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Keto and Atkins. Paleo and veganism. There’s a flood of internet advice about healthy weight loss. Throw in a Polycystic Ovary Syndrome (PCOS) diagnosis and it’s hard to know where to start.

PCOS affects more than your ovaries. It causes high levels of androgen, a male hormone, which leads to embarrassing facial hair (or male-pattern baldness), acne, and a wacky flow.

And then there’s the weight gain. PCOS messes with your hormone balance and often causes insulin resistance, which means your body isn’t so great at regulating blood sugar and energy stores.

The good news is that lifestyle changes, like getting to a healthy weight, can help. Even losing 5 to 7 percent of your body weight can make a big difference in your insulin resistance, androgen issues, irregular periods, and fertility.

Everyone’s PCOS story is a little different, and you should always consult with your healthcare provider. But we do know there is a healthy diet that will work for your body. You might need to study up and prepare yourself for a little trial and error, but you’ve got this.

To kickstart your research, we talked to four women about their PCOS and weight loss wins.

[Note: Portions of the interviews have been edited for length and clarity.]

Mira, 29, food blogger

How long have you had PCOS?

Age 11, when I first got my periods. I was diagnosed at age 21. However, my PCOS has been in remission since age 24, meaning that I haven’t had a single PCOS symptom in the last 5 years.

How has PCOS affected your weight?

I gained the most weight from 18 to 23 years old. My heaviest was 300 pounds.

Why did you turn to a diet to manage PCOS?

No matter how much I exercised, and even if I took the pill to induce my periods, I still couldn’t lose weight.

What has worked for you?

Low carb and keto eating with a combination of intermittent fasting.

By cutting carbs and sugar, my insulin levels have balanced out. My hormones became normal again, ovarian cysts disappeared, my facial hair stopped growing, I lost over 100 pounds, my cholesterol decreased, my periods came back naturally every month.

Plus, I’m currently pregnant, which is something that’s usually very hard to achieve when you have PCOS.

What hasn’t worked?

Eating gluten, rice, sugar, pasta, bread, starchy vegetables, beans, legumes, and so on. I gain weight automatically, my facial hair grows again, and my periods disappear again.

Any side effects from the new diet?

I’ve only experienced positive side effects, and my yearly health check-ups prove it.

What do you wish you’d known when you were first diagnosed with PCOS?

Carbs and sugar are your enemy! Increased insulin and blood sugar levels will only worsen your PCOS symptoms. Between 20 to 50 grams of carbs per day has been my sweet spot for maintaining my weight.

Favorite PCOS-friendly snack?

My latest gluten-free cake recipe (German Black Forest cake) is my ultimate favorite dessert on my blog! I’ve made it a good eight times in the last 4 months.

The bottom line:

Start slow. People tend to go cold-turkey and cut all carbs at once, but I find they rebound and cheat sometime later. By taking your time and letting your body adjust to eating low carb, you’ll be able to follow a low carb, ketogenic diet long-term and experience all of its benefits.

Casey, 24, journalist

How long have you had PCOS?

Since I was about 14.

How has PCOS affected your weight?

The main treatment for PCOS is birth control. I have been on a variety of BC types, and most of them have included at least some weight gain.

Why did you turn to a diet to manage PCOS?

Using food as medicine has always made sense. I will always use Western medicine as well, but I supplement with natural solutions whenever I can.

What has worked for you?

I try to eat as few processed foods as possible and include nutrient-dense foods in every meal.

I try to eat inflammation-fighting foods and foods that balance hormones: broccoli, pomegranate, avocado, and dark leafy greens. I also rely heavily on natural supplements like turmeric to limit inflammation.

Hydration is also really key. Drinking a lot of water can help with the bloating that comes with PCOS and endometriosis. Sometimes I add a little fruit to water if I’m getting bored.

What hasn’t worked?

Some people suggest going gluten-free for PCOS, but that didn’t work for me.

What do you wish you’d known when you were first diagnosed with PCOS?

I wish I had realized earlier how easy it is to incorporate all kinds of different vegetables into recipes — smoothies, sauces, etc. There are so many ways to use nutrient-dense foods to perk up meals with flavor!

Favorite PCOS-friendly snack?

I am avocado obsessed. I snack on it with a little lemon juice and pepper.

The bottom line:

For someone who wants to lose weight… I would suggest green juices and lots of vitamin B. But I think it’s much healthier for me to just focus on how I want my body to feel and try to use exercise and diet to contribute to that. Yoga has also been a lifesaver for symptom management with PCOS and my other chronic diseases.

Clare, 34, PCOS-specific nutritionist

How long have you had PCOS?

I was diagnosed when I was 25.

How has PCOS affected your weight?

I’ve had major issues managing my weight with PCOS. I was competing at the World Champs level in athletics and triathlon, both sports that prioritize a ‘lean’ figure, and I was never that! I was training up to 25 hours per week and recording every calorie. But I was still overweight.

Why did you look to nutrition as a way to manage PCOS?

When I was diagnosed with PCOS, I also was told by my doctor that my insulin wasn’t great and I was on the cusp of being prediabetic. This came as a massive shock to me.

