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How to lose weight with PCOS

Updated: Feb 5, 2023

One of the biggest issues for those with PCOS is weight gain that can be incredibly hard to shift. Frustrating right?

One of the misconceptions about weight maintenance is that a calories in/calories out approach - i.e. eating less calories and exercising more should result in weight loss. Unfortunately the calories in/calories out model is flawed and does not work for the majority of people - particularly those with polycystic ovarian syndrome. Let’s explore why.

Unfortunately the calories in/calories out model is flawed and does not work for the majority of people - particularly those with polycystic ovarian syndrome.

Understanding METABOLISM and what can slow it down or speed it up is crucial to being able to manage your weight successfully - and it may not be as hard as you think. Metabolism can be affected by many things, however the most obvious, and easy to manage are the following -

  1. Diet/nutrients

  2. Exercise

  3. Inflammation

  4. Hormones

  5. Sleep

  6. Stress

Yes, diet and exercise need to be done well, however if you have issues with your hormones, inflammation, sleep or stress it is highly unlikely that diet and exercise alone are going to shift things.

PCOS is a hormonal disorder - high androgens/testosterone and insulin resistance are not behaving as they should (in the case of metabolic PCOS where insulin is high or there are issues with glucose regulation - see my post about metabolic PCOS vs adrenal PCOS if you don’t necessarily fit the regular PCOS avatar) .

Insulin resistance also promotes inflammation and I commonly see oestrogen excess in women with PCOS who find it hard to shift weight and those with PCOS who have painful periods (painful periods are not a common symptoms of PCOS when only androgens/testosterone are high) which can also be pro-inflammatory.

If you throw poor sleep and stress into the mix then voila - your body is so busy trying to keep you awake and up and running in survival mode that metabolism comes second, and in fact it might get so panicky that hormonal messages are sent to your brain saying “hang on - hold onto some of these fat stores as we don’t know what is going to happen next - we might need them for survival”.

Naturopathically, we are always looking for the holistic way to support our bodies - this means identifying the areas that are out of balance and addressing several things at once to try and regain balance. You might visualise this as a boat that needs to have it’s cargo packed evenly so that it doesn’t keel over - if you keep packing diet and exercise onto one side of your boat and don’t address the other aspects on the other side you will just keep leaning into that water and going round in circles. Address each area evenly and you will stand upright and allow the wind in your sails to guide you forward without effort.

Where do I start?

Identify the areas that are out of balance in your life and plan how to make small changes to improve these. I have outlined the 6 areas you need to identify with PCOS below.

1. Diet

First and foremost you need to be aware that you will never be able to manage metabolic (insulin resistant) PCOS if you have an unhealthy diet. Diet is one of the key ways to manage PCOS, however if you are already hitting the mark here then take a look at the other areas we have discussed.

Insulin is a hormone produced as a vital part of our metabolic system that regulates the breakdown and use of glucose as energy. We get glucose from carbohydrates and sugars that we eat. Too much of these, or not enough healthy fats and proteins, can contribute to insulin resistance and weight gain can be both a consequence of this, but also make insulin resistance worse (chicken or egg).

The good news is that diet is THE BEST WAY to improve insulin resistance (and I will dare to say more effective than metformin) along with exercise, reducing inflammation, good sleep and stress reduction.

There are several “diet” that will help to do this. Low-GI, Low-carbohydrate, paleo, ketogenic and low-inflammatory diets will all assist with resetting your metabolism. I personally don’t gel with the word “diet” however the benefit of talking about these is that it makes it easy to find resources such as recipes and have guidelines to follow. Once you get the hang of it you can bend the rules ever so slightly so that you don’t feel restricted (most people will not survive long term on a restrictive diet and you might risk missing out on nutrients long-term and potentially worsen your stress!). It will take too much room to break these down here so jump over to this blog to determine which might be best for you.

The main aim is to avoid or reduce refined sugars and carbohydrates and make sure you get plenty of nutrient dense foods in your diet to support everything to run the way it should.

2. Exercise

It is incredibly important with PCOS to get the balance of exercise right. Too little and you will not get your insulin under control, too much and you might actually be increasing your androgen and testosterone hormones and adding extra stress and inflammation to your body. Yikes! I actually see over-exercising in women’s health issues frequently in clinic - and it is one of the hardest things to persuade women to try and change and exercise generally makes us feel GOOD! Find the middle road and you will be on the right track.

