Kickstarting a new habit is hard, especially when it comes to weight loss. While losing weight is difficult for anyone, the challenge may be greater for women with polycystic ovarian syndrome (PCOS).
Here, we will take you in-depth on the “why” behind the weight loss challenge that PCOS presents and provide tips that people with PCOS can use to actualize their new, healthy habits.
Why is weight loss with PCOS so difficult?
PCOS is a disorder that impacts menstruation and fertility, and affects anywhere from 4% to 20% of women around the world .
PCOS is characterized by multiple cysts (fluid-filled sacs) on the ovaries, and common symptoms include weight gain, abnormal hair growth, acne, and missed periods. It’s also considered a hormonal disorder because of its connection to fluctuating blood glucose, insulin resistance, and weight gain.
The relationship between PCOS and insulin resistance
Although the precise relationship between insulin resistance and PCOS is not well understood, there is a clear association between the two, as between 65-70% of women who have PCOS also experience insulin resistance .
Insulin is the hormone that helps the body absorb glucose, a molecule essential for energy production. When the body becomes desensitized to insulin, it absorbs less glucose, resulting in elevated blood sugar levels. To prevent those levels from getting too high, the body needs another outlet for that blood glucose. High insulin and glucose levels trigger the liver to convert glucose into fat, causing weight gain .
Since PCOS and insulin resistance go hand in hand, having PCOS can make reversing insulin resistance — and losing weight — more difficult. On top of that, a lot of recommendations for weight loss aren’t focused on women with PCOS, which can make it challenging to know how to manage it.
What is the PCOS belly?
Many people with PCOS experience the “PCOS belly,” which is characterized by increased fat deposition in the abdomen while the rest of the body remains the same size.
A large study conducted in 2007 suggested that women with PCOS have more central abdominal fat than women without PCOS . The researchers also found that women who were overweight and had PCOS were more likely to have higher insulin levels than women who were overweight and didn’t have PCOS.
These findings support previous research that shows abdominal fat specifically is correlated with insulin resistance. It’s hypothesized that because abdominal fat is more metabolically active, it can interfere with normal insulin function .
Other research in women with PCOS has revealed that consuming glucose can trigger inflammation and oxidative stress that leads to greater androgen (male sex hormone) production by the ovaries — even in women without PCOS belly .
As a result, the cycle self-perpetuates: as greater abdominal fat stimulates more insulin resistance, the high insulin levels promote fat storage. Likewise, high insulin levels also tell the body to produce more androgens, specifically testosterone, leading to telltale symptoms such as body/facial hair.
The interplay between insulin resistance, fat storage, and excess androgens can make weight loss a challenge, but the great news is that certain behavioral changes can make limiting weight gain more feasible — even if you have PCOS.
Tips to lose weight with PCOS
Losing the abdominal weight associated with the PCOS belly is possible. Because abdominal fat is linked to insulin resistance, the key to losing weight begins with reducing our insulin.
Although we cannot directly control our hormones, lifestyle behaviors can be powerful in improving hormone health. For example, if we eat more sugar, our bodies will produce more insulin to absorb that sugar. Through diet, exercise, sleep, and supplements, we can manage blood sugar levels, reverse the insulin resistance associated with PCOS, and prevent weight gain.
1. Focus on fiber-rich and anti-inflammatory foods
How you choose to fuel your body impacts your blood sugar levels — and can help you manage your PCOS symptoms. Refined carbohydrates and sugary beverages commonly cause blood sugar spikes, because the body absorbs them easily and quickly.
One of the best ways to avoid glucose spikes and crashes is incorporating fiber-rich vegetables, fruits, and whole grains into your diet.
Soluble fiber, like pectin, slows glucose absorption and prevents radical spikes . Insoluble fiber, on the other hand, helps satiate by lessening hunger cravings and increasing feelings of fullness, which may reduce food intake and additional weight gain .
Since oxidative stress is also a key part of PCOS, consuming vegetables and fruits that are rich in antioxidants and anti-inflammatory properties can be an important way to manage your body’s inflammatory response. Red-hued vegetables and fruits — such as beets, tomatoes, watermelon, red bell peppers, and pomegranates — are particularly helpful in reducing whole-body inflammation.
