A Note on the non-diet approach

As a Non-Diet Dietitian, I focus on self-care and health support without centering weight loss. Most nutrition advice prioritizes weight loss and restrictive eating, which I believe harms more than helps and zaps the joy from eating. This unsustainable approach often hinders lasting health changes.

My first post in this non-diet series focused on lowering cholesterol without dieting. This month I’ve chosen to focus on Polycystic Ovary Syndrome (PCOS). I’ll explore evidence-based ways to support health with PCOS through food, movement, and lifestyle choices, emphasizing positive nutrition and sustainable changes over weight loss and restriction.

Just a quick note: The information that follows is provided to help you learn and stay informed, but it’s not meant to replace medical advice, diagnosis, or treatment.

So, let’s talk about PCOS!

What is PCOS?

Polycystic Ovary Syndrome (PCOS) is a hormonal, metabolic, and reproductive disorder that impacts girls and women. It is estimated to impact 1 in 10 women of reproductive age in the U.S. I feel like PCOS is one of the most common chronic conditions that many people have never heard of.

Despite affecting millions of women and the serious health consequences, PCOS is unknown to most people and a staggering 75% of the women living with PCOS are going undiagnosed.

The symptoms of PCOS vary from person to person. Some common symptoms include:

• increased inflammation
• irregular periods or ovulation
• insulin resistance
• weight gain
• growth of excess facial and body hair
• Acanthosis nigricans (dark, velvety skin in skin folds and creases)
• difficulty getting pregnant
• small cysts on ovaries
• alopecia or hair loss
• increased incidence of anxiety and depression and mood disorders

How is PCOS diagnosed?

PCOS is diagnosed based on the Rotterdam criteria, requiring at least two of three of the following after other conditions are ruled out:

• irregular periods or anovulation (lack of ovulation)
• signs of high androgens (like excess hair growth or high testosterone levels)
• polycystic ovaries levels on an ultrasound OR elevated AMH (anti-Mullerian hormone) levels

A healthcare provider can do a physical exam, take a detailed medical history, and order blood tests to check hormone levels and screen for conditions like diabetes to confirm diagnosis.

Why “lose weight” is not a helpful recommendation for people with PCOS

Like so many other chronic conditions, a common first-line approach given by medical professionals for PCOS is to tell patients to lose weight. Dieting is the default tool given to women with PCOS.

Being told to lose weight to manage PCOS can be frustrating, as many women with this condition have tried everything under the sun to lose weight without long-term success. If this is you, and you’ve gotten the message that your body is the problem, I’m sorry.

Often people think that weight gain has caused their PCOS or insulin and hormone imbalances, but the opposite is true. Weight gain is a symptom, not the cause. Insulin resistance is considered the underlying cause that can lead to weight gain and other hormonal imbalances. 

The truth is that women with PCOS have unique factors that make it harder to lose weight. Insulin resistance and chronic low-grade inflammation are two characteristic features of PCOS that drive metabolic and hormonal imbalances. These underlying conditions can cause strong and intense cravings (especially for carbohydrates), blood sugar dips and spikes, impairment in appetite regulating hormones, and a slowed metabolism – all of which impact weight.

It is also important to note that people with PCOS are at higher risk for eating disorders and disordered eating. A review of studies including nearly 29,000 women confirmed an increased risk of bulimia and binge eating disorder.

The bottom line is that weight loss diets and advice to lose weight, can lead to women with PCOS feeling discouraged, bad about their bodies, and toward disordered eating behaviors and as a result actually worsen symptoms.

5 Ways to Manage PCOS Without Dieting

So, what is the answer when we are interested in caring for our bodies and improving our health with PCOS, without the misery of restrictive diets?

The noise promoting dieting for symptom management with PCOS can be loud. Instead, focusing on healthy habits that you can keep up with and align with your lifestyle can be more helpful for managing symptoms like insulin resistance, hormone imbalances, and chronic inflammation. While PCOS isn’t curable, its symptoms are manageable through lifestyle changes, medication, and fertility treatments.

Here are 5 evidence-based non-diet strategies for managing your PCOS and feeling better in and about your body.

#1 Eat regular and consistent meals and snacks

Our bodies, with or without PCOS need nourishment! The best way to nourish our bodies is to eat regularly and consistently throughout the day. Skipping meals and doing diets like intermittent fasting can cause large fluctuations in blood sugars putting the body under stress, increasing levels of the stress hormone cortisol and increasing inflammation.

Eating regularly is helpful in stabilizing blood sugar, helping to prevent large dips and spikes in blood sugar throughout the day, insulin resistance, and regulating hormones.

Consistent eating means feeding your body in a balanced way within an hour or two of waking and every 3-5 hours throughout the day. Just making this change can have a huge impact on how you feel and the symptoms you experience with PCOS.

#2 Focus on adding in instead of taking away

When we are trying to manage a chronic condition through dieting, we are often encouraged to focus on avoiding certain foods. Instead, it can be far more helpful to shift our focus to changing how we eat and adding in nutritious foods that can help manage PCOS symptoms like insulin resistance and inflammation.  