As a registered nutritionist, I was already following all the healthy food guidelines. This led me to dive deeper into the research and learn that our food pyramid wasn’t the best for someone who was prediabetic and essentially “carbohydrate intolerant.”

What has worked for you?

Focusing on eating foods that keep my insulin down. Eating lots of non-starchy vegetables, a moderate amount of protein, lots of healthy fats, and a smaller amount of carbohydrates from foods like lentils and beans rather than bread and pasta.

What hasn’t worked?

Focusing solely on calories. Everywhere you look on Instagram, you’ll see well-meaning nutritionists and personal trainers who will tell you that the only thing that matters when it comes to weight loss is a calorie deficit.

But this just isn’t true: Studies have shown that if our insulin is high, we’ll gain weight — even if we’re reducing calories.

Any side effects of your PCOS diet?

Positive side effects: My periods, which had been missing for 3 years, came back and started to regulate. And my acne improved significantly.

What do you wish you’d known when you were first diagnosed?

Our food pyramid diet that I was taught at university isn’t right for everyone. We need to adapt it for individuals. About 60 to 70 percent of women with PCOS have insulin resistance.

Favorite PCOS-friendly snack?

Coconut yogurt and blueberries! Fruit on its own can spike insulin, so always pair it with a fat or protein.

Aisling, 35, writer

How long have you had PCOS?

About 3 1/2 years. The diagnosis was also related to IBS and thyroid imbalances.

How has PCOS affected your weight?

I was gaining weight rapidly despite exercising regularly and trying to eat healthily. When I was diagnosed, I was at 156 pounds (I’m 5’3”) and it felt as if my body just kept swelling.

Why did you look to nutrition as a way to manage PCOS?

I didn’t want to go back on the pill, so we decided to explore natural solutions.

What has worked for you?

Cutting all gluten, dairy, and processed sugar made the biggest difference in terms of weight gain and the crippling pains I would get during ovulation. My diet is largely plant based with lots of protein and a minimum of carbs.

Within a year on a very strict diet, I had come down to 116 pounds. My weight eventually stabilized around 124 pounds and the cysts disappeared. But I also started Tai Chi and was swimming and cycling regularly.

What hasn’t worked?

My adherence to the diet has fluctuated a lot as it requires a regular routine and lots of self-discipline.

Did you experience any side effects when you shifted your diet?

Only good ones, except for my social life! Eating out or with friends has become rather awkward with the list of things I can’t or shouldn’t eat.

What do you wish you’d known when you were first diagnosed?

It requires a whole lifestyle change — taking more time to prepare and eat healthy foods, getting a full night’s sleep, reducing stress, moving. Basically a lot more self-care. Also, I am realizing that the diet is not a quick fix. It’s something I have to maintain long term.

Favorite PCOS-friendly snack?

Roasted nuts and seeds!

Bottom line:

Don’t focus on losing weight. That was not my goal. I wanted to get well naturally and the weight loss was a positive side effect.

So what should you eat when you want to shed excess weight and take control of your PCOS symptoms?

Pound that protein

Protein helps you feel full, stabilizes your blood sugar, and — get this — could lower your androgen levels.

In a 6-month study, women with PCOS who ate a high protein diet (more than 40 percent of calories from protein) lost an average of 9.7 pounds, which was significantly more than the control group who ate a standard American diet.

The bottom line:

Eating daily eggs, nuts, seafood, and other lean protein could aid weight loss and reduce pesky PCOS symptoms like facial hair and irregular periods.

Make fat fun again

Recent studies show that eating fat is not what makes us fat. And eating healthy fats can actually work wonders for PCOS symptoms.

The research shows that a high fat diet (40 percent of calories from fat) results in more fat loss than a low fat diet (27 percent of calories from fat). This might be because healthy fats are filling, which helps reduce cravings. Belly fat, be gone!

When it comes to fat, remember that quality is just as important as quantity. Stick with healthy fats like avocados, nut butters, and coconut or olive oil for the best benefits.

Stock up on supplements

While it’s best to check with your doctor before switching up your supplements, research has shown that both myo-inositol and carnitine (vitamin-like substances) can alleviate PCOS symptoms (yes, including weight gain).

The deets: In a 14-week study of women with PCOS who took 4 grams of myo-inositol per day, the supplement facilitated “significant weight loss.” In a small 12-week study, women with PCOS who took 250 milligrams of carnitine per day lost an average of 5.9 pounds each.

Watch those carbs

Eating fewer carbs can help with weight loss, especially if you’re one of the 70 percent of women with PCOS who also has insulin resistance.

In one small study, women with PCOS who had a BMI of over 27 restricted their carbs to 20 grams or less per day for 24 weeks. Results were promising: They lost an average of 12 percent of their body weight.

Sometimes a low carb diet can feel like you’re banned from “all the things.” Make it fun by stocking up on low carb snacks.

Fill up on fiber

Fiber is a low-key digestive hero. It helps you feel full faster, scrubs your gut, and yes, makes you poop. All these benefits set you up for a win in the PCOS department.

