Understanding PCOS and Managing Your Eating Habits

What is PCOS?

Polycystic ovary syndrome (PCOS) is a common hormonal condition that affects 10-13% of women, from teenagers through menopause. Despite how common it is, many women experience delays in getting diagnosed and often feel unsatisfied with their care.¹

A PCOS diagnosis requires at least two of these criteria:

• High levels of male hormones (androgens) in your body or symptoms like excess hair growth, acne, female pattern baldness
• Irregular, absent, or unusual periods
• Polycystic ovaries seen on ultrasound OR elevated anti-Müllerian hormone levels

If you’re concerned that you may have symptoms of PCOS, it’s important to consult your health care professional to get a proper diagnosis. Note that excess hair growth (“hirsutism”) is a particular red flag for high androgen levels, while acne or hair loss in isolation are much weaker predictors.¹ Even if your periods are regular, but they are very heavy or light, or your cervical mucus doesn’t change in mid-cycle, you may be having anovulatory periods (where you don’t produce an egg during your cycle).¹ Your doctor can get your testosterone measured to check your androgen levels, and if necessary, your progesterone measured to confirm you’re ovulating.¹

PCOS isn't just about reproductive health—it's also linked to insulin resistance, metabolic problems, and an increased risk of type 2 diabetes.² It’s important to have it properly diagnosed and managed over your lifetime, to prevent these and other associated conditions. This article focuses on the importance of managing your weight in PCOS: not only are higher weights associated with worse PCOS symptoms, but overweight and obesity are themselves more likely if you have PCOS.²

There are multiple reasons why PCOS develops, including genetics (and how your environment influences them), psychological, endocrine and metabolic factors.

The PCOS-Weight Connection

PCOS and weight gain seem to go hand in hand. Girls with higher body weight are more likely to develop PCOS as young adults, while teens with PCOS are more likely to struggle with weight in their twenties.² However, it's important to know that PCOS also occurs in women who aren't overweight.

How Hormones Affect Your Appetite

PCOS creates a perfect storm of hormone changes that make managing weight more challenging:

Insulin and Blood Sugar: Higher insulin levels stimulate the ovaries to produce more male hormones and disrupt normal hormone balance. Your insulin receptors become desensitized (so-called “insulin resistance”), and a blunted response to insulin receptors in your brain promotes changes in food intake.² These factors leads to increased hunger and cravings.

Appetite Hormones: Several hormones that normally help control hunger don't work properly in PCOS:

• Leptin (which should make you feel full) is higher but doesn't work as well²
• Ghrelin (which makes you hungry) doesn't drop as much after eating²
• CCK (which creates feelings of fullness after meals) is lower than normal³

Psychological Factors

PCOS can take an emotional toll. The condition is associated with higher rates of anxiety and depression, which can lead to emotional eating and other eating challenges.² In fact, anxiety affects 40% of women with PCOS, and depression 37% of them⁴—not surprisingly, as raised testosterone can increase anxiety and depression.² Symptoms like unwanted hair growth, acne, weight gain, and irregular periods can affect self-esteem and body image, potentially triggering unhealthy eating patterns even more.²

Eating Disorders and PCOS

Women with PCOS are 3-4 times more likely to develop eating disorders compared to women without the condition.⁵ The most common issues include:

• Binge eating (occurring in 60% of women with PCOS who are overweight)⁶
• Bulimia nervosa⁵

As weight increases in women with PCOS, food cravings also tend to increase. This creates several vicious cycles where PCOS symptoms worsen weight issues, which then make PCOS symptoms worse. In addition, weight gain and the symptoms of PCOS often affect self-esteem and mental health, leading to disordered eating patterns, which themselves can further increase anxiety, depression and body dissatisfaction in PCOS.⁵

Managing Your Eating Habits

If you’re diagnosed with PCOS, your doctor is likely going to recommend certain medications to treat particular symptoms and signs of PCOS (for example, a combined oral contraceptive to manage hirsutism or irregular periods, or metformin if you have insulin resistance). However, the good news is that diet and lifestyle changes are the cornerstone of PCOS treatment, both to interrupt the vicious cycles and to have better outcomes in terms of your reproductive, heart, and general health.^7,8 While weight loss can be more challenging with PCOS,⁴ it's absolutely possible with the right approach. Even if you’re not overweight, it’s still important to foster healthy eating to avoid developing other health problems later.

