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Paleo and treating PCOS (Polycystic ovary syndrome)

by (323)
Updated February 15, 2014 at 4:20 AM
Created April 30, 2012 at 8:48 AM

Hello all,

My name is Nick and I am a personal trainer based in London. I have a question for you all regarding a client of mine that has Polycystic ovary syndrome (PCOS).

(For those of you who are just reading but don???t know PCOS is this??? http://en.wikipedia.org/wiki/Polycystic_ovary_syndrome)

She came to me with 3 goals in mind. 1) Get off Metformin - her diabetic drug (done) 2) Have regular periods again and increase fertility (getting there) 3) Lose weight (Frustrating as hell)

I've implemented a lower carb version of the Paleo diet with her that I am monitoring with a photo food diary once per week (so low she cant take metformin) and have managed to restore much of her insulin sensitivity and menstrual cycle but weight loss is still really stubborn.

I was wondering if there are any good blog posts out there or if someone here can offer me some advice on how to deal with this situation. Is it the case that people with PCOS need to be nigh on Ketogenic to see fat loss? How else can I help this person?

I am looking for very prescriptive information as a "Paleo diet" can obviously mean a great number of things.

Thanks for your assistance as always.

Nick Kinsella

Bac49edb31092c3d6db9d461485cb310
0 · February 15, 2014 at 4:20 AM

See below, Paleo Pepper strongly warns against anything remotely similar to fasting/starving in women.

23fe01308e3320ecf144b47b99a135a4
0 · September 02, 2013 at 12:12 PM

These are the sights I would also recommend. Stephanie Ruper is all over this shit.

3491e51730101b18724dc57c86601173
0 · September 02, 2013 at 6:41 AM

Curious as to how you are measuring "increased fertility"? What does that mean? Do you know if she is ovulating on her own? Dr. Michael Fox has a very good pregnancy rate with PCOS women. His treatment is largely diet based, very high in fats and low in carbs. Look him up. She may need more fat.

3491e51730101b18724dc57c86601173
0 · September 02, 2013 at 6:37 AM

Hormones need fat for synthesis. I experience worse symptoms and weightloss stalls if I restrict calories or fats.

3491e51730101b18724dc57c86601173
0 · September 02, 2013 at 6:34 AM

I'm giving you a down vote because of your statement that "if she drops the weight the disorder does reverse." It's simply NOT true. I had severe PCOS from the beginning of menses with very low body weight. My 12 year old daughter has a perfect BMI, yet tests show she has PCOS. Losing weight isn't going to help my daughter because clearly obesity is not the cause. Obesity is a symptom of PCOS. Losing weight alone will not correct PCOS unless the weightloss is a result of the corrected metabolism. In my case, low carb high fat works. Cutting calories tends to slow my thyroid down.

20aee218ca5bce816122348144db9792
0 · July 27, 2012 at 1:27 PM

Why the down vote?

Eead82aa93bbcdada0bcd817d0952e58
0 · May 27, 2012 at 3:51 PM

Just as a testament to individual differences- I have PCOS and hypo and had to reduce fat calories specifically to see weight loss on VLC Paleo while keeping protein high (1g/lbm)

6747a5447a3440b5c87ebf5f2c1e0ead
0 · May 23, 2012 at 4:11 PM

Hi Aglaee, I'd be happy to :) especially if it means I can potentially help out fellow PCOSers! I'll email you this evening after work.

E12ead3bf63c94b5b619b03722ef554f
0 · May 23, 2012 at 5:57 AM

Hi Lily, Thanks for sharing! I am very interested in your experience! Do you mind contacting me at aglaee.paleoRD at gmail dot com just to give me more details? :)

6747a5447a3440b5c87ebf5f2c1e0ead
0 · May 23, 2012 at 12:08 AM

Just speaking from personal experience as a fellow PCOS sufferer..I have been trying to get rid of PCOS related weight gain for about 3 years and the scales only started moving when I INCREASED both my calories and fat intake. I've tracked my macronutrient rations on FitDay for a while and I can confidently say that as soon as I upped the fat, the jeans started to fit. Can't prove causation but still....

6120c989fd5b69f42a0834b69b87955b
0 · May 14, 2012 at 7:30 PM

It sounds like you are doing great work here, just remind both yourself and your client that it is a long road back to normal. I've fallen off the wagon here and there, but making more right decisions than wrong ones over the last year led to my first cyst-free ultrasound since my diagnosis 8 years ago. There are still other symptoms, and the weight does not want to go, but overall things seem to be headed in the right direction.

