Is Inflammation The One Thing Behind Your PCOS Symptoms?
By Clare Goodwin
Last updated: September 3, 2020
I woke up this morning, my body throbbing with pain. Okay, not my whole body, just my index finger. It’s amazing how much pain a mere phalange can inflict! I opened one blurry eyelid, lifted my hand out from under the covers and inspected said finger. Just as I suspected — it was red and puffy, with the slightest black glimmer of a thorn poking out from under the skin. Evidence of yesterday’s slightly hairy mountain bike ride.
Interestingly, I didn’t notice it yesterday. Not a bit. It wasn’t the thorn itself that was causing me pain, it was the reaction my body was having to it that hurt. My body had detected that there was a foreign invader and started off the inflammation process to force the thorn to the surface and kill any residual pathogens on it.
As I lay there inspecting my finger and mulling over what instrument would be best for extracting it (needle, tweezers?), it dawned on me how similar the situation was to PCOS. This very same inflammation is what researchers now believe is the root cause of PCOS.
How are inflammation and PCOS linked?
The cause of PCOS has long baffled scientists. This is because many of us have a variety of different symptoms: some overweight, others lean, some insulin resistant and some not. The only common denominator is high levels of testosterone.
Our immune systems react to foreign invaders and stressors. If you get a thorn in your finger then the inflammation is reduced as soon as the thorn is extracted. However, if you experience chronic inflammation then the inflammation doesn’t reduce. Instead, the immune system is constantly on high alert, causing damage to our cells.
Studies have shown that women with PCOS have higher levels of the following inflammatory markers:
- C-reactive protein (CRP)
- Monocyte chemoattractant protein-1
- White blood count (WBC)
Researchers have proposed that this is what causes higher levels of testosterone and therefore, the symptoms that we experience. They also found that the symptoms occur independently from weight gain, explaining ‘lean PCOS’.
How does inflammation cause PCOS symptoms?
Inflammation wreaks havoc on our body in many ways. It affects every cell in our bodies, which is why PCOS has such a vast array of symptoms. In the interest of keeping this concise, I’ll explain the one I get asked about most often: weight gain. Or more accurately, the inability to lose weight.
We now know that the calorie equation provides a very simplistic explanation of weight loss/gain. There are a lot of other hormonal factors at play in regulating weight.
Inflammation and weight gain: leptin
Leptin is our satiety hormone and is produced by body fat. It tells the brain to decrease appetite, increase metabolic rate, and increase physical activity. The more fat you accumulate, the more leptin is secreted. This causes more fat to be burned.
If you become leptin resistant then your brain cannot tell that you’re full. If you’re feeling hungry all the time then this is most likely because of leptin resistance. It also explains why you seem to keep gaining weight.
Leptin acts like a thermostat: if it’s working properly then it’s impossible to gain more than a few pounds. If leptin is working then our body upregulates to burn additional energy and decrease hunger when we eat more than we expend. This explains why leptin resistance is a precondition of significant fat reduction. Leptin resistance also impacts the way your body metabolises fat and contributes to insulin resistance.
Inflammation and weight gain: fat metabolism
Inflammation also affects the way we metabolise fat. If you’ve ever felt like your friends only have to look at the treadmill and they lose weight, while you lose nothing even though you run for miles, then this is probably due to your PCOS. PCOS actually impairs our ability to burn fat.
Fat exists in your body in two forms. The first is as free fatty acids (FFAs) – the form we’re most familiar with (love handles, anyone?). FFAs are fat molecules that have broken off from your stored fat and are in your blood ready to be used by your cells as a form of energy.
In healthy people, FFAs break off from the stored fat and are burned by the cells soon after. With PCOS, inflammation impairs our cells’ ability to burn these fats. The excess FFAs then ‘spill over’ into our liver, pancreas, and skeletal muscles, causing damage where they don’t belong. This is called lipotoxicity and it further exacerbates inflammation.
Moreover, our body cannot use fat as energy, so it tells our brain that we are starving and need more food. This is why you cannot lose weight even though you are eating less and exercising often. The underlying inflammation must be fixed first.
What causes inflammation?
There are many things that we can attribute to the modern lifestyle that cause a long term inflammatory response. The four most common factors that I see in my practice are:
- Eating foods that our body detects as toxins.
- Poor gut health.
