Why is it so hard to lose weight with PCOS?
Want to learn how to ditch the diets and develop a healthier relationship with food and your body? Together we address your health concerns and goals holistically, focusing on nurturing and nourishment instead of the restrictions and rules to help you heal on a cellular level, learn more about my programs here.
Obesity affects up to 80% of women with PCOS and is a common side effect of the syndrome. But why is it so hard to lose weight with PCOS? I get this question all the time, and I see so many women miserably counting their calories and exercising for hours with no success. What gives?
It’s not about motivation or weakness. You didn’t fail, the diet failed you. I’ve said it before and I’ll say it again. Diets don’t work, at least not in the long term, because they don’t address any of the core foundations and imbalances. Weight loss is so much more than calorie counting and the cardio machine.
But why does weight loss seem like such a struggle with PCOS?
There are several factors that play into weight gain and PCOS which make it more challenging to lose the excess weight:
Inflammation
Chronic low-grade inflammation is characteristic of PCOS. This means that there is a constant steady supply of inflammatory chemicals being secreted in the body.
Like stress, inflammation is good in acute situations like when you cut yourself or get a bruise. When it’s chronic this becomes a problem.
Inflammation drives weight gain but weight gain can also promote inflammation, which results in a vicious cycle.
Fat cells become inflammation making factories as they expand beyond capacity and release fatty acids that are inflammatory. These fatty acids are released into the bloodstream, which is dangerous and causes tissue damage which feeds the inflammatory cycle.
Chronic inflammation also promotes insulin and leptin resistance, sabotaging your ability to burn fat.
So what came first? Inflammation or fat? Though weight loss can bring down inflammation, they both feed each other which means you need to address where this inflammation is coming from. And a lot of the time what is causing inflammation is also driving weight gain (1).
The most common sources of inflammation include your diet, heavy metals, stress, food sensitivities and allergies, and the state of your gut microbiome.
Stress
As you know when the body is under stress, cortisol is activated. This is fine during acute situations but not so much when it is happening over and over and over again. We are literally triggering the stress response all day long from stress at work to traffic to family to finances, etc. And also what you are thinking on a daily basis because we as humans are the only species that activate the stress response by thought alone.
There exist many types of stressors and these include emotional, physical, and chemical, so it adds up!
A lot of people report stress eating and specifically cravings for high sugar and high fatty foods. This makes sense from an evolutionary standpoint because under stress the body needs quick glucose for energy. With emotional stress we tend to crave these types of comfort foods to help soothe us but which later backfires on us and makes us want more and more.
Chronic stress contributes to insulin resistance because it decreases insulin sensitivity and the uptake of glucose into the cell (2) (3) (4). Cortisol also breaks down muscle mass releasing stored glycogen as glucose which increases blood sugar. This essentially means less energy in the cell and more fat storage, resulting in cravings, increased appetite, and belly fat.
You may find that you store fat around your abdomen more easily, this is because there are 4 times more cortisol receptors here which means under stress you tend to store more fat in the belly area.
Over-exercising is a common cause of chronic cortisol levels so if you find yourself pushing yourself super hard at the gym and neglecting your rest days, I highly suggest you take it down a notch! You’ll be surprised by how stress management supports your weight loss goals. More isn’t always better.
Insulin resistance
Insulin resistance means that your cells are no longer responding to insulin. Insulin is a hormone that ushers blood sugar out of the blood and into the cell to be utilized for energy. In insulin resistance, the cells are no longer responding to the insulin so high blood sugar levels circulate in the bloodstream triggering more insulin to be secreted. This results in blood sugar crashes, fat storage, energy crashes, and more cravings.
Insulin’s job is simple: to decrease blood sugar in the bloodstream and store energy as fat. When insulin is elevated you are in fat-storing mode, not fat-burning mode. This is why it’s important to leave time between meals so that insulin can lower again and fat-burning systems can kick in.
High insulin also leads to increased androgens and inflammation in PCOS which additionally drives weight gain.
Leptin resistance often goes hand in hand with insulin resistance. Leptin is your satiety hormone and it is secreted by fat cells. However, higher secretion of leptin from fat cells overtime impairs your brain’s ability to receive the signal for being full, making you eat more. This is leptin resistance.
Hormone imbalances
imbalanced hormones also affect your weight. Your thyroid hormones, for instance, are in charge of overseeing your metabolism. This is why hypothyroidism and Hashimoto’s often result in weight gain that is hard to lose. High estrogen, common in PCOS, also promotes fat storage and usually occurs around the hips, butt, and thighs. Low progesterone encourages weight gain as progesterone supports thyroid hormone production which increases body temperature and metabolism and it supports the utilization of stored fat for energy. Leptin promotes weight gain when your cells become resistant to it. Your brain is not getting the signal that you have had enough to eat. This means you may always feel hungry and unsatisfied, which leads to overeating and storing more energy as fat.
Make sure to test your hormones (complete panel) with a practitioner who can assess optimal levels. The most comprehensive and complete hormone testing would be the DUTCH test.
Imbalanced microbiome
PCOS women have been shown to have a lack of diversity of beneficial microbes in the gut.
What does this have to do with weight loss? Well part of our good gut bacteria, known as the estrobolome, breaks down estrogen to be excreted in the bowels. If you have dysbiosis and an imbalance of bacteria you may not be breaking down estrogen and instead re-circulating it. This can lead to estrogen dominance due to poor elimination. Additional reasons for estrogen dominance may be high exposure to exogenous toxins like endocrine-disrupting chemicals or low progesterone relative to estrogen. Estrogen promotes fat storage, particularly around the hips and thighs.
Secondly, bad bacteria can actually extract more calories from your food and certain species of bacteria are associated with obesity (5). Your bacterial composition can also affect your appetite, cravings, mood, and elimination time.
In addition, about 20% of your thyroid hormones actually get converted into their active form in the gut by your microbes. So if they aren’t the good ones you will probably not be converting properly which means a lowered metabolism.
As the gut is directly linked to the brain via the vagus nerve, your mood and cognitive function are greatly influenced by your gut health (read more about it here). Pathogenic bacteria can actually induce cravings for poor food choices and even anxiety and depression can be linked to the state of your digestive system.
Read more about how you can support your gut here.
I always recommend testing and not guessing when it comes to digestive health. but the first place to start is to remove pathogens as well as inflammatory foods, junk food, processed foods, excess sugar and replacing with whole foods instead. It all starts on your plate!
You may also need to supplement with enzymes, probiotics, and herbs depending on your situation.
Want to learn how to ditch the diets and develop a healthier relationship with food and your body? Together we address your health concerns and goals holistically, focusing on nurturing and nourishment instead of the restrictions and rules to help you heal on a cellular level, learn more about my programs here.
Disclaimer: Information on this site is intended only for informational purposes and is not a substitute for medical advice. Always consult with a healthcare provider before implementing changes. Read additional disclaimer info here.