The promise of the PCOS diet is falling apart
For years, people with polycystic ovary syndrome and obesity were told that their symptoms would improve if they lost weight through a restrictive diet. In 2018 a leading group of PCOS experts recommended that overweight or obese women with the hormonal disorder should consider reducing their caloric intake by up to 750 calories per day. That guidance helped with that produce questionable diet programs on social media, reinforcing the impression among people with PCOS that they would feel better if they could just successfully change their diet.
But the recommendations were not based on robust PCOS research, and researchers now say there is no solid evidence to suggest that a restrictive diet has any significant impact on PCOS symptoms in the long term. Dieting rarely leads to sustainable weight loss for anyone, and for people with PCOS, losing weight is especially difficult. In addition, the link between sustained weight loss and improved symptoms is not very clear or well established, says Julie Duffy Dillon, a registered dietitian specializing in PCOS care.
In 2023, the same group, called the International PCOS Network, revised its policy accompaniment based on a new analysis of the research and removed all references to calorie restriction. The group now recommends that people with PCOS maintain a “generally balanced and healthy diet” similar to the Mediterranean diet, which is associated with a reduced risk of health problems associated with the condition, such as cardiovascular disease and diabetes. It is not known whether eating this way can improve symptoms of PCOS.
The changes to the guidelines reflect “the PCOS literature and the lived experience of people with the condition,” says Dr. Helena Teede, an endocrinologist at Monash Health in Australia and lead author of the 2023 guidelines. “It is no longer about to blame or stigmatize people, or to suggest that it is their personal behavioral failure that carries more weight.”
What is PCOS?
PCOS is a hormonal condition that affects so many people five million women in the United States. It is characterized by irregular periods, infertility, excessive facial hair growth, acne and hair loss on the scalp – symptoms that are also common with other health conditions, making diagnosis difficult. People with PCOS usually ovulate less than once a month and also often have higher levels of androgens (male sex hormones) or multiple underdeveloped follicles on their ovaries (not, as the name suggests, cysts) or both.
When a woman experiences symptoms, a doctor will typically scan the ovaries to look for those follicles, or take blood to test hormone levels. There is no cure for PCOS; the first line of treatment often involves some form of contraception to help regulate the menstrual cycle.
Although PCOS is usually thought of as a reproductive problem, it can also affect metabolic health, including blood sugar, blood pressure, and cholesterol levels. People with PCOS often have that chronic infectionThis happens when the immune system is overstimulated for an extended period of time. And they are at higher risk for developing cardiovascular disease, endometrial cancer and diabetes, said Dr. Heather Huddleston, director of the PCOS Clinic and Research Program at the University of California, San Francisco.
The condition has also been linked to an increased risk of mental health problems depression, tension, suicide attempts And eating disorders.
The body weight connection
The relationship between PCOS and weight is complex; the condition is strongly associated with obesity. Someone with PCOS is prone to weight gain, and when they do, their symptoms can worsen, says Dr. Anuja Dokras, director of the University of Pennsylvania Penn Polycystic Ovary Syndrome Center and co-author of the 2023 guidelines. “It’s a bidirectional relationship,” she said, but “we don’t understand why they tend to gain weight.”
The 2023 guidelines also noted that obesity rates among people with PCOS vary in different parts of the world. And, said Dr. Docras, not everyone with obesity has PCOS.
Some research has shown that weight loss through lifestyle changes could improve some hormonal and metabolic symptoms of PCOS, said Dr. Teede, but “the evidence around fertility is challenging.”
Very little studies measured changes in ovulation and pregnancy rates. “One of our biggest research questions is how much weight loss, over how much time, and how much stability of that weight we need to get the body’s reproductive system going again,” she added.
The most compelling sign that weight loss may be linked to improved ovulation and pregnancy rates comes from recent studies that looked at pregnancy outcomes of bariatric surgery in obese women with and without PCOS, said Dr. Dokras. That facts show that after surgical interventions and drastic weight loss, people with PCOS “begin to have very regular periods and male hormone levels also drop.” Research to investigate whether weight loss medications like Ozempic can improve the symptoms of PCOS patients is still ongoing.
But many women with PCOS have insulin resistance – when the body doesn’t use the insulin it produces effectively, leading to elevated blood sugar levels. This can worsen some symptoms, including weight gain, and make weight loss particularly difficult, said Dr. Huddleston.
And Ms Dillon said the old advice to restrict calories to lose weight is especially troubling given the higher rates of eating disorders among people with PCOS. Anecdotally, she said she had seen the lasting damage of the advice in many of her patients.
When people try diets “and inevitably fail because they don’t work for most people, they take responsibility for it and say, ‘Well, that’s my fault,’” Ms. Dillon said. “So then they no longer seek health care. It is not unusual for people with PCOS to meet me and tell me I am the first person they have seen in ten years.”
At that point, she added, “they have many different health problems, like diabetes and high cholesterol, but they are also ashamed, depressed and anxious.”