Getting Started

Screen for Mental Health: It's important to address any anxiety, depression, or eating disorders early in your diagnosis.^1,4,5 Hopefully, your healthcare provider will raise these PCOS-associated conditions with you; if not, ask her about them yourself, regardless of your weight. Your doctor will work with you on a plan to treat any mental health issues.

Avoid Weight Stigma: Focus on health improvements rather than just the number on the scale. This applies not only to you, for your own mental health, but also to healthcare professionals who may be guiding you. If you’re not comfortable with how your healthcare team is addressing any weight issues you may have, try to address this with them.

Diet and Exercise

Regular Exercise: Follow current guidelines for physical activity, including both cardio and strength training. An international body of PCOS experts recommends the following if you’re aged 18-64 years:¹

• To prevent weight gain and maintain health: minimum 150-300 minutes of moderate or 75-150 intense aerobic exercise a week (or a combination of both) AND muscle strengthening (flexibility/resistance) on 2 non-consecutive days.
• For modest weight loss and prevention of weight gain: minimum 250 minutes of moderate or 150 intense aerobic exercise a week (or a combination of both) AND muscle strengthening (flexibility/resistance) on 2 non-consecutive days.
• For adolescents under 18 with PCOS, aim for 60 minutes of moderate-to-vigorous physical activity daily, including muscle and bone strengthening on 3 days.¹

Remember: any movement is better than no movement!¹ (Housework and dog walking count!) Use whatever works for you to help you increase or measure your physical activity, (such as fitness monitors, an exercise buddy, or a personal trainer), but set yourself realistic goals and don’t chide yourself if you don’t meet them.

Healthy Eating: While there's no single "PCOS diet,"¹ some strategies that may help include:

• Eating adequate protein, which may increase your CCK and glycogen-like peptide-1 (GLP-1) gut hormones to help with fullness²
• Including plenty of fiber from fruits, vegetables, and whole grains²
• Supporting your gut health with probiotic-rich foods and prebiotics (look for ones containing (Lactobacillus acidophilus, Lactobacillus casei, and Bifidobacterium bifidum, amongst others)⁷

Treatment Options

GLP-1 Medications: Drugs like semaglutide (Ozempic, Wegovy) and liraglutide (Saxenda) have shown promising results for weight loss in women with PCOS.⁸ They work better than lifestyle changes or metformin alone and can improve insulin resistance.⁸ What’s more, in combination with metformin they improved fertility more than metformin alone.⁹ However, they can cause side effects like nausea and headaches, and up to 40% of women with PCOS experience mild-to-moderate digestive issues.⁸

A Natural Alternative: There’s an alternative for those who don’t want to or can’t use GLP-1 medications. Calocurb® contains a hop extract that naturally increases GLP-1 levels, helping reduce appetite and food cravings, with fewer side effects than prescription medications. It works by boosting your body’s production of natural GLP-1. In a human study it raised baseline GLP-1 levels to six times normal, causing study participants to feel full faster and so eat almost 20% fewer calories at their next meal.¹⁰ In a study of women who were fasting for 24 hours (having only water), Calocurb taken at hours 16 and 20 reduced their overall cravings by 40% and their overall hunger by 30% —and when they broke their fast four hours after their last Calocurb, they ate almost 15% less.¹¹

Calocurb is an affordable alternative or add-on to GLP-1 medications. If you’ve got PCOS, but are otherwise in pretty good health, you can use it to help maintain a healthy weight. If you’re taking a GLP-1 medication, adding in Calocurb may allow you to decrease your dose of the injection while maintaining its effects (which can be helpful in reducing unwanted side effects). Finally, if you’ve been on a GLP-1 medication but are looking at stopping it—for whatever reason—you can start taking Calocurb the week of your last injection to “kick start” your body back into making its own GLP-1 (which, unfortunately, it kind of forgets to do when you use the injections¹²). Of course, in each case, you should discuss the use of Calocurb with your healthcare provider before making any changes to your treatment program.