A recent study showed that amping up fiber intake lowers three things in women with PCOS: total body fat, belly fat, and insulin resistance (three cheers for blood sugar regulation!).

Standard dietary guidelines recommend 14 grams of fiber per 1,000 calories you eat a day, but most Americans don’t hit the target. Up your intake by snacking on high fiber snacks like kale chips, oatmeal, and hummus.

Ditch the processed food

If tearing open a new bag of Skittles has you feeling some type of way, you probably already know it’s time to give sugar the slip.

But there’s another reason to ditch sugary snacks and processed foods: Research shows that sugar spikes your insulin even more when you have PCOS. And that can lead to obesity.

Try trading candy, sugary drinks, and cookies for naturally sweet foods like berries and bananas. And don’t forget to freshen up your pantry by swapping refined carbs like bagels for sprouted grain bread or oatmeal.

Find your mealtime zen

Here’s the skinny: PCOS triples your risk of developing an eating disorder. And while mindful eating might sound a little woo-woo at first, the truth is that there are studies that suggest mindfulness is important for healthy weight loss.

Mindful eating means checking in with your body throughout the day. Are you craving avo toast because you’re hungry? Or are you pounding that Ben & Jerry’s pint to cope with a bad day?

Kickstart mindful eating by starting each meal with small portions and thoroughly chewing (and savoring!) each bite.

Say it with me: Moderation, not deprivation

Skipping and skimping on meals is never a healthy way to lose weight. Restricting calories can actually force your body into starvation mode, when it hoards fat instead of burning it.

In this study of more than 600 people, participants lost weight by swapping processed foods for whole foods, all without cutting calories.

So instead of eating less, focus on the kinds of food you eat. Nosh on nutrient-dense foods (fruits and veggies, FTW) instead of processed foods.

Diet isn’t your only weight loss tool. A lifestyle overhaul increases your chances of success.

Keep it moving

Lizzo, hair tosses, calisthenics… it’s a whole mood. And on top of serving up happy endorphins, studies show that regular cardio (at least 30 minutes three times per week) can shrink your waistline and improve insulin sensitivity.

In a 4-month study of 45 women with PCOS, 45 minutes of weight training three times per week led to weight loss and testosterone reduction (peace out, facial hair!).

The takeaway?

Whether you prefer pumping iron or pounding the pavement, exercising at least three times per week can help kick PCOS symptoms to the curb.

Watch out for inflammation

Inflammation isn’t always a bad thing — swelling is part of the body’s healing process — but chronic inflammation from PCOS can wreak havoc.

Chronic inflammation triggers your body to create more androgens, which can lead to acne, irregular periods, and (again) excess hair in unexpected places.

The good news is that it’s possible to protect yourself against inflammation by avoiding sugar and following a diet like the Mediterranean diet.

Breathe in, breathe out

Need one more excuse to keep calm and self-care on? PCOS has your back.

Stress raises cortisol, and cortisol has been linked to weight gain and insulin resistance. So whether it’s yoga, meditation, or a walk in the woods, find something that helps you chill. Then go do it.

Catch some Zzz’s

Research has linked lack of sleep with obesity. Clocking 8 hours of sleep each night is one of the best things you can do for your mental and physical health.

If you’re struggling to get enough shut-eye, try these pro tips:

  • go to bed before 10 p.m.
  • avoid screen time after dark
  • tune into a guided sleep meditation app or podcast

Metformin

Metformin is a prescription drug meant to treat type 2 diabetes, not PCOS. But doctors often prescribe it “off label” (as treatment for something other than its FDA-approved purpose) for PCOS.

Why? Because insulin spikes may contribute to PCOS weight gain. Since metformin reduces insulin and blood sugar for people with type 2 diabetes, it can do the same for you.

One study found that taking metformin while also exercising and following a healthy diet led to weight loss, lower blood sugar, and regular monthly flows.

Birth control

Many women with PCOS use birth control (BC) pills to regulate their periods and ward off unwanted hair growth. Taking estrogen and progestin might help alleviate some of your PCOS woes, but there isn’t much proof it will help you shed pounds.

Anti-androgen drugs

Meds created to cut down on androgens are kind of like metformin — they’re “off label” when it comes to PCOS. But anti-androgen drugs can alleviate PCOS symptoms like acne and excess hair.

Though anti-androgen drugs aren’t likely to help you slim down long term, they do reduce swelling from water weight.

Depending on your PCOS symptoms, your doctor can help determine whether or not anti-androgen drugs could be helpful for you.

PCOS might complicate your health #goals, but it doesn’t mean they’re impossible.

Lifestyle changes like cutting carbs, focusing on fiber, and filling up on healthy fats could help you shed extra weight in a healthy way. Exercise and self-care are also effective ways to slim down and feel better.

Always check with your doctor or nutritionist before making big changes — including adding supplements to your daily regime!

Though a PCOS-friendly diet goes a long way in making you feel and look healthier, sometimes medications can help too. Talk to your doctor if you’re interested in using meds to regulate your hormones and kiss your PCOS symptoms goodbye.