It can be said that current conversations around polycystic ovary syndrome (PCOS) and weight, particularly when regarding relatively higher BMI levels, are just plainly not helpful. A PCOS diagnosis often comes with the advice of, lose weight and your PCOS symptoms will improve. However, this advice can not only be ineffective and dismissive, but also harmful depending on what’s actually going on within a person’s body. As much as weight loss can help—studies show that a 5% reduction in body mass can help to support PCOS symptoms—the reality is that many people diagnosed with PCOS did not achieve higher weight levels due to their diet. In these cases, as we’ve observed firsthand with patients, eating differently and exercising more does not necessarily help to regulate weight and improve PCOS symptoms.

Conventional scientific understanding of weight regulation and health falls short in explaining why this is the case. We’ve collectively been taught that eating smaller amounts of healthier foods and increasing the amount we exercise equals weight loss and improved health. And yet, the reality of what we see in practise shows this does not always hold up. So, where’s the disconnect? When it comes to PCOS and weight loss, why are so many people left feeling under helped and overlooked? 

Thanks to ground-breaking research that supports the realities of what many people with PCOS experience, we are able to see that there is more to the story of weight regulation than simply eating less and moving more. A recent study on the role of insulin and the HPA axis (the neuroendocrine control centre that manages our reaction to stress and regulates key functions such as digestion, the immune system, and energy production) has brought to light the impact of auto generation of fat cells, and how our body’s ability to process both insulin and cortisol significantly impacts our health, stress management, and weight.

Cortisol and the Impact on our Bodies

Research has shown that consistently high levels of insulin can trigger a reaction from the hypothalamic-pituitary-adrenal (HPA) axis. There are many reasons why insulin levels can be high that go beyond dietary choices including genetic background, changes in digestion, changes to the microbiome, changes in sleep patterns, stress, and historic nutritional patterns. Activating the HPA axis has been linked to increased production of cortisol. A stress hormone, cortisol is our body’s vital survival tool going back to our cavepeople times; it initiates our fight or flight response and supercharges our muscles so that we can escape from being chased by a bear. Cortisol works by increasing insulin levels in order to draw out stored glucose for fast fuel, giving our muscles the energy they need to escape from perceived danger. While this is especially helpful if you are ever being chased by a bear, most day-to-day stressors aren’t so extreme. Unfortunately, our HPA axis is unable to tell the difference between being chased by a bear and being cut off in traffic, and so it treats both with the same survival-driven reactionary stress response, and gets to work on increasing insulin production.

Auto Generation of Fat Cells: The Relationship between Cortisol and Insulin

When the body has a reactionary response due to high levels of insulin, a well-balanced system should work to draw glucose out of storage from fat cells, muscles and the liver to use for fuel, and then be able to regulate itself back to baseline functionality after the threat has passed. However, if the body is unable to manage insulin effectively, this process can result in a double-negative chain reaction. In these cases, when a reactionary response triggers an increase in cortisol production, this sparks more glucose to be made at the level of the liver. This increase in glucose requires higher levels of insulin in order manage the extra glucose. If the body in unable to properly process this increase in insulin, insulin levels remain high. The body perceives these higher insulin levels as indication of more danger, and the reactionary process repeats. Higher levels of insulin trigger increased production of cortisol, which causes more glucose, which requires more insulin, which activates more cortisol, and in this way the body becomes stuck in an imbalanced and self perpetuating cycle that can result in liver damage and the auto generation of fat cells. 

With this research in hand, it can be seen why simply eating less and exercising more is not going to break the pattern, and why prescribing weight loss alone can be ineffective and overwhelming for patients. Resistance to weight loss is commonly seen in cases of PCOS, and because of this budding research we are now better able to understand why, and how this can be an indication of a more foundational issue. Equipped with this knowledge, there are many systematic steps we can now take to reduce and manage cortisol and insulin levels. This not only helps to reduce symptoms of non-metabolic fatty liver and weight regulation, but can also improve symptoms associated with PCOS including androgyne symptoms, hair loss, acne, depression, anxiety, and fluctuating energy levels related to metabolising insulin. 

The moral of the story

If you are diagnosed with PCOS and familiar with the frustrations of struggling to lose weight to help manage your symptoms, it is important to know that there are more effective means of support available than weight loss. The most important initial steps are to get your body properly assessed for inflammation, investigate the health of your gut microbiome, and to get help that supports your stress and sleeping patterns.

Most importantly, the best thing you can do is advocate for your health and work with a health care provider who is not only up to date with the most recent medical literature, but empowers you to make the changes your body needs in order to get it unstuck from that insulin – cortisol – glucose loop. Thanks to recent research in an area that so commonly gets overlooked and undiagnosed, know that there are many effective options out there that can effectively support your health and get you back to feeling your best.

References

Janssen, JAMJL (2022, August). New Insights into the Role of Insulin and Hypothalamic-Pituitary-Adrenal (HPA) Axis in the Metabolic Syndrome. Retrieved from National Library of Medicine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9331414/