Final Thoughts

Managing PCOS requires a comprehensive approach that addresses both the physical and emotional aspects of the condition. While the relationship between PCOS and weight can create challenging cycles, understanding these connections empowers you to work with your healthcare team to develop effective strategies.

Remember, PCOS is a chronic condition that requires long-term management, but with the right support and treatment plan, you can successfully manage your symptoms and improve your overall health and quality of life.

References

1. Teede HJ, Tay CT, Laven JJE, et al. Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2023;108(10):2447-2469. doi:10.1210/clinem/dgad463PCOS
2. Stefanaki K, Karagiannakis DS, Peppa M, et al. Food cravings and obesity in women with polycystic ovary syndrome: pathophysiological and therapeutic considerations. Nutrients. 2024;16(7):1049. Published 2024 Apr 3. doi:10.3390/nu16071049
3. Hirschberg AL, Naessén S, Stridsberg M, Byström B, Holtet J. Impaired cholecystokinin secretion and disturbed appetite regulation in women with polycystic ovary syndrome. Gynecol Endocrinol. 2004;19(2):79-87. doi:10.1080/09513590400002300
4. Lee I, Cooney LG, Saini S, Sammel MD, Allison KC, Dokras A. Increased odds of disordered eating in polycystic ovary syndrome: a systematic review and meta-analysis. Eat Weight Disord. 2019;24(5):787-797. doi:10.1007/s40519-018-0533-y
5. Lalonde-Bester S, Malik M, Masoumi R, et al. Prevalence and etiology of eating disorders in polycystic ovary syndrome: a scoping review. Adv Nutr. 2024;15(4):100193. doi:10.1016/j.advnut.2024.100193
6. Jeanes YM, Reeves S, Gibson EL, Piggott C, May VA, Hart KH. Binge eating behaviours and food cravings in women with polycystic ovary syndrome. Appetite. 2017;109:24-32. doi:10.1016/j.appet.2016.11.010
7. Singh S, Pal N, Shubham S, et al. polycystic ovary syndrome: etiology, current management, and future therapeutics. J Clin Med. 2023;12(4):1454. Published 2023 Feb 11. doi:10.3390/jcm12041454
8. Jensterle M, Herman R, Janež A. Therapeutic potential of glucagon-like peptide-1 agonists in polycystic ovary syndrome: from current clinical evidence to future perspectives. Biomedicines. 2022;10(8):1989. Published 2022 Aug 16. doi:10.3390/biomedicines10081989
9. Szczesnowicz A, Szeliga A, Niwczyk O, Bala G, Meczekalski B. Do GLP-1 analogs have a place in the treatment of PCOS? New insights and promising therapies. J Clin Med. 2023;12(18):5915. Published 2023 Sep 12. doi:10.3390/jcm12185915
10. Walker EG, Lo KR, Pahl MC, et al An extract of hops (Humulus lupulus L.) modulates gut peptide hormone secretion and reduces energy intake in healthy-weight men: a randomized, crossover clinical trial. Am J Clin Nutr. 2022;115(3):925-940. doi: https://doi.org/10.1093/ajcn/nqab418
11. Walker E, Lo K, Gopal P. Gastrointestinal delivery of bitter hop extract reduces appetite and food cravings in healthy adult women undergoing acute fasting. Obes Pillars. 2024;11:100117. Published 2024 Jun 20. https://doi:10.1016/j.obpill.2024.100117
12. Kim SH, Abbasi F, Nachmanoff C, et al. Effect of the glucagon-like peptide-1 analogue liraglutide versus placebo treatment on circulating proglucagon-derived peptides that mediate improvements in body weight, insulin secretion and action: a randomized controlled trial. Diabetes Obes Metab. 2021;23(2):489-498. doi:10.1111/dom.14242