woman with pcos eating a donut

You’ve probably wondered what’s the best diet for PCOS. The simple truth is that diets don’t work for PCOS.

In fact, depending on the study you look at, 60-90% of dieters gain back the all the weight they’ve lost within 18 months.

The science

One extreme example of this was shown in a study done on the contestants from the TV show The Biggest Loser. Participants gained back an average of 70% of the weight they had lost within 6 years. In addition, those who kept the most weight off saw their metabolism slow down the most too. In the study, the 14 participants gained back 41 of the 58.3 pounds they lost, and were burning 704 fewer calories per day! This begins to explain why it’s not as simple as “calories in calories out,” — an idea that may work in a lab setting, but not within the human body, where metabolism is affected by hormone levels and bio-individuality. This is particularly true in the case of women with PCOS.

Weight loss diets often work in the short-term, but long-term studies show that the majority of dieters gain back the weight. In an analysis of long-term weight loss studies, researchers found that participants had gained back more than half of the weight they lost after two years and more than 80% of the weight lost after 5 years. 

Why is this, when all we’ve been told all our lives is that to eat less and move more to lose weight? Well, it’s not that simple. Our bodies are actually designed to keep weight on for our survival. Because of this, they work against us when we lose weight, particularly when we lose a lot of weight fast, as seen in the case of The Biggest Loser contestants. 

Hormonal changes

The worst part is that this adaptation makes us feel more hungry by lowering satiety-inducing hormones such as leptin. So, not only does your metabolism slow after weight loss, you feel more hungry

And dieting — particularly not eating enough calories or not eating enough carbohydrates — can raise adrenal hormones. Since high DHEA can make PCOS symptoms worse, this strategy may backfire on you.

Finally, our thyroid hormones (sex and fertility hormones) also affect the way we burn calories. This is particularly important for women with PCOS. Women with PCOS actually metabolize (break down & use) nutrients — especially carbohydrates — differently from people without PCOS. And women with PCOS are at higher risk for thyroid dysfunction.

So, hormones are a major reason why diets don’t work for PCOS.

Racial disparities

In addition, there is the problematic role that socioeconomic status and race play in weight loss. Not only are people of color more likely to be “obese” in the first, place (due to a multitude of factors from healthcare disparity to social and cultural settings), they respond less well to the types of interventions available and have lower access to interventions that tend to work. 

Increased risk for eating disorders

Many women with PCOS are told to decrease what they’re eating and increase exercise without taking this into account. In fact, it is common to see women with PCOS undereating, which does not help with long-term weight loss or overall health. This is particularly problematic, because restriction is the number one risk factor for binging, and women with PCOS are at a significantly higher risk for disordered eating, especially binge eating disorder. Extreme restriction increases this risk even more. 

A functional medicine approach to weight loss

From a functional medicine perspective, weight is a SYMPTOM. It’s a sign that something is not quite right in your body – whether that’s insulin resistance, inflammation, gut bacteria imbalances, or hormone imbalances, such as high cortisol, low thyroid hormone, or high androgens, which is what happens with PCOS.

All of this is not to say that you can’t lose weight in a healthy way. However, if you have a condition like PCOS, first you need to look at your overall hormonal picture and make sure those hormones are in balance. It’s also a good idea not to focus on the number on the scale, but rather on overall health and healthy eating, addressing the root causes of the weight gain in the first place. This way you can work on a plan tailored to your hormonal and personal needs, getting at the root causes of your health issues and building healthy habits that will last you a lifetime.

The bottom line is that diets don’t work for PCOS. That’s why there is no best diet for PCOS. Instead, you have to focus on the root causes.

Click here to read more about why it’s so hard to lose weight with PCOS. And click here to find out what you should do instead.

And to join the next round of The PCOS Root Cause Roadmap 6-week program, click here to get on the list for next time. Or if you’re interested in working one-on-one with Melissa, you can click here to apply for the waitlist.

Cowritten by Jeani Hunt-Gibbon.

 

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