Why Is It So Hard To Lose Weight With PCOS?

By Clare Goodwin

Last updated: September 3, 2020

How to lose weight with PCOS naturally is something that many women with PCOS want to know the secret to. When you were diagnosed with PCOS, your doctor probably told you that the most effective thing you could do to improve your symptoms would be to lose weight, right?

If you’re anything like me, you would have retorted something along the lines of, ‘Well I’ve been trying that for the last 6 years! What’s the secret, doc?’. Your doctor probably then gave you the spiel about eating less and exercising more.

However, for I and 99% of my PCOS clients, we’ve been doing that for the last decade. We’ve been living off salads and running for hours, but the scales keep climbing. We’ve even gone a step further by removing all refined carbohydrates to help our insulin levels. And still, nothing. WTF!?

Here’s the secret… The reason it’s so hard to lose weight with PCOS is because you’re not treating the root cause of the problem. I’m going to tell you how to lose weight naturally with PCOS by looking much deeper than calories and carbs. Specifically, I’m going to tell you more about leptin resistance.

The calorie equation

The calories in versus calories out model of weight is far too simplistic. Our bodies are far more sophisticated than this. If the calorie equation was really the only weight regulation mechanism then every single person in the world would need to count calories to keep a constant weight. We’d constantly be over or under estimating our energy needs.

For example, an average piece of toast is 80 calories. If you ate a piece of toast more than you expended each day then that would equate to something like 6kg of weight gain a year. Or if you underestimated and ate one piece of toast less than you were burning then you would lose 6kg a year. For someone like my mother who weighs about 50kg, you couldn’t do that for long before you wasted away to nothing.

So how can some people eat whatever they want and maintain the same weight throughout their life? First of all, they’re lucky! Second, HORMONES! Specifically leptin and insulin. And surprise, surprise, studies have shown that 70-80% of women with PCOS are resistant to both leptin and insulin.

Leptin: the famine survival hormone

Leptin’s role is to keep us alive by preserving our fat stores in case of famine. Unfortunately, our hormones haven’t kept up with the evolution of the 24 hour drive through or stops at the convenience store with it’s endless supplies of sweet and crisps.

Our body still thinks we’re going through periods of feast and famine, and leptin’s role is to make sure we have enough fat stores to get us through the famine. It doesn’t want us dying out there in the desert, so it’s main role is to maintain good fat stores for when the famine comes.

Leptin is actually released by our fat stores. It travels in the blood up to our brain, specifically to the hypothalamus. Our hypothalamus acts like a thermostat for weight gain. It’s constantly detecting the level of leptin in the blood. The more leptin, the more fat we have.

Leptin Regulation

Just like a thermostat detects the temperature in the air, the hypothalamus detects the concentration of leptin in the blood and decides whether it has enough fat stores in case famine hits tomorrow. If the level is sufficient, it will send a message to the thyroid to tell it to up metabolism to burn off some of the stores and decrease hunger.

But if the level is too low, it tells the thyroid to decrease our metabolic rate and increase our hunger so we are motivated to get out there and eat every bag of crisps we can get our hands on. It is so incredibly smart. No maths degree required.

So if that’s the case, then how come when we’re overweight? Does the hypothalamus not pick this up and crank up metabolism and make us not want to eat for weeks? The problem is the sensitivity. Just like our cells with insulin, our hypothalamus can lose sensitivity to leptin.

This means that our fat is producing more and more leptin, but our hypothalamus can’t detect it—it’s like the sensor has been turned off but it doesn’t realise it. So the hypothalamus keeps thinking, “I haven’t detected much leptin in a while—let’s turn down the metabolism, up hunger, and make this human super hangry.”

The second problem is that our body gets used to a higher amount of fat, and this becomes the new normal. So if we then try to lose weight, our body will resist it and do what it can to try to increase body fat again.

This is why so many of us lose weight, only to regain it again. Not because we lack any form of self control, but because our body will use all the tricks in the book to get that fat back again: raising our hunger levels and interest in food, reducing metabolism and body temperature, lowering our immune system, and even making us more efficient when we exercise.

PCOS and Leptin Resistance

While there are no studies (that I can find) into the number of women with PCOS and Leptin resistance, we do know that there is a strong connection between insulin resistance and leptin resistance.  Studies have shown that where there is insulin resistance, leptin resistance usually follows. 

We also know that 70% of us with PCOS also have insulin resistance.  So if you’ve got PCOS and insulin resistance, you likely have leptin resistance too.

So what can we do about Leptin Resistance?

Avoid inflammatory foods

Let’s get back to the thermostat analogy for a moment. Imagine your thermostat sensor is broken. It wouldn’t be able to detect that the room is warm enough and so it would continue to fire the boiler to produce more heat. What would you do about it? You wouldn’t just open up all the windows and doors to let the hot air out—well, we might until the boiler man can come. No, you’d get that boiler man (or lady) around to fix the issue that’s causing it not to detect the heat: the broken sensor.

When we react to weight gain by running for miles and reducing calories, we are effectively just opening the doors and windows and hoping for the best. We are completely disregarding the root cause of the problem, which is the resistance.

Studies have shown that chronic inflammation is present in Leptin Resistance, and as well as in PCOS.

So the first thing to do is to remove all the foods that studies have shown increase inflammation. These are grains, dairy, high fructose corn syrup, soy, and seed oils (canola, etc).

Get more sleep

Studies have shown that Leptin decreases and BMI increases proportionally for every minute of sleep lost from the 8 recommended hours.s They also showed that people who get 5 hours sleep a night have 15.5% less leptin than those who get 8 hours sleep.

How much sleep do you need?  Well, as far as this study is concerned, at least 8 hours, but some people need more. I’m a 8-9 hour girl. I definitely operate better with 9 hours. One way to test this is by simply not setting your alarm and seeing when you wake up. If you consistently wake up after 9 hours then this is what you need.

Improve your gut health

The gut has been the most overlooked organ of our body in the last century, and we are only beginning to understand the role that the community of microorganisms that live in your intestines (the microbiome) play in regulating everything from our immune system to weight. The microbiome gets disrupted by medications like antibiotics, the contraceptive pill, and ibuprofen, and leads to an overgrowth of bad bacteria.

Studies have shown that too much bad bacteria causes inflammation of the hypothalamus, thus contributing to leptin resistance.

The two things you should be doing to help your gut health are:

  1. Eating more fermented foods such as Sauerkraut, Kombucha, or Kimchi, as these reintroduce good bacteria back into the gut. You can also take a good quality probiotic.
  2. Eating resistant starch. Resistant starch is what feeds the good bacteria and helps them populate. Resistant starches can’t be digested in our intestines, and therefore can be used as food to feed the bacteria. Resistant starch doesn’t spike either blood glucose or insulin, and we do not obtain significant calories from RS. Some examples of resistant starch are cooked and cooled potatoes, green plantains, or green bananas.

Summary: How to lose weight with PCOS naturally

The calories model of weight is far too simplistic.  Our body is much smarter than this and has hormones, specifically Leptin which acts on our fat thermostat (the hypothalamus) to regulate weight and make sure we have enough blubber to survive the impending famine.

However, our modern lifestyle, and specifically inflammation breaks the sensor of our fat thermostat and loses sensitivity to Leptin.  Consequently our body wants to hold on to all the fat it can and defend the ‘fat mass set point’.

So instead of berating yourself that it’s a lack of self control that’s stopping you from loosing weight, focus on improving your bodies sensitivity to leptin.  Three things you can do today to improve your leptin sensitivity are:

  1. Avoid anti-inflammatory foods
  2. Get more sleep and
  3. Improve your gut health