PCOS and Intermittent Fasting
by Catherine Morris | October 6, 2020, updated 13 days ago
As we bid farewell to PCOS Awareness Month, it's a good reminder that polycystic ovary syndrome isn't just a month-long concern, but a debilitating, multi-symptom condition that requires a multi-faceted approach.
PCOS affects one in ten women, according to the National Polycystic Ovary Syndrome Association. That's millions of women, many of whom struggled for years to get a diagnosis, living with a severe hormonal imbalance that can cause irregular periods, excess facial hair, acne, depression, weight gain and anxiety.
The good news is that this complex condition often responds well to natural interventions, especially dietary. A new tool gaining ground in the fight is intermittent fasting, or time-restricted eating, often combined with a low carbohydrate diet.
What is PCOS?
PCOS involves several body systems, which makes it hard to pin down. It's a hormonal, reproductive, and metabolic disorder that is primarily diagnosed from abnormal menstrual cycles.
The ovaries produce estrogen, progesterone and, in smaller amounts, androgens. In a PCOS body, the ovaries produce too much androgen, knocking the hormones out of balance and causing cysts, irregular and painful periods, and a host of other symptoms.
The condition is tightly linked with inflammation and insulin resistance–where the cells stop responding to insulin. This is damaging in a number of ways. Insulin's main role in the body is to regulate your blood sugar levels. Say you're eating a couple of slices of bread—as you ingest those carbs, your blood sugar rises and your pancreas produces insulin to get it back down by telling the cells to grab the sugar and either use or store it.
Insulin resistance occurs when this mechanism falters and your cells stop listening to your insulin. The pancreas then pumps out more, thinking it's a supply problem, and both blood sugar and insulin levels rise.
Up to 70 percent of women with PCOS have insulin resistance, which means they also have a hard time controlling their weight and, over time, may be headed for other complications such as diabetes and damage to the pancreas.
Can Fasting Help With PCOS?
For Functional Medicine Consultant Dr Shabnam Das Kar and Nutrition Consultant Michal Ofer, PCOS is a complex issue with a relatively simple solution—eat less often. The co-founders of the Metabolic Dietary Solutions Program support and guide their PCOS clients to start a fasting regime in combination with a keto diet that limits carbohydrates. They have even produced a free ebook on the topic.
Fasting significantly improves insulin sensitivity and enables weight loss—it's the latter that is usually top of mind for PCOS patients, says Dr Kar.
“Women come to us for weight loss, but the weight loss is related to everything else. The metric we measure is not only weight loss, we look at weight loss maintenance. We focus on benefits beyond the number on the scale. The weight loss is the one thing that is going to help them regulate their cycles, [and deal with] their hirsutism, infertility, and body image issues.”
Shifting the pounds is harder for PCOS patients due to their hormonal dysregulation, meaning that sometimes longer fasts are necessary. The approach varies from client to client, with some doing well on shorter fasts, and others needing to go over 24 hours. Dr Kar says—
“There is no general rule of thumb. Some people want to do a deep dive right away, and some people are much more comfortable slowly easing in. If someone has 30 or 40lbs to lose doing 16 or 18 hours of fasting usually doesn't give those results. They need longer fasts. They may not even achieve the weight they were looking for when they joined the program but after they've lost 30lbs or something like that, they feel quite comfortable and not so bothered about a number on a scale.”
How Does the Keto Diet Help With PCOS
Fasting is only one part of the puzzle. Given that insulin resistance is such a big factor in PCOS, avoiding that blood sugar spike by limiting carbohydrates is also key.
“A 12 hour or a 16 hour fast might help in the short-term but, because there is this inherent hormonal weight loss resistance with PCOS, there is something deeper going on [and] it's not just about when you eat but what you're eating as well,” explains Ofer who says a Ketogenic diet (i.e one where the body switches from burning carbs to burning fat stores) is optimal for sustainable weight loss.
Many MDS Program clients are in India, where vegetarian diets are a cultural norm, making it tricky to implement a standard Keto diet which relies heavily on meat. It's challenging, but not impossible, to devise a PCOS-friendly diet for vegetarians says Ofer—
“When we're dealing with a vegetarian we need to be mindful of adding extra fats and reducing carbs, but not to the point where they're not getting enough protein. Part of the healing process with PCOS is having the raw materials to heal, and that's protein.