- Too much or too little exercise.
- High levels of the stress hormone, cortisol.
1. Dietary and environmental toxins
When you think about diets, you probably think calories, low carb, and low GI. But when it comes to PCOS, dietary toxins are far more important than calories and carbs. This is because dietary toxins cause inflammation.
Dietary toxins are anything we eat that the body detects as an invader. This can be due to their physical makeup (e.g. fructose) or because we have leaky gut and they are getting into our body where they don’t belong (e.g. gluten sensitivity).
You can find a full list of foods to avoid if you have PCOS here, but one major dietary toxin is industrial seed oils. Industrial seed oils are all the yellow oils you see on the supermarket shelves. The most common ones are corn, canola, soybean and sunflower oils. These oils are very high in Omega 6 fats, which cause inflammation.
On the other hand, Omega 3 fats can reduce inflammation and help to reverse PCOS. Omega 3 fats are in foods like fatty fish, olive oil, and avocados. Use avocado, coconut and olive oil and avoid fried foods from restaurants and takeaways as they’ll most likely use canola oil to fry food.
2. Poor gut health
The main role of our intestines is to absorb the nutrients we need and to keep foreign objects out. The lining of our intestinal wall is made up of cells which are packed together, forming tight junctions. These tight junctions are responsible for keeping any foreign objects out of our body, including large proteins like gluten.
Our intestines also harbour 10 trillion bacteria, many of which are beneficial for bodily processes. Our body is generally good at regulating the ratio of good bacteria to bad bacteria, but both antibiotics and the contraceptive pill disrupt this. A dominance of bad bacteria causes the tight junctions to become loose. This is known as ‘leaky gut’ or intestinal dysbiosis. Leaky gut is responsible for letting large proteins into our bloodstream, where they are identified as antigens and trigger the inflammation process.
Probiotics help to introduce good bacteria back into the intestines. I recommend that all my patients take a good quality probiotic and eat lots of fermented food. Trust me, like all supplements, good quality probiotics are worth the money so make sure you buy a good one.
Prebiotics help feed probiotics, the good bacteria. Prebiotics are resistant starch – as their name indicates, it’s starch that is resistant to our digestion. An example of this is potatoes that have been cooked and cooled or green plantains.
Find out more about the relationship between gut health and PCOS in my article: Is Your Gut Bacteria the Secret to Your PCOS Weight Loss?
3. Too much or too little exercise
Exercise is like your mother in law: best kept to small doses. Although it can be very beneficial and help to reduce inflammation, too much of it can actually increase inflammation, slow the fat burning process and damage your immune system. Over-exercising is a common problem that I see in my clinic.
We’ve all grown up with the calorie equation being the dominant paradigm in health and weight loss. We aim for an hour or more a day to help gain a calorie deficit and lose weight. However, the calorie equation doesn’t work if your cortisol levels are already elevated or disrupted by other stressors, such as gut infections, insomnia, or food toxins.
When you’re exercising for an hour or more a day, it actually raises your cortisol. This actually makes it even harder to lose weight. Don’t get me wrong, exercise is good! What’s not good is too much exercise, particularly at a high intensity.
If your cortisol is high or disrupted, don’t just stop exercising, simply:
- Reduce your workouts to 3 x 15 minute, high intensity sessions per week.
- Focus on exercises that calm you down.
- Do as much incidental activity (i.e. walking and standing) as possible.
4. Stress hormones and inflammation
Being a nutritionist, most of my patients expect me to tell them that diet is the most important factor in reversing their PCOS. Whilst it’s really important, stress hormones are equally important and most often overlooked.
Cortisol is our long term stress hormone. It’s the long-term friend of adrenaline, which is involved in our ‘Fight or Flight’ response. Cortisol is raised when our body detects that we are in some sort of danger. In the days of our ancestors, this would have usually been due to an impending attack from an animal, famine, or a disease — major causes of human deaths at the time.
Stress isn’t just the obvious things (for example, being stuck in traffic), it’s also:
- Not enough sleep
- Chronic infections
- Autoimmune diseases
- Environmental toxins
- Too much exercise
- Too much coffee (or any coffee if you’re sensitive to it)
Stress triggers the release of things called pro-inflammatory cytokines. Cytokines are hubs of action: they tell cells to do things. And in this case they are telling the immune system to kick off the inflammation process.