I prefer to refer to it as MOVEMENT over exercise. We need to understand how to treat our bodies gently - particularly as women. This is vital to balancing hormones.

Just as eating a variety of foods is going to give us a wider range of nutrients, a varied amount of MOVEMENT is going to be good for us. We are designed to move so that we can build strength and muscles, clear toxins and excess hormones from the body and to regulate metabolism.

Including a variety of cardio, strength building, flexibility, restorative and incidental exercise is where it is at - a little each day - not being sedentary and not pumping iron at the gym daily. Jump over the my blog “Exercise for PCOS” to find out more.

3. Inflammation

This is an interesting one as it was probably not something your GP or specialist has flagged, however it is a given with metabolic hormones disorders and weight gain and focusing just on reducing inflammation as a key goal would encompass all that we have talked about here.

The best ways to manage inflammation are via diet, movement, stress reduction and quality sleep. It is also important to consider any other health issues such as endometriosis, autoimmune diseases or digestive issues (ie leaky gut or SIBO) that might be impacting on your ability to manage your weight. Getting the order right and finding out how to manage what first is incredibly tricky, so if you have more than just PCOS going on I would certainly recommend getting some help from a naturopath, herbalist, acupuncturist or other integrative health practitioner.

4. Hormones

PCOS is a classic hormonally-driven women’s health condition. The cysts appear on the ovaries due to hormones being the issue in the first place - not the other way around.

If your diet and exercise look good but you still have an issue with high testosterone/androgens and insulin there are many herbal and nutritional medicines you can use to help.

Jump over to my blog “Herbal and Nutritional Medicines for PCOS” to find out more about these, or seek the advice of a naturopath, herbalist, acupuncturist or other integrative health practitioner to help you come up with a prescription individually for you.

5. Sleep

Ah...the big one. If we could all just make sleep priority #1 in life we would be winning.

Sleep makes up a really huge stretch of our day which is required for healing and repair, neuronal wiring such as the laying down of memory, hormonal production and rebalancing, inflammation control, digestion, and you guessed it - healthy metabolism.

With or without PCOS - the links between A LACK OF or BROKEN sleep and poor metabolism and weight gain are huge.

There is one hormone in particular which hates disrupted sleep - leptin. Leptin is a cousin to insulin - instead of regulating the metabolism of glucose, leptin regulates the metabolism of lipids (aka fats) and it does the majority of it’s work at night while we are asleep. Disturb sleep, and you disturb leptin, and where there is insulin resistance, there is often leptin resistance.

This means your body decides to hold onto fat stores and can have a really hard time getting rid of them. Thankfully the diet suggestions that help with insulin resistance, also help with leptin resistance (the answer if definitely NOT in a low fat diet) and daily exercise (particularly using the thighs so squats, yoga and walking in the soft sand or against the tide can be great) and getting an adequate 7-9 hours of restful sleep a night will go a huge way.

As a mum to two children who were absolutely horrendous sleepers and for those of you thinking “well gee, that’s all gone out the window for me” just make sure the sleep you are getting is good - address any insomnia with herbal medicines for sleep, include daily movement, and address stress to help with peaceful slumber. You could also try my 7 day sleep detox to get things happening.

6. Stress

This really could have been lumped with hormones as the first thing stress will do is produce a cascade of stress hormones (cortisol and adrenaline) which will interfere with the natural balance of our sex hormones (testosterone, progesterone, oestrogen etc).

Stress really sits behind most health disorders somewhere - and that is before the extra stress of dealing with something like PCOS.

My message is MAKE STRESS RELIEF A PRIORITY - it is as important as food and movement in this day and age.

My message is MAKE STRESS RELIEF A PRIORITY - it is as important as food and movement in this day and age.

The best ways to do this? Remove stressors where possible. Most of the time this is not an option so the use of breath (check in to see if you are breathing deep into your abdomen or shallowly in your upper chest) and focus on 3 deep breaths, 3 times daily or more. Prioritise some daily alone time or time in nature and adopt a mindfulness or meditation practice.

As a very important note - don’t expect to put all of the above into place overnight. Make small and achievable changes or implement things gradually to set yourself up for success and not failure. By making positive lifestyle changes that can last a lifetime you are much more likely to manage your health for the long term, rather than a band-aid effect in the now.

Emma xx

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emma jacques

Women's Health

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