“There are two ways to deal with carbohydrate intolerance—you either remove the carbohydrates or you increase the time in between feedings. With a vegetarian who is getting their protein together with a carbohydrate, you can't remove the carbohydrates without removing the protein but you can increase the time [between eating].”
Changing Your Lifestyle to Treat PCOS
The MDS Program is not a diet, or a quick fix, but rather a long-term lifestyle shift. In many ways, Ofer and Dr Kar give as much mental support to their clients as dietary. They keep their clients motivated and help them rethink their relationship with food.
“It is important to create a mindset of abundance and positivity around this lifestyle, rather than a mindset of lack around what you're missing. It doesn't mean you can never indulge, we teach you how to indulge smartly and do it properly”
Ofer continues with, “It's what you do most of the time that allows you to play around some of the time. Once your weight has settled down, once your hormonal levels have settled, once your level of circulating insulin has reduced, you might be able to be more flexible [but] it is important to emphasize that you will never go back to what was your normal. If you are prone to insulin resistance and, if you trigger it again, your PCOS symptoms will come back.”
Depression and anxiety often go hand in hand with PCOS, and the more visible symptoms don't help—excessive hair growth and weight gain are almost guaranteed to lead to poor body image for many. Some women then turn to comfort eating, creating a vicious cycle. Fasting can help break that cycle and develop a healthier relationship with your food and your body.
“We've been taught from a young age that emotions and food are very connected. You're happy, you celebrate with food. You're sad, you drown your sorrows with food. Women tend to eat more emotionally than men, their appetite is governed by their hormones more than men. Fasting really allows you to differentiate between emotional hunger and actual hunger. It teaches you intuitive eating. It teaches you to listen to your body.”
Different Care for Different People
While natural interventions can have miraculous results, everyone responds differently to dietary solutions and it's important to remember that PCOS is an incurable and often lifelong condition.
“I won't say we can cure PCOS,” says Dr Kar. “I talk about PCOS remission. Conditions like PCOS can be managed well [with fasting and diet]. Results depend on age and how much metabolic flexibility clients have.”
Age is also a factor, with PCOS showing up at every stage in a woman's life. Dr Kar says—
“We don't know the exact causes of PCOS. There are genes involved but no-one is born with PCOS. The first symptoms usually show up in adolescence or later when women have a problem getting pregnant. Even in older women, the basic problem of insulin resistance persists after menopause. It is a lifelong problem and you need different strategies for the different stages of life. Younger people respond faster, older women have insulin resistance and along with that they have gone through menopause, so they take longer to get results.”
Evolution and Intermittent Fasting for PCOS
PCOS is notoriously under-diagnosed, but diagnosis or not, women suffering from irregular periods, weight gain and/or mood disorders can still benefit from fasting. It may seem like an unfamiliar, and even intimidating step, but it's actually closer to our ancestral eating patterns than constantly reaching for readily available processed foods says Ofer—
“We have been programmed to eat all the time. It's amazing what happens when you change that. Our bodies have been taught to store excess energy and use that when food is scarce. The problem with modern society is that food is always plentiful. Fasting allows the body to begin to access its energy stores in a comfortable way. Everyone can fast. You can go without eating for six hours, you won't die.”
Ofer also says it's important not to get caught up in the details, especially when new to fasting and adds—“When you're perfect at it, you can start looking at all the little things to become even more perfect, but in the beginning just focus on not eating for a bit. The more you focus on the small details, the greater your chance for failure.
“One of the wonderful things about fasting is that it's good for everybody—from better body composition to less brain fog, to better immunity, it's all there. There is no loss, it's a win-win.”
Fasting is not advised for pregnant women, people who are underweight, or those with eating disorders. If you'd like to find out more about fasting, or book a consultation to discuss your dietary needs, reach out to the MDS Program or one of the many dietitians and nutritionists in our network. The MDS Program has also released a free 'ebook' available from their website for further information.
Catherine Morris is an award-winning journalist with a bad case of wanderlust and a passion for all things health and wellness. Originally from Northern Ireland, she worked as a news and feature writer for media outlets in the UK, South Africa, France and the Caribbean before settling in Canada. Catherine now lives in Alberta with her husband and rescue mutt and spends her time happily exploring the great outdoors with both.