What is PCOS & How To Lose Weight With PCOS?
The first thing to know is that PCOS and insulin resistance go hand and hand, but it is much more than that. Saying it is about insulin resistance makes 2 mistakes.
1) People think that means it is always about obesity and starchy/sugary carbs (and many with PCOS are not obese and eat low carb diets).
2) It often pulls attention away from the other issue which is the brain ovary connection and its impact on being able to achieve weight loss with PCOS.
To understand the question, “What is PCOS?”, you need an understanding of the normal female menstrual cycle. Here is a little background on normal menses. The hypothalamus (a part of the brain just above the brain stem) at the beginning of the woman’s cycle secretes ganodatropin releasing hormone (GnRH). This hormone then activates the release of follicle stimulating hormone (FSH) and leutinizing hormone (LH). These two hormones are involved in ripening the follicle (the place where the egg is held) and then causing the follicle to rupture and release an egg.
FSH causes the ovarian follicle to mature/ripen, and this is the primary defect in PCOS (the follicle fails to mature). An immature follicle will not develop a mature egg and when the “LH surge” happens, the release of an egg is unable to occur and a cyst forms instead.
All of this also results in rising estrogen and testosterone levels and a low or absent progesterone level. This is because only after an egg is released will the follicle become the corpus luteum, which is the major source of progesterone in a non-pregnant women (interestingly women and men have the same level of progesterone until the follicle ruptures and the corpus luteum forms).
This lack of formation of the corpus luteum and therefore lack of progesterone further disrupts the cycle since progesterone is needed to prime estrogen receptors and visa versa. All of this together creates a negative hormonal feedback effect on the brain which then in turn impacts the ovaries. In time this can develop into all manner of hormonal issues including infertility. This is the answer to the question what causes PCOS.
PCOS varies from woman to woman and can result in a spectrum of menstrual disorders making it difficult to pinpoint and diagnose. This is an exceedingly frustrating situation for women and their healthcare providers. Each woman with PCOS requires a different approach, and patience is required when working the way back to normal hormonal regulation.
What causes PCOS?
The cause of PCOS is debated, and it is likely not one single factor. Stress is a huge issue, but as everyone knows stress is one of the most elusive terms used in medicine and health. What exactly is stress? Some of the other contributing factors are thought to be excess estrogen exposure through environmental estrogen (milk, water, plastics, etc.), excess insulin production, and increased metabolic tension (Tension is another word for stress I like to use because it clarifies more fully that stress may not be emotional in nature at all, but may be coming from disturbance in metabolic function outside of emotional influence).
Lean Type PCOS
In lean physically fit women, the chronic stress/tension of exercise and diet is suspected as a major cause or at least one of the primary contributing factors. This persistent metabolic tension leads to several disrupted hormonal signals resulting in thyroid, adrenal, and ovarian issues. This happens because the ovaries, thyroid, and adrenals share a common path of communication through the brain, the hypothalamus and pituitary.
Heavy Type PCOS
The primary issue in someone who is overweight or obese is thought to be insulin metabolism. This can be addressed by a lower starch/sugar diet along with exercise. But this insulin resistance can occur in those who are not obese as well. The fix here is to restore the brain ovary connection by lowering the effect of excess stress hormone production (i.e. cortisol), as well as insulin and estrogen production.
Treatment Approaches To Lose Weight?
As you can imagine, this is not an easy thing to do since all women are very different. One of the things many in the alternative medicine world do is treat with progesterone which can result in a “resetting” of the system since in normal PCOS there is not the progesterone priming effect as in the normal cycle (loss of the formation of the corpus luteum).
The other thing many people miss is the stress/tension related dysfunction that leads to improper brain feedback. This is why adrenal adaptogens and hypothalamic-pituitary-adrenal (HPA) herbs are used. Things like rhodiola, Relora, and holy basil can be very effective here. And of course a lower starch/sugar diet is essential. One confusing aspect occurs in those who are more “stress driven”. This metabolic type can be made worse by diets that are too restricted in carbohydrates actually acerbating the situation (usually the case in lean types). In many others keeping lower carb may be the most significant change they can make (usually heavy types).
What is described above is a VERY simple story of a complex hormonal condition. There is much more going on than this, but this description does provide a good base of understanding and a good place to start. If you are dealing with PCOS, I have highlighted the most important starting places below. Many people will want to jump right to designer supplements, but the approaches listed below provide the best and most important first steps.
1) If you are an aerobics junky, stop. Do low intensity relaxing exercise (leisure walking, tai chi, restorative yoga) and weight training instead to control cortisol which can be one of the major issues in disrupting brain ovary signaling.
2) Lower your starch/sugar and dairy intake…especially if you are overweight. A paleo-based diet is very useful here.
3) Take an adrenal adaptogen….my favorites for PCOS are Rhodiola and Holy Basil.
4) Work to control estrogen by avoiding estrogen exposure (plastics, coffee, pesticides, OCPs, dairy, etc.) AND facilitating their removal= fiber and DIM.