Why is Weight Loss So Hard when you have PCOS ?

Why is Weight Loss So Hard when you have PCOS ?

Why Is Weight Loss SO hard when you have PCOS?

Did you know that weight loss can help with improving almost all the symptoms of PCOS? Even a modest weight loss of 5 – 10 % of a woman’s initial weight can lead to improvements in insulin sensitivity, ovulation and fertility!  But, I know this is easier said than done. Weight gain and weight loss are two of the most common issues women with PCOS are forced to deal with.

even modest weight loss

But, what gives ? Why is weight loss so hard if you have PCOS? Well my dietetic intern Jackie Budlowski and I are here to lay the smack down and give the 411 of why the heck it so friggin’ challenging to lose weight when you have PCOS. Get your notebook out — these are some golden nuggets of information 🙂


I truly believe insulin is one of the most important hormones in controlling weight!  Your pancreas secretes insulin to regulate your blood glucose levels. In most individuals, insulin helps lower one’s blood glucose levels by shuttling glucose into the cells where it can be used for energy. However, most women with PCOS do not effectively process glucose. They experience what is called insulin resistance.Their bodies are less sensitive to the effects of insulin. In response, the pancreas dumps out even more insulin, leading to high insulin levels, or what is known as hyperinsulinemia.

High levels of insulin signal to the body that energy is abundant. In turn, rather than use the extra energy as fuel, women with PCOS store excess glucose as fat. Therefore, one of the biggest keys to controlling weight is to regulate blood sugar and control insulin levels. This is best accomplished through a moderate carbohydrate diet supplemented with the insulin sensitizing agent metformin.

If you are not already familiar with the benefits of metformin please read my previous blog post which will bring you up to speed.

Slow Metabolism

Women with PCOS have been shown to have a slower metabolic rate. This is based on many factors but the primary one being the amount of body fat women with PCOS tend to carry. Your metabolic rate is the number of calories you need for your body and organs to work. You see, body fat is what I consider metabolically “dead.” It does nothing for you but kind of just hang there.

Muscle on the other hand is very thermogenic. It burns more calories than fat does – even while at rest. In fact, muscle tissue is about 8 times more metabolically demanding than fat. A higher percentage of lean body weight (muscles) results in a higher metabolism compared to people of the same weight with a lower percentage.

PCOS and weight

If you have a slower metabolic rate, this means you must consume fewer calories than the average woman. Eating more calories than you burn can lead to weight gain. In future blog posts we will discuss some of the different ways to improve your metabolic rate (Hint – Hint : strength training is definitely one of them!)

If you are curious what your metabolic rate is and you live in the Connecticut area shoot us an email at amy.plano@yahoo.com. We can set up a time to test your metabolism. We have a device called the Bodygem which tests your metabolism by using a simple breathing device. The Bodygem is the “gold standard” of metabolism testing devices. Don’t believe us ? Click here bodygem validation to review the research. The cost of the test is $150.00. You must be fasted, with no caffeine or exercise for 4 hours before the test.

Appetite Hormones

There are a number of hormones involved with hunger and appetite control. Ones of particular interest for women with PCOS are leptin, cholecystokinin (CCK) and insulin. These hormones are responsible for signaling to the body to tell it that is it full and to “stop eating.”  Research has shown that women with PCOS have altered hormone signals, which may lead you to feel constantly hungry even when you are consuming enough calories. This leads to overeating, increases in body fat and overall lower esteem. Not a winning combination for weight loss.


Did you know that your fat cells produce hormones? This is one reason women who carry a significant amount of body fat often have hormonal problems. One of the hormones produced by your fat cells is leptin. This hormone sends a signal to the hypothalamus gland in your brain when fat cells are full. Due to the fact that cells produce leptin in proportion to their size, overweight women with PCOS also have very high levels of leptin.

