffone et al. 201018).
This isn’t the only time myo-inositol has proven to be better than metformin in certain circumstances.
For example, inositol’s potential was demonstrated during a recent randomized controlled trial where researchers pitted 1500 mg per day of metformin up against 4000 mg per day of myo-inositol. In this direct comparison that included patients both with and without insulin resistance, myo-inositol outperformed metformin when it came to reducing testosterone levels, hirsutism, and markers of inflammation (Jamilian et al. 201719).
With results like these continuing to come out, I don’t think it’ll be long before metformin finally gets a long overdue retirement pension.
In my view, if you’re trying to conceive, then it’s well worth giving myo-inositol a try before messing with metformin. You’ll get better results and with less side effects too!
And since we’re talking about one of the most commonly prescribed PCOS drugs, it’s also worth mentioning that researchers are now investigating using myo-inositol to improve the efficacy of clomid for ovulation induction. While it’s too soon to say for sure, early results look very promising (Rolland et al. 201720).
Again the key message here seems to be that myo-inositol is well worth considering when trying to conceive given its low cost and low risks (see the Side Effects and Safety section below).
7. Taking Straight D-Chiro-Inositol Is A Bad Idea When Trying To Conceive With PCOS
However, recent studies on IVF patients with PCOS suggest that in a straight comparison between these two forms of inositol supplements, myo-inositol seems to be better at improving fertility than D-chiro-inositol (