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I'm new here, and looking into paleo as a way of helping to manage my PCOS (and concurrent insulin resistance). I've been cutting simple carbs and industrial oils out of my diet and increasing my fat consumption, though I'm still eating legumes and dairy (in addition to fruits and vegetables, including tubers), and finding that I really like the resulting increase in satiety and decrease in cravings. I'm working on figuring out where I'm taking my diet with the goals of both improved health and fat loss, but I am disinclined to go VLC unless it's really necessary for one or both of these goals. Do people have experience or research indicating whether or not PCOS requires lower carb intake (<50g/day?) for weight loss? Thanks very much!

Edited to add that I do take Metformin, though I'm not sure if that's relevant, and since I've been on it my A1C has been quite low.

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You may already know about this site ovarian-cysts-pcos.com I've found a lot of useful PCOS info there. – Happy Now Sep 15 2011 at 18:49

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According to this study, it might be caloric restriction that counts with PCOS http://www.ovarian-cysts-pcos.com/pcos-news135.html

Personally, I found the difference in macronutrient ratios in study's diets to to be too close together to tell us much, VLC certainly wasn't represented, it was just lower carb than SAD. Sure if you restrict calories, you get some autophagy (i.e. high fat diet, just high fat from your own stores). I've tried reducing calories with moderate carbs and it makes me hungry and irritable. However when I've gone VLC I haven't run into those problems. When I get into the territory where 60+% of my diet is fat, and very little is carb, I lose all cravings, feel quite good, and eat less than I would otherwise. So accidental calorie restriction happens. If you don't find that eating fruit and starch make you crave more food, you might be able to handle them. Unfortunately, my body doesn't seem to work that way.

In dealing with my own PCOS I've been under the impression that my sugar metabolism is essentially broken right now, and the closer I get to and stay at VLC the sooner I will be able to repair my metabolism and be able to reintroduce carbs into my diet. Maybe I won't ever be able to eat carbs with gusto, but I'm hoping at some point to be able to eat them in moderate quantities without damaging my body. It might also help to ditch the dairy for a while and see what your results are, dairy can be insulemic some people.

You also seem a little afraid of VLC. Sure it might seem like you are limiting what you eat at first, but there also comes an amazing freedom from not being preoccupied with food. I used to be a much more exotic cook, but I don't miss it because my mood and energy are so even keel, and a significant part of my day that had previously been occupied by daydreaming about and planning meals is now free for other endeavors.

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1 
 Thanks for this helpful answer! I'm not sure I've been at this long enough to have a real sense of what I tolerate, and I am working to decrease carb intake, though not to a minimum, hopefully. I am concerned about VLC because I have a history of eating disorders (cycles of restriction and binge eating serious enough to require inpatient treatment), and subjecting myself to extreme dietary shifts like VLC can set off symptomatic behavior. My nutritionist would be pretty distressed (not about VLC itself, but about VLC in an eating-disordered client). – curious Sep 15 2011 at 5:16
I hear ya, about VLC and a history of eating disorders. Would it be possible for your nutritionist to oversee your work with a check-in a few times a week? If you do have a habit of being too strict, and then having something in your body say, "Aw, fuck it!", followed by a binge, go slow and careful here. I would actually urge you to not restrict calories consciously in that situation (I find arbitrary calorie restriction to be an eating disorder anyway). If you are still relearning how to eat healthfully you need to take the time to learn your body's satiety cues and energy needs. – Happy Now Sep 15 2011 at 5:35
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 As a bit of homework, you might find Nora Gedgaudas book Primal Body, Primal Mind, interesting. It talks a lot about VLC and mental health. primalbody-primalmind.com – Happy Now Sep 15 2011 at 5:41
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 Just noticed you mentioned Metformin. A study was just done that found out the supplement NAC (n-acetylcysteine) was even more effective than Metformin at reducing insulin resistance, plus no worries about B-12 deficiency that way. – Happy Now Sep 15 2011 at 5:45
Didn't know that! NAC proves to be xtraordinary supplement more and more each day. But I hear lots of praise for Metformin - many people use it as a supplement. – majkinetor Sep 15 2011 at 6:59
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I have type 2 diabetes & found low carb to help at first. It got rid of my cravings and hunger (leptin resistance). Instead of VLC, I'd say that not eating dairy has helped me. No studies, just n=1.

As for metformun - it can lead to issues with b12 & magnesium so I prefer to control with my diet alone. I think I have some micronutrient deficiencies, so creating more wouldn't do me any good :-/

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I recently learned that glycemic problems (whether hyper/diabetes or hypo) are the result of a lack of chromium and/or vanadium. I've been having hypoglycemia since childhood and since I started taking these in colloidal form (a couple weeks ago), I've noticed some noticeable improvements.

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