Given the way leptin is supposed to work, women who are overweight and have PCOS should have a diminished appetite. But we know this is not the case. You can have a lot of fat making a lot of leptin, but it doesn’t turn the hunger valve off. The brain isn’t listening. No drop in appetite. In fact, your brain might even think  you’re starving. This because as far as it’s concerned, there’s not enough leptin!  So you get even hungrier. This condition is known as leptin resistance. This causes an up regulation of appetite. This supports why women with PCOS tend to constantly be hungry despite taking in an ideal amount of calories.

Cholecystokinin (Alias: CCK)

Therefore, it may come at no surprise that women with PCOS often feel less satisfied after a meal than women without PCOS. This can be attributed to the hormone cholecystokinin (CCK). CCK is responsible for telling your body you are full after a meal. Women with PCOS are reported to secrete less CCK in response to a meal. So, if your CCK levels are lower, this means you will be hungrier after meals despite just eating. It has also been speculated that impaired CCK secretion may play a role in the greater frequency of binge eating in women with PCOS.

Not so awesome, right ? But the plot thickens …


Lastly, insulin also acts as an appetite stimulating hormone. You may already be familiar with the concept of insulin resistance and PCOS. If you are not click here to brush up on your knowledInsulin resistance occurs when there is a lot of insulin being produced (such as, with many women who have PCOS), but the body and brain have stopped “listening” to insulin’s effects. The scenario becomes : you eat, your body releases insulin, but your body still tells you to eat more.  So you eat more and increase the likelihood of storing the food you do eat as excess body fat. And if this is not bad enough – you rarely feel satisfied.Therefore, high levels of insulin may be one of the many reasons why you may experience more hunger than other people. Higher hunger levels inevitably leads to more eating which results in weight gain.

Just because it is harder to lose weight, doesn’t mean it is impossible. Here are some tips on how to take the bull-by-the-horns and make your hunger hormones work for you!

Weight loss & PCOS: How to manipulate your hunger hormones for weight loss 

Pump up the protein

Do your best to have protein at all meals, but especially at breakfast. Breakfast sets the “appetite tone” for the day!  Therefore, consuming high-quality protein sources such as eggs, Greek yogurt or cottage cheese with some nuts will help reduce your hunger hormones and keep your appetite at an even keel throughout the day.

Screen Shot 2016-08-24 at 7.26.07 AM

Skip the processed carbs (duh!)

Stay away from refined-carbohydrate-only meals and snacks such as cereal, a bowl of pasta, crackers, chips and starchy snacks. Even having a healthy snack such as fruit alone can trigger a spike and an immediate drop in insulin, so add some nuts, a piece of cheese or Greek yogurt to your fruit.

Focus on high fiber foods

Fiber is deeply tied to satiety. High volume, low-calorie, nutrient dense foods delay gastric emptying keeping food in the stomach for a longer period. Therefore, do your best to include foods such a vegetables, high fiber cereals, fruit and legumes to keep hunger at bay. The goal is aim for 25-30 grams of fiber spread throughout the day.

Eat a diet rich in omega-3 fatty acids to boost leptin

People who are overweight tend to release too much of a group of molecules that the body uses to combat inflammation. These molecules reduce leptin’s ability to communicate with the brain. They are thought to be one of the underlying causes of leptin resistance. Omega-3 fatty acids decrease the production of these molecules by reducing inflammation in the body. The body does not produce omega-3 fatty acid therefore you must get from the diet.Screen Shot 2016-08-24 at 7.27.48 AM Foods high in omega-3 fatty acids include grass-fed meats, walnuts the fattier fish salmon, anchovies, sardines, mackerel, trout as well as chia seeds, flax seeds, summer squash and kale. Aim for about 800 – 1000 mg per day.

While the hormones that effect and control your hunger might be seen as complex, the three I’ve just discussed are keys to to unravelling this complicated web of PCOS, hunger and weight gain. As you can see, there are many factors at play, beyond just your determination to eat properly.  These are factors I want you think about when you become frustrated with your PCOS and weight gain.What is important to understand is that your behavior around eating is not always something you can always consciously regulate.