16e617676c5ac710e5235e0b773edc0b
0 · May 14, 2012 at 11:09 AM

Thanks, I agree with the calorie restriction part for weight loss (unfortunately). I thought initially you just meant that fat needed to be restricted for some other reason. Thanks for the clarification!

6120c989fd5b69f42a0834b69b87955b
0 · May 14, 2012 at 6:29 AM

That makes sense with the nature of metabolic syndrome, and the associated liver issues that can impair fat digestion. I think shooting straight into that would be pretty difficult for most though. Personally I've found that I really needed to feel fortified by eating to satiety for months with lc/hf before eating less didn't make me feel like a crazy person, and then seemed easier to just skip a meal every few days than to consciously restrict meal size.

E12ead3bf63c94b5b619b03722ef554f
0 · May 14, 2012 at 6:11 AM

I think that many women with PCOS can have great success by simply restricting their carb intake, but in my own experience, it is not always sufficient. Some women with PCOS on a low-carb high-fat diet are not able to lose weight and may need to restrict their calories by keeping their fat intake more moderate.

16e617676c5ac710e5235e0b773edc0b
0 · May 13, 2012 at 9:20 PM

Can you provide more detail/sources which support the fat intake reduction for PCOS? I've never heard this before and wonder what the reasoning behind it is. Thanks.

B6114a1980b1481fb18206064f3f4a4f
0 · April 30, 2012 at 2:21 PM

Sounds like you are doing a lot right! I'm not sure how long you've been working with this client, but I also had PCOS, thyroid issues and severe reactive hypoglycemia. It takes a long time to heal the underlying metabolic issues that cause these problems and they all make weight loss challenging. You are definitely looking at a journey of months, possibly years. Do look into thyroid function if she hasn't already. And encourage her to keep with it. I now have 3.5 year-old twins . . .

B6114a1980b1481fb18206064f3f4a4f
0 · April 30, 2012 at 2:16 PM

Don't feel the need to reply with a comment because you said it all! I also had PCOS and thyroid problems and hypoglyemia. One thing I'll say is it really takes a lot of time to heal these types of problems.

8496289baf18c2d3e210740614dc9082
0 · April 30, 2012 at 1:43 PM

Really awesome, thorough advice. I wouldn't worry too much about the folate recommendation, as that has become such a medically mandatory part of prenatal care that it is tested on licensing exams. It's not a fertility matter, it prevents neural tube (brain/spinal cord precursor) defects in the first eight weeks. I also think you're spot-on with the thyroid. Keep in mind that thyroid hormone receptors are genetically coupled to LDL receptors, which can be dysfunctional in PCOS. Ketogenesis and increased saturated fat intake should help that.

16e617676c5ac710e5235e0b773edc0b
0 · April 30, 2012 at 10:41 AM

+1 Excellent advice. I suffer from PCOS & Hashimoto's and couldn't have said it better.

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8 Answers

3eca93d2e56dfcd768197dc5a50944f2
9
11682 · April 30, 2012 at 9:17 AM

The following is not a medical advice, just what I personally do for my similar problems:

If she is doing everything right and she still doesn't lose weight, I'd check the thyroid. Also, for some women especially, if the estrogen levels are too high (and usually if you have PCOS, you have high estrogen), a reduction in calories might be needed, not just reduction of carbs. For me, who I'm small framed, if I eat more than 1200 calories per day, I don't lose a gram.

Regarding a Paleo-ketogenic diet (not plain keto), I think it will help lots. I have a few gynecological pains myself that are going away when on less than 40 gr of carbs per day for over a month (25-50 gr of carbs per day is the goal I keep). I also take a grapeseed/pomegranate/trans-reservator extract, and a curcumin extract, that helps with inflammation in these body parts (and they also lower estrogen).