Three things to add in…

1. Balance: All the major nutrients – protein, fats and yes even carbs – at regular meals and even at snacks between meals when you can. Balanced eating can help to improve insulin sensitivity, decrease inflammation, and manage hormone irregularities.
2. Carbs: Despite online claims, low-carb diets are not recommended for PCOS management. Carbs are essential for managing PCOS and don’t need to be severely restricted. Foods like fruits, starchy vegetables, and whole grains provide energy, fiber, vitamins, and minerals. Including fiber-rich carbs can help control insulin levels.
3. Anti-inflammatory foods: Anti-inflammatory foods include fruits, vegetables, whole grains, nuts, seeds, beans, peas, omega-3 seafood, and olive oil. They offer essential nutrients like fiber, healthy fats, vitamins, minerals, and antioxidants. There is still room for some packaged or pre-made items too. All the chatter around processed foods of late can make it feel like eating needs to be an all-or-nothing endeavor. In reality, healthful patterns of eating can have a good balance of both.

Both the Mediterranean diet and the DASH diet are examples of evidence-based patterns of eating that have been shown to be beneficial for PCOS – as well as many other chronic conditions. (I cringe at the word “diet” but see both of these more as “patterns” of eating that are highly evidence-based and provide examples of foods to add in that can be beneficial to not only PCOS, but overall health.)

#3 Embrace joyful movement

Gentle, consistent activity can both improve insulin sensitivity and reduce inflammation, and as a result improve PCOS symptoms. There are so many ways to move. The most important thing is to find what you enjoy.

Moving in ways that make you happy and don’t feel like exercise are fantastic. Things like dancing, hiking, swimming, biking, and playing a sport like pickleball or tennis (one of my personal favorites) are excellent ways to get moving without feeling like you are “working out” or torturing yourself. Laughing while you move is highly recommended!

Simply getting outside for a walk can also be a good option. I love walking with my husband and dogs and to me walking and catching up with a close friend is medicine for both body and mind. One of the best ways to lower stress in my opinion.

Other mind-body exercises like yoga, Tai Chi, and Qigong are also good options and all combine movement, breath, and mindfulness to improve both physical and mental well-being.

As I say often to clients, any and all movement matters and is beneficial. Finding enjoyment in whatever you do will make it something you look forward to instead of something you dread.

#4 Reduce your stress levels

Stress is also a contributing factor to the symptoms of PCOS. Stress can come and go and no one’s life is stress free, but if it is chronic it can take a toll and can worsen the two key factors of PCOS – insulin resistance and inflammation.

Chronic stress can trigger our sympathetic nervous system putting our bodies and minds into constant “fight or flight” mode, negatively impacting our physical, mental, and emotional health and worsening PCOS symptoms.

Finding and practicing ways to manage stress is key. Mindfulness, journaling, spending time with people you love, getting adequate sleep, regularly moving your body, and setting boundaries can help regulate hormones, improve metabolic health, and improve our mood and outlook.

Even just intentionally breathing can be extremely helpful in reducing stress and helping activate our parasympathetic nervous system, bringing a sense of relaxation and calm. One very helpful practice is the 4-7-8 breathing technique. It can calm your nervous system and reduce the stress-hormone response. Give it a try. Start by taking a good deep inhale through your nose and out of your mouth. Then inhale for 4 counts, hold for 7, and exhale for 8. This technique takes practice, but the more you practice it the more you will reap the benefits.

#5 Consider helpful supplements

While lifestyle adjustments are key, certain supplements, with guidance from a healthcare provider, can provide additional support.

Some that I recommend often are:

• Inositol: Myo-inositol and D-chiro-inositol have been shown to improve insulin sensitivity and help regulate menstrual cycles. (I recommend Ovasitol.)
• Omega-3s: Fatty acids found in fish oil may help reduce inflammation. (I recommend Kirkland or Nature Made softgels.)
• Magnesium: Many people with PCOS are deficient in magnesium. Increasing your intake through food sources like leafy green vegetables, nuts, seeds, and whole grains or in a magnesium glycinate supplement can help. (I recommend Pure Encapsulations).
• Vitamin D: Correcting a vitamin D deficiency, which is common in women with PCOS, can support hormonal balance. (I recommend Nature Made or Kirkland D3).

Key Takeaways

• PCOS is not your fault, your weight did not cause PCOS, and your body is not broken.
• Women with PCOS are particularly affected by the stress associated with dieting and are at increased risk of developing eating disorders and disordered eating patterns.
• There are many options for management of PCOS without having to diet, restrict, or feel like you need to “fix” your body.

To consider…

What is one step you can make towards eating more regularly and consistently?

What can you add in when it comes to food, stress reduction, and movement?

Need support? A registered dietitian, (like me!) with experience with PCOS can help. Together we will take a closer look at your current food choices and lifestyle and come up with a plan to make improvements in sustainable and easy ways.

If you have tried to restrictive diets to manage PCOS, which has left you in a cycle of perpetually being on and off diets, please know that it is possible to take charge of your PCOS without dieting. Managing symptoms and improving your overall health is not one-size-fits-all. It’s about finding sustainable, gentle practices that work with and for your body and your lifestyle.