2. Get more protein into your diet
Protein is another food that helps stabilize blood sugar.
Studies suggest that eating protein before carbohydrates enhances the release of insulin, slows down stomach emptying, and curbs blood sugar rises, making for more stable post-meal blood sugar levels .
One study even found that a protein and fiber-rich energy bar significantly reduced blood glucose elevation, so pairing a protein with a fibrous carbohydrate can decrease blood sugar rises and inhibit additional calorie intake .
Research on high-protein diets in women with PCOS has also been promising from a weight loss perspective.
One study from 2012 found that women with PCOS who ate a high-protein diet without caloric restriction for 6 months (more than 40% of total calories from protein) experienced fewer glucose spikes and lost an average of 9.7 pounds more than women with PCOS who ate a standard-protein diet (less than 15% of total calories from protein) .
3. Exercise regularly
You may be wondering what the best form of exercise is to improve hormone balance and lose weight with PCOS. Exercise type and frequency can be key regulators of two hormones that highly influence weight: insulin and cortisol.
Normally when we exercise, cells absorb glucose quickly to produce energy. Absorption during exercise can occur independently of insulin, exercise helps to clear glucose from the blood and decreases the body’s reliance on the hormone . The less insulin is used, the more effective it becomes when we do need it to digest food.
For women with PCOS, who typically have high insulin levels, exercise can enhance the sensitivity of insulin receptors and lower circulating insulin.
The Androgen and PCOS Society (AE-PCOS) recommends exercise for women with PCOS because preventing weight gain is a key strategy in managing PCOS symptoms.
To get started, AE-PCOS proposes engaging in 150 minutes of moderate activity per week with at least two days of weight training . Simple activities like walking (even for just 15 minutes) have cardiovascular benefits and can prevent post-meal glucose spikes and improve insulin sensitivity.
Studies also show that three 1-hour strength training workouts per week can improve lean muscle mass and decrease body fat percentage in women with PCOS .
When looking at exercise for PCOS from an insulin point of view, most forms of exercise — even high-intensity — can help. Studies have shown that 3 HIIT (high-intensity interval training) workouts per week for 10 weeks improved insulin sensitivity and body composition in women with PCOS . That said, not all exercises are equal when it comes to their effects on cortisol production.
Cortisol is a stress hormone that is normally released when we feel endangered or overwhelmed. But the prolonged release of cortisol has harmful effects. One study with 2,500 participants revealed that consistently high cortisol levels over time were associated with increased weight circumference, weight gain, and obesity . It can also contribute to reduced insulin sensitivity and an inability to burn fat.
Research about cortisol levels in women with PCOS is mixed, as some experience higher-than-average cortisol levels while others experience normal levels . This is a problem for women with high cortisol because exercise, particularly high-intensity exercise, can trigger the production of even more cortisol . HIIT workouts can increase cortisol and testosterone levels for at least 24 hours after working out, which can temporarily make your PCOS symptoms worse .
Although it’s released during exercise, workout-induced cortisol release is not exactly the same as stress-induced cortisol release . Cortisol from exercise stimulates the release of feel-good hormones like dopamine and endorphins, which improve cognitive function, mood, and reduce stress [23, 24]. Cortisol release during workouts also helps to fuel the activity while long-term cortisol release is associated with chronic stress, muscle breakdown, poorer cognition, and poor mood.
Still, it’s essential not to overdo workouts with PCOS because intense workouts can disrupt hormone balances and affect period regularity .
Since every body is different, we recommend starting out with three 40-50-minute sessions of low-to-moderate-intensity exercises per week, including walking, swimming, and cycling (especially if you’re just getting back into exercise after a sedentary period), with 2-3 days of low-intensity weight training.
If your PCOS symptoms don’t get worse after a month, try rotating between aerobic exercises and HIIT (working your way up to 2-3 sessions of HIIT per week) and incorporating a tool like a CGM to see your body’s glucose response.
4. Get better sleep
Lack of sleep and poor quality sleep are both linked to weight gain. In a large study of 120,500 participants, people with higher body mass indexes (BMIs) tended to sleep fewer hours and had more variable sleep . When it comes to blood glucose, another study showed that people with high blood sugar were more likely to experience poor sleep than those with normal blood glucose levels .
