PCOS and Obesity/ Weight Problems
"Simply assuming overweight women are 'out of control' is inhumane and uneducated. Women with PCOS struggle valiantly against weight gain; often an uphill, losing battle. Malicious comments and ignorant physician assumptions that they just need to 'go on a diet' are monstrous and need to be eliminated." - PCOS Advocate
Obesity or persistent weight gain is a common feature of polycystic ovarian syndrome. Many women find it almost impossible to lose weight, even when on a strict diet. It seems that every calorie that is eaten is stored as fat.There are many possible reasons why women with PCOS are overweight. A few of them are:
- A genetic predisposition toward "thrifty genes".
- A disordered biochemical signaling system affecting fat metabolism/storage, and appetite.
- Glandular disorders or diseases such as hypothyroidism.
- Chronic stress.
- Hidden food allergies.
- Medications.
- Sodium retention.
PCOS Women More Prone to Gain Weight
We've heard lots of stories about PCOS women who are very disciplined in what they eat, yet they still gain weight or can't lose weight. Meanwhile, their family or friends can eat more and stay thin.
This is borne out by a study at the University of Pittsburgh where the diet of PCOS women was compared with non-PCOS women.
The study found that although PCOS women tended to be more overweight, there was virtually no difference in their dietary intake.This study suggests that PCOS women tend to gain more weight with the same amount of calories when compared to non-PCOS women.
Why are PCOS women so efficient at converting calories into fat? Or maintaining their weight with fewer calories than normal women?
Your Genes and Weight
Most researchers agree the polycystic ovary syndrome is at least partly caused by the set of genes you were born with. Your genetic pattern is different compared to women who don't have PCOS.
Recent genetic research suggests that PCOS is partially the result of "thrifty" genes, providing advantages in times of shortage of nutrition such as muscular strength, moderate abdominal fatness and decreased insulin sensitivity, i.e. an anabolic (body building), survival, energy-conserving constitution.
However, the era of famines and food shortages is long past. "Thrifty genes" are ill-equipped to deal with the overwhelming supply of food to which you are now exposed. If you have the "thrifty genes", then your body is evolutionarily very adept at storing calories for a rainy day that never comes.
Disordered Biochemical Signaling
Our research suggests that a very complex biochemical signaling disorder is primarily responsible for PCOS weight problems. The cells in your body behave according the information (signals) they receive from their environment. Hormones such as insulin are messengers that tell cells what to do or not do. In addition to numerous hormones, there are dozens of other signaling proteins in your tissues and blood that communicate information to your cells.
A number of studies have shown that the complex interplay of signaling proteins in PCOS is disrupted and disordered.
Insulin, Insulin Resistance and Weight
Insulin is a hormone that is known for its ability to store glucose ("blood sugar") into cells. Overweight PCOS women have higher insulin levels than lean women. In addition, they tend to have a condition called insulin resistance. Insulin resistance means that insulin cannot perform its work efficiently, thus requiring an excessively high level of insulin in order to get blood sugar stored into cells.
Popular diet writers have made insulin the "bad guy", saying this is the hormone that makes you fat. They say that if you cut out the carbs, your blood sugar will not rise as much when you eat a meal. Rising blood sugar from dietary carbohydrates triggers an increase in insulin, which causes excess energy (calories) to be stored into cells. At some point, the cells cannot store any more blood sugar and the remainder is than stored as fat.
The other reason why insulin is the "bad guy" is that excessively high levels of insulin turn off a fat-metabolizing enzyme, thus preventing you from burning off stored fat. In essence, your fat storage switch is turned "on", and your fat-burning switch is turned "off".
However, there is a lot more to the insulin story than you have been told. An increasing body of evidence indicates that insulin can also be thought of as an "anti-obesity" hormone, because it can suppress food intake and thus prevent weight gain and obesity. Insulin is a long-term regulator of food intake, energy balance, and body fat.
Insulin performs this regulatory function in the hypothalamus gland inside your brain. The hypothalamus gland receives many different signals (including insulin) from throughout the body. Based on the information it receives, it sends out instructions to your body that influence your appetite, and whether you will burn calories or store them.
However, insulin resistance can occur in your hypothalamus gland. Thus, incoming insulin messages will not be "heard" by the hypothalamus and it cannot give out the correct instructions for optimal energy balance in your body. In other words, insulin is not the "bad guy". In people who do not have insulin resistance, insulin plays an important balancing role for weight.
Leptin Resistance and Weight
Leptin, a hormone produced by your fat cells, is involved in long-term weight and appetite regulation. It signals the hypothalamus gland in your brain when fat cells are full. The hypothalamus uses this information to maintain energy homeostasis (balance) in your body.
Leptin levels should be in a balance, not too high and not too low. Low levels can result in food cravings.
Therefore, it's thought that women with PCOS may become resistant to the effects of leptin, and despite higher circulating levels of the hormone, do not experience its beneficial effects. Leptin resistance is much the same as insulin resistance in that an excessive amount of leptin is required to get biochemical work done. Leptin resistance could result from impaired leptin signaling to the hypothalamus gland in the brain.
What you eat can affect leptin and leptin resistance. If you have leptin resistance, your hypothalamus gland cannot optimally regulate your energy balance. In other words, what you eat will greatly affect how your body governs your weight.
Ghrelin and Your Appetite
Ghrelin is a "hunger hormone" that was discovered in 1999. A lot of research is being done on ghrelin so you may be hearing more about it.
It helps to regulate how much food you eat and how much weight you gain. In normal individuals, ghrelin levels go up before meals, and down after meals. Elevated ghrelin triggers strong feelings of hunger. In addition to regulating eating behavior, ghrelin may slow your metabolism and reduce your ability to burn fat.
Several studies suggest that women with PCOS have disordered ghrelin levels, or have an impaired ability to regulate ghrelin. For example, one study showed that PCOS women were less satiated and more hungry after a meal than normal women. The ghrelin levels of the PCOS women did not decline after a meal as much as the non-PCOS women.
Once again, diet is important because it appears that composition and amount of fat and carbohydrate in the diet will influence ghrelin levels.
Cholecystokinin (CCK) and Satiety
Cholecystokinin (CCK) is a hormone secreted in the gastrointestinal tract when you eat a meal. It slows down the digestive process and functions as a short-term satiety signal to inhibit food intake and thus decrease meal size. "Satiety" means a feeling of fullness or satisfaction.
However, some women with PCOS have reduced CCK secretion after a meal and deranged appetite regulation.
There may be a number of factors at play. A primary factor is that short-term CCK must work in concert with the long-term hormonal regulators of energy balance, such as insulin and leptin.
The size and composition of your meals will influence insulin and leptin. Since the caloric size of the meal is partly determined by CCK, CCK influences insulin and leptin. However, as long-term regulators of your body fat, insulin and leptin will also influence CCK.
A Web of Interrelated Hormones and Signaling Proteins
Insulin and leptin influence each other in your hypothalamus gland and elsewhere in your body. In addition, they interact with a large number of other hormones such as ghrelin and CCK.
A large proportion of PCOS women have thyroid dysfunction, resulting in a lower metabolic rate and great difficulty in losing weight.
As you can see, overweight PCOS women tend to have multiple hormone disorders and genetic tendencies that predispose them to be overweight.
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