And of course, it's not just what you remove from the diet, but also what you add: bone marrow broth, offal, coconut oil (very important in the keto diet), sea vegetables, live sauerkraut, and home-made goat kefir. If your patient doesn't go out much either, she should consider supplementing with 5000 IU D3 almost daily (which also lowers estrogen btw, among other major things it offers). These are not optional in my opinion. It's what I do to myself to get healthy from similar ailments. My superfoods: http://eugenia.queru.com/2012/03/05/top-10-must-eat-paleo-foods/

Regarding fertility btw, no matter what you might hear about dairy in Paleo sites, home-made GOAT kefir (24-36 hour fermentation, which means very little lactose, and different casein than that of the offending cow dairy), is the top "drug" you need: http://www.scientificamerican.com/article.cfm?id=real-males-eat-yogurt Kefir is 5-10 times more potent than yogurt, so as long as your patient AND her husband eat kefir, I'd expect good baby results. But it MUST be home-made (store-bought kefir doesn't contain all the needed yeasts and bacteria because of bottling regulations). More info about kefir: http://eugenia.queru.com/2012/04/19/a-word-about-kefir/

If she's trying to get pregnant (and if her doctor is ok with this, don't take this reply as a medical advice), she might need to supplement with folate (not folic acid, they're different) a few times a week too, about 3-6 months before she conceives. Especially if she goes low calorie Paleo-keto, where folate becomes less common in the food. http://chriskresser.com/folate-vs-folic-acid

I'd highly suggest she keeps a food blog, like on fitday or on Chronometer.com, to see which vitamins she's missing. Then she could supplement accordingly (but not overdo it of course, D3 and Mg are the most important ones).

Bac49edb31092c3d6db9d461485cb310
0 · February 15, 2014 at 4:20 AM

See below, Paleo Pepper strongly warns against anything remotely similar to fasting/starving in women.

B6114a1980b1481fb18206064f3f4a4f
0 · April 30, 2012 at 2:16 PM

Don't feel the need to reply with a comment because you said it all! I also had PCOS and thyroid problems and hypoglyemia. One thing I'll say is it really takes a lot of time to heal these types of problems.

8496289baf18c2d3e210740614dc9082
0 · April 30, 2012 at 1:43 PM

Really awesome, thorough advice. I wouldn't worry too much about the folate recommendation, as that has become such a medically mandatory part of prenatal care that it is tested on licensing exams. It's not a fertility matter, it prevents neural tube (brain/spinal cord precursor) defects in the first eight weeks. I also think you're spot-on with the thyroid. Keep in mind that thyroid hormone receptors are genetically coupled to LDL receptors, which can be dysfunctional in PCOS. Ketogenesis and increased saturated fat intake should help that.

16e617676c5ac710e5235e0b773edc0b
0 · April 30, 2012 at 10:41 AM

+1 Excellent advice. I suffer from PCOS & Hashimoto's and couldn't have said it better.

7e1433afbb06c318c4d90860d493c49d
4
5949 · April 30, 2012 at 12:01 PM

You might find some useful info on Pepper's websites:

http://www.paleoforwomen.com/

http://paleopepper.com/

23fe01308e3320ecf144b47b99a135a4
0 · September 02, 2013 at 12:12 PM

These are the sights I would also recommend. Stephanie Ruper is all over this shit.

E12ead3bf63c94b5b619b03722ef554f
2
4002 · May 13, 2012 at 8:41 AM

Many women with PCOS need not only to watch their carb intake, but their fat/calorie intake as well.

3491e51730101b18724dc57c86601173
0 · September 02, 2013 at 6:37 AM

Hormones need fat for synthesis. I experience worse symptoms and weightloss stalls if I restrict calories or fats.

Eead82aa93bbcdada0bcd817d0952e58
0 · May 27, 2012 at 3:51 PM

Just as a testament to individual differences- I have PCOS and hypo and had to reduce fat calories specifically to see weight loss on VLC Paleo while keeping protein high (1g/lbm)

6747a5447a3440b5c87ebf5f2c1e0ead
0 · May 23, 2012 at 4:11 PM

Hi Aglaee, I'd be happy to :) especially if it means I can potentially help out fellow PCOSers! I'll email you this evening after work.

E12ead3bf63c94b5b619b03722ef554f
0 · May 23, 2012 at 5:57 AM

Hi Lily, Thanks for sharing! I am very interested in your experience! Do you mind contacting me at aglaee.paleoRD at gmail dot com just to give me more details? :)

6747a5447a3440b5c87ebf5f2c1e0ead
0 · May 23, 2012 at 12:08 AM

Just speaking from personal experience as a fellow PCOS sufferer..I have been trying to get rid of PCOS related weight gain for about 3 years and the scales only started moving when I INCREASED both my calories and fat intake. I've tracked my macronutrient rations on FitDay for a while and I can confidently say that as soon as I upped the fat, the jeans started to fit. Can't prove causation but still....