Be confident and believe in yourself. Weight loss may initially be a struggle, but with the proper approach I am confident you can do it!

Support for women with PCOS

Amy Plano PCOS Dietitian

The Awesome Benefits of Metformin for Women with PCOS: What Every Cyster NEEDs to Know

The Awesome Benefits of Metformin for Women with PCOS: What Every Cyster NEEDs to Know

If you have PCOS favicon, there is a good chance you have heard of the medication metformin. However, what you may not know is why it was prescribed for you in the first place. So much of the advice I give to patients surrounding diet revolves around many of the same reasons and principles why women with PCOS are put on metformin. Therefore, I thought it would be beneficial to discuss the basics of metformin and how it can help with insulin resistance, decreasing your testosterone, improving your chances of ovulation, enhancing fertility and you guessed it – weight loss!


What the heck is metformin? 


Metformin is an insulin-sensitizing agent. What this means is metformin makes your body more sensitive to the effects of the hormone insulin. But more about that later!

Metformin comes in tablet form and the dose is gradually increased until the maximum dose required is achieved. Most women with PCOS start at a dose of 500 mg and increase their dose up to 1500 – 2000 mg usually in a 4-6 week span.


 Metformin does the following:

  1. inhibits liver production of glucose
  2. increases the uptake of glucose by the cells
  3. decreases oxidation of fatty acids
  4. decreases the absorption of glucose in the intestines


 Note: Metformin is the most commonly prescribed drug for diabetes.


I have PCOS, NOT diabetes? So, why did my GYNO prescribe metformin for ME?!?


Around 70- 80 % of women with PCOS experience what is called Insulin Resistance (IR). If you have IR, your body produces enough insulin, but does not effectively use it. Therefore, your body is not sensitive to the effects of insulin. Your doctor prescribed metformin to help your body respond better to insulin.



Why is insulin SO dang important?


Insulin plays a critical role in metabolism—the way the body uses food for energy. When you eat, the digestive system breaks down carbohydrates—sugars and starches found in many foods—into glucose. Glucose is a form of sugar that enters the bloodstream. With the help of insulin, glucose gets processed into the cells where it is used for energy.



What is Insulin’s Role in Blood Glucose Control?


When blood glucose levels rise after we eat, the pancreas releases insulin into the blood. Insulin and glucose then travel in the blood to the cells throughout the body.



faviconInsulin plays three key roles in the body- 1. Allows muscle, fat, and liver cells to absorb glucose from the bloodstream. This helps lower blood glucose level 2. Stimulates the liver and muscle tissue to store excess glucose. The stored for



In a healthy person, these actions help regulate blood glucose to keep insulin levels within a normal range.


But I already told you, my doc told me I am NOT healthy! I have PCOS AND Insulin Resistance SO what does that mean?


When someone has insulin resistance their muscle, fat, and liver cells do not respond properly to insulin. Their bodies cannot easily absorb glucose from the bloodstream. As a result, the body needs higher levels of insulin to help glucose enter cells. Basically the cells, despite the presence of insulin in the bloodstream, don’t function properly and don’t allow the glucose in the blood into the cells.


What Role does Insulin Resistance play in PCOS and Weight Loss ?


Insulin is considered a storage hormone. When insulin levels are high (as they are in most women when they are diagnosed with PCOS), the body goes into storage mode. This means the body stores glucose as body fat instead of using it for fuel.


And guess what? What do you think has one of the biggest affects on raising insulin levels? Carbohydrates – especially the refined types! Eating substantial amounts of processed carbohydrates creates large spikes in insulin levels. For women with PCOS – this is like pouring salt on an open wound. No bueno amiga!


As you know, many women who have PCOS are already overweight and carry a substantial amount of body fat in their belly area. Elevated weight and belly fat can further increase IR. Therefore, it no surprise that women who have PCOS have a hard time losing weight – even if their diet and exercise are “spot on.” Insulin resistance and excess weight creates a vicious cycle of weight gain in women with PCOS. And for some – without metformin – this weight is increasingly difficult to take off.