The nature between sleep and weight gain is not precisely understood, but one hypothesis is that poor sleep triggers tiredness which may promote caffeine and high-calorie food consumption. Another theory is that those who stay up late may eat calorie-dense foods more frequently.
Because the endocrine system has an important role in influencing sleep-wake cycles, irregular metabolism associated with PCOS poses an even greater sleep challenge.
Only a few studies involving PCOS and sleep exist, however, the available research suggests that women with PCOS have a higher incidence of obstructive sleep apnea, even when accounting for age and BMI . Researchers hypothesize that insulin resistance and heightened cortisol may contribute to disturbances in sleep-wake cycles.
Improving sleep time and quality is the key to weight management. Some tips to improve your sleep include: setting a regular time for going to sleep and waking up (even on weekends), avoiding bright lights, limiting caffeine and alcohol intake two hours before bed, and creating a cool, comfortable sleeping environment.
The best supplements to take for PCOS
Supplements offer a novel method for reducing insulin resistance and managing blood sugar levels. Most research related to supplements is emerging and more studies are required to show how supplements can relieve PCOS-related insulin sensitivity .
A natural compound in grapes and wine, resveratrol is a compound that has anti-inflammatory effects. In a randomized, double-blind, placebo-controlled trial of 30 participants with PCOS, 1500mg/day of resveratrol significantly decreased fasting insulin levels by 31.8% and increased insulin sensitivity .
Other beneficial effects included reduced ovarian and adrenal androgens, which the researchers hypothesize could be a result of improved insulin sensitivity. We suggest trying anywhere between 500-1500mg/day and seeing how you feel, though doses of 2000-3000mg/day have been shown to be safe .
2. Vitamin D
Vitamin D, a vitamin synthesized in the sunshine, is integral to hormone functions in the body. Research suggests low vitamin D is associated with metabolic complications like obesity, diabetes, and insulin resistance .
Researchers have studied whether vitamin D supplementation can improve insulin sensitivity. One systematic review that included 11 studies with 600 women diagnosed with PCOS showed vitamin D supplementation (<4000 IU/day) improved insulin sensitivity and lowered fasting blood glucose concentrations .
Another more recent meta-analysis comprised of 10 randomized control trials and 520 women diagnosed with PCOS showed no significant effects of vitamin D supplementation on fasting insulin concentration, but low dose (<4,000 IU/day) and high dose (>4,000 IU/day) supplementation significantly decreased fasting glucose concentration. We suggest trying the lower dose because the upper tolerable limit for Vitamin D is 4,000 IU/day .
One purported supplement called berberine shows promise in PCOS treatment. Berberine comes from a chemical compound in plant roots and barks. Traditional Chinese medical practice used it to treat inflammation, infections, and gut-related issues . More recently, research suggests that it can treat insulin resistance. In a review that included over 1,000 women, researchers found that berberine was more effective at improving insulin sensitivity and reducing blood sugar levels than a placebo . The same study highlighted 500-1,500mg of berberine divided into two to three servings with meals is a safe amount to take. We recommend taking a dose in this range.
Making all these changes to manage blood sugar at once can be intimidating. We suggest starting with one tip and focusing on making simple adjustments first. As you incorporate more tips, you may find that the results are positively effective, as research shows losing weight is also a mechanism to improve blood sugar levels. Here are some starting points for you to try:
- Losing weight with PCOS is difficult, as the disorder disrupts hormonal function and can lead to blood sugar spikes and insulin resistance. But through behavioral changes, managing blood sugar and hormones is possible.
- Diet changes like incorporating fiber-rich foods like vegetables, fruits and whole-grains, and lean proteins like poultry and fish can help curb blood sugar spikes and promote feelings of fullness.
- Try strength training at least twice a week for 20 minutes a day to boost insulin sensitivity, reduce cortisol levels, and burn calories.
- Create a sleep routine around bed time to maximize the number of hours and quality of sleep every night.
- Experiment with your choice of one daily supplement like 1500mg Resveratrol, 500-1500 mg of Berberine or <4000 IU of vitamin D to get hormones in check.