16e617676c5ac710e5235e0b773edc0b
0 · May 14, 2012 at 11:09 AM

Thanks, I agree with the calorie restriction part for weight loss (unfortunately). I thought initially you just meant that fat needed to be restricted for some other reason. Thanks for the clarification!

6120c989fd5b69f42a0834b69b87955b
0 · May 14, 2012 at 6:29 AM

That makes sense with the nature of metabolic syndrome, and the associated liver issues that can impair fat digestion. I think shooting straight into that would be pretty difficult for most though. Personally I've found that I really needed to feel fortified by eating to satiety for months with lc/hf before eating less didn't make me feel like a crazy person, and then seemed easier to just skip a meal every few days than to consciously restrict meal size.

E12ead3bf63c94b5b619b03722ef554f
0 · May 14, 2012 at 6:11 AM

I think that many women with PCOS can have great success by simply restricting their carb intake, but in my own experience, it is not always sufficient. Some women with PCOS on a low-carb high-fat diet are not able to lose weight and may need to restrict their calories by keeping their fat intake more moderate.

16e617676c5ac710e5235e0b773edc0b
0 · May 13, 2012 at 9:20 PM

Can you provide more detail/sources which support the fat intake reduction for PCOS? I've never heard this before and wonder what the reasoning behind it is. Thanks.

031a90464542376e2ff06703bef9da15
1
10 · September 02, 2013 at 2:19 AM

I would lose weight and gain it right back even on Metformin. I have PCOS, Insulin resistance. I knew something else was wrong - hypothyroid. Go to an endocrinologist to get this checked. With the natural supplements and eating right and exercising all together, the weight is under control.

C8549e3ab0e3d77910e72c87cb5e0918
1
435 · August 23, 2012 at 4:52 PM

What has been working for me is very low carb, moderate protein and high fat.

There have also been other helpful tweaks; giving up dairy helped, as did adding coconut oil. Now that I have lost much of the weight, I do ok with adding an ounce of almonds and a cup of berries daily.

23fe01308e3320ecf144b47b99a135a4
0
144 · September 02, 2013 at 9:48 AM

Stephanie Ruper 'Paleo for Women' is all about women and hormones and POCs. She recommends a higher carb version of paleo for women with POCs to balance out their hormones. As a POCs sufferer myself, I've got my weight down to 59kg and 24% body fat. Always used to sit around 27% bodyfat with chubby (but not fat) weight of around 63kgs before changing to higher carb version of paleo. I felt really agitated and stressd when I tried to go low carb. I have roughly 80g-100g starchy carbs a day. Still low compared to the typical SAD diet.

2f93df1053b6a1b5f269fd49e4955dfd
0
0 · August 23, 2012 at 3:20 PM

You might want to talk to primalgirl.com she seems to have figured it out.

20aee218ca5bce816122348144db9792
-1
122 · July 24, 2012 at 8:58 PM

I have PCOS and was on metformin until recently. I had issues with metformin in that it made me crave carbohydrates and made animal protein unappealing. I also had to be prescribed waterpills. It was kind of a mess. I was prescribed the metformin to increase my insulin sensitivity, but I have decided to stop taking it and manage it through Paleo and Crossfit. This seems to be working well for me, albeit very slowly. If she drops the weight, the disorder does reverse, but therein lies the problem. She will have to increase her activity. I'm not saying she has to up her sessions to everyday, but doing stuff like walking a couple miles outside more than once a day, or more time working in the yard in addition to regular workouts.

3491e51730101b18724dc57c86601173
0 · September 02, 2013 at 6:34 AM

I'm giving you a down vote because of your statement that "if she drops the weight the disorder does reverse." It's simply NOT true. I had severe PCOS from the beginning of menses with very low body weight. My 12 year old daughter has a perfect BMI, yet tests show she has PCOS. Losing weight isn't going to help my daughter because clearly obesity is not the cause. Obesity is a symptom of PCOS. Losing weight alone will not correct PCOS unless the weightloss is a result of the corrected metabolism. In my case, low carb high fat works. Cutting calories tends to slow my thyroid down.

20aee218ca5bce816122348144db9792
0 · July 27, 2012 at 1:27 PM

Why the down vote?

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