As if that was not bad enough! IR also increases testosterone levels, disrupts menstrual cycles and decreases a women chance of fertility.


How Does Metformin Benefit Women with PCOS?


Metformin is a super hero in my book for women who have PCOS and IR!


Metformin has been used off label in PCOS to prevent diabetes and increase ovulation through weight loss (1). In a recent randomized controlled trial comparing metformin, oral contraceptive pills (OCPs), and the combination of the two in patients with PCOS without T2D, metformin alone or with OCPs decreased weight and BMI. The median decrease in weight with metformin at 12 months was 3 kg (25th and 75th quartiles; -10.3, 0.6). OCP use was associated with increased weight changes of 1.2 kg (25th and 75th quartiles; -0.8, 3.0), and the combination decreased weight by 1.9 kg (25th and 75th quartiles; -4.9, 0.1). One patient in the metformin group dropped out due to nausea; no other side effects or adverse events were reported (2). Therefore, by using metformin by itself or in conjunction with OCPs, women with PCOS experienced a significant decrease in weight over the course of one year.


benefits metformin

Metformin is also likely to delay diabetes onset and has a role in PCOS in those at high risk of diabetes. Boom!


While I do not think it is a miracle drug by any means, I personally have seen many of the positive outcomes I described above in my patients. However, with that being said, these same patients are also strongly adhering to my dietary and exercise advice AND are compliant with taking their metformin. You cannot have one – without the other!


Therefore for many women who have PCOS, taking metformin should be a no brainer due its profound impact on metabolic and reproductive function.


experiences metformin


Support for women with PCOS

Amy Plano PCOS Dietitian






  1. Nieuwenhuis-Ruifrok AE, Kuchenbecker WK, Hoek A, Middleton P, Norman RJ. Insulin sensitizing drugs for weight loss in women of reproductive age who are overweight or obese: systematic review and meta-analysis. Hum Reprod Update. 2009;15:57-68
  2. Glintborg D, Altinok ML, Mumm H, Hermann AP, Ravn P, Andersen M. Body composition is improved during 12 months’ treatment with metformin alone or combined with oral contraceptives compared with treatment with oral contraceptives in polycystic ovary syndrome. J Clin Endocrinol Metab. 2014;99:2584-2591.
Hot off the Press – New PCOS Drug in the works

Hot off the Press – New PCOS Drug in the works

New PCOS Drug on the Horizon 

Wow cysters this is HUGE! Finally some promise on the horizon for treating women with PCOS. A new PCOS drug has just completed a phase 2 clinical trial. And the results seem quite promising!  Yay – Hooray!

Will this drug help “cure” PCOS? 

While there is no solid consensus for what causes PCOS, we do know there are several trends that exist in this population. One of these trends is that women with PCOS tend to present with higher than normal levels of Luteinizing Hormone (LH) and elevated testosterone levels. It is the “pulse” of these two hormones that is speculated to be responsible for both the absence and abnormalities seen in the menstrual cycles of women with PCOS. This new PCOS drug has the potential to correct these hormonal abnormalities. However, the data is preliminary and much more extensive testing is required. Also due to the fact that PCOS is a syndrome, it is unlikely any single drug would resolve the myriad of symptoms many women with PCOS experience.

When should we expect to see the new PCOS drug on the market? 

It is important to note this PCOS drug has just completed the second of three phases of rigorous testing. In the third and final phase, the drug will be tested in a much larger, diverse population of women with PCOS. Currently the stage 2 phase only examined the effects of the drug after 7 days. In order to successfully reach the market, the new PCOS drug will need to under go much more clinical testing. We can likely assume that the investigators will be interested in the long-term effects of this drug as well as whether or not it can be used side-side with the administration of fertility drugs. But it is likely several more years before these studies are complete.

So until then we will continue to know what works best – diet – exercise – sprinkled with a little metformin and 

Fingers crossed  — 🙂

Here is a link to the article. You can click on the actual trial within the press release to examine the various treatment protocols and study demographics.