PCOS and Weight Loss: Why You Might be Struggling to Lose Weight
If you’ve been diagnosed with PCOS and are finding it hard to lose weight, or if you’re struggling with weight loss and wondering if PCOS could be the reason, you’re right to recognize that losing weight can be more challenging for those with PCOS.
What is PCOS?
Polycystic Ovary Syndrome (PCOS) is a hormonal condition that affects the ovaries, primarily affecting individuals during their reproductive years. It is believed that it affects 6-10% of individuals of child-bearing age. Common symptoms include irregular or absent menstrual periods, acne or oily skin, excessive hair growth (hirsutism), weight gain, thinning hair or hair loss on the scalp, cysts on the ovaries, dark patches of skin (acanthosis nigricans), and infertility.
A PCOS diagnosis requires 2 of the 3 following criteria:
- Irregular or absent menstrual cycles (absent ovulation)
- Clinical signs of high androgens (acne, hirsutism, male-pattern baldness) or high androgen levels on blood work (DHEAs, Free Testosterone)
- The presence of 12 or more follicles in one or both ovaries on ultrasound.
Factors contributing to weight loss challenges in PCOS
Insulin Resistance: It is estimated that 60-70% of women with PCOS have insulin resistance. Insulin is a hormone that is important in blood sugar regulation. In those with insulin resistance, cells don’t respond well to insulin which can lead to elevated insulin levels. Insulin promotes fat storage especially around the abdomen and can lead to visceral fat accumulation (fat stored around your organs that can further exacerbate insulin resistance). Insulin resistance can also increase cravings for carbohydrates and sugary foods, making dietary control harder.
Hyperandrogenism: Elevated androgen level are commonly found in PCOS which can contribute to weight gain, and you guessed it, weight gain particularly in the abdominal area. Androgens can also affect hormones and neurotransmitters involved in appetite regulations, such as leptin and ghrelin. This can lead to an increased appetite and cravings for high carb foods. There is also a feedback loop with insulin. Elevated androgens can exacerbate insulin resistance, but high insulin can further stimulate the ovaries to produce more androgens.
Inflammation: PCOS has been associated with chronic low-grade inflammation. The release of inflammatory markers is associated with long term metabolic complication and increases cardiovascular risk. Metabolic complications include impaired insulin sensitivity and the disruption of fat metabolism leading to increased fat accumulation. Inflammation can also cause us to become resistant to leptin (our hormone that tells us that we are full and no longer hungry) leading to an increased appetite.
Role of Naturopathic Medicine
If you’re feeling overwhelmed and feel like there’s nothing you can do, that’s not the case! PCOS is a condition that cannot be cured but it is a condition that can be well managed. When it comes to weight loss, it will be very important to address the root causes through a combination of dietary changes, supplementation, lifestyle changes, and more!
Blood work: It is important to understand what factors are playing a part in your weight loss resistance. Blood tests like the insulin-glucose challenge test, ESR, CRP, DHEAs, and Free Testosterone will help us get a better understanding if the 3 factors mentioned above are at play. Other blood tests may be warranted to get a bigger picture of what is going on and provide more information to have a treatment tailored to you!
Dietary interventions: Blood sugar and insulin regulation will be super important. Avoiding snacking throughout the day to prevent continuous insulin spikes and moving to 3 proper meals per day is a great start. Really focusing on having enough protein, fiber and healthy fats with EVERY meal to stabilize blood sugar and insulin release. Furthermore, understanding that some foods can be very insulin stimulating compared to others, for example dairy.
Lifestyle changes: Focusing on regular exercise will be important and engaging in regular movement throughout your day. This is important not only for weight loss but also stress management. Chronic stress can lead to inflammation so especially in our busy lives, finding time for reducing stress whether that be through meditation, journaling, partaking in a hobby, spending time with friends, etc. can be equally as important.
Supplementation: There is a whole array of supplements that can be beneficial depending on what’s going on. For example, berberine and myo-inositol can help improve insulin sensitivity and reduce insulin resistance. NAC is a great antioxidant and liver support. Omega-3’s are great anti-inflammatories. Saw palmetto, spearmint tea and green tea extract has anti-androgenic activity.
Conclusion
Weight loss resistance is common in those with PCOS due to insulin resistance, hyperandrogenism and low-grade inflammation. It can feel overwhelming feeling like you are doing everything to lose weight but the number on the scale won’t budge or you just keep gaining weight. This is where naturopathic medicine comes in! Having a practitioner that understands and validates what you are going through and can support you in your healing journey can make a profound difference in achieving better health outcomes and get you feeling empowered to make the changes you need!
References:
- PMID: 35456928
- PMID: 35319122
- PMID: 29678491
- PMID: 33481370
- PMID: 38285626
