PCOS and Belly Fat: What’s the Connection?

Have you found out you have PCOS and were told to lose weight? But that stubborn PCOS belly! What is it exactly and how do we combat it for good? If you’re looking for tips to overcome PCOS belly fat, keep reading!

What is PCOS?

Polycystic ovary syndrome is a health condition that can result in unbalanced hormones and infertility in women. To have PCOS, women need at least two of the following:

  • High testosterone levels
  • Irregular or absent periods
  • Cysts on the ovaries

Women with PCOS face a series of other challenges, like higher cravings, facial hair growth, and risk of getting other health conditions including diabetes.

Read my blog on the different types of PCOS to learn more.

what is pcos bloating

What Causes PCOS Belly Fat?

Insulin Resistance

Your pancreas releases insulin to shuttle glucose (sugar) to the appropriate spots in your body. Insulin resistance occurs when insulin isn’t being used as efficiently by the body anymore, requiring more insulin to move the sugars along.

PCOS and belly fat

Insulin works like a key for the cells in our bodies, it unlocks the cell door to bring nutrients like glucose into our cells. Your pancreas releases insulin after an increase in blood sugar in order to clear glucose from your blood.

If you have insulin resistance, the locks on your cell are harder to unlock.

Your body could pump out all of the insulin it wants but if the lock on your cell is busted, your body will have a harder time clearing sugar from your blood which can increase the risk of developing diabetes, heart disease, and weight gain.

Check out another blog on common conditions that are associated with PCOS.

All Women with PCOS Are More Likely to Have Insulin Resistance than Healthy Women

Women with PCOS are more likely than healthy women to have insulin resistance. This remains true for all women with PCOS – whether in a smaller or larger body.

One study noted that for women with PCOS, around 60% with a normal BMI were insulin resistant, compared to almost 80% of overweight women and nearly 100% of obese women.

This is likely due to the higher amount of visceral (organ) fat that women with PCOS have.

What is Visceral Fat and Why Do Women with PCOS Have More of It?

Visceral fat, the internal fat around your organs, releases various hormones related to health. So, having more of this type of fat can cause a hormonal imbalance, leading to health conditions such as metabolic syndrome, cardiovascular disease and even several types of cancer (prostate, breast and colorectal).

There appears to be a connection between visceral fat in women with PCOS and higher blood sugars (both fasted and after eating). Even in women without PCOS, it seems that with increasing visceral fat comes increasing blood sugars. Remember – the body needs insulin to unlock the cells to move the sugar. High blood sugars could imean there is also insulin resistance.

The PCOS Belly Shape is from Insulin Resistance

Insulin resistance tends to result in a particular distribution of fat, giving PCOS belly a shape, known as an “apple” shape. Fat is mostly around the belly, which differs from a “pear” shape, where fat is more below the waist, in the thighs and glutes. Hence, PCOS belly “shape”.

With insulin resistance, too much sugar in the blood means the body as it can’t act fast enough to respond. Therefore, it sends some of the excess sugar to be stored in the fat cells, further causing a PCOS belly fat.

vitamin D for PCOS

On another note, because of the role of vitamin D in fat tissue, inadequate vitamin D could contribute to insulin resistance. People living in northern climates and people with more body fat are more likely to be deficient in vitamin D, so supplementation is key.

Read my blog for more information about vitamin D!

High Testosterone in PCOS

Many women with PCOS have high testosterone, which may or may not include physical signs (facial hair, oily skin, acne) or clinical signs (high testosterone in blood). Women with phenotypes A, B and C all have high testosterone, which is the majority of women with PCOS.

pcos high testosterone

Read my blog about the different types of PCOS!

High testosterone can result from an imbalance of steroid hormones. The “steroid hormones” are hormones made from the ovaries, testes or adrenal cortex.

In particular, women with PCOS may have elevated dehydroepiandrosterone sulfate (DHEAS), a steroid hormone in the androgen category (male hormones).

Typically, DHEAS should be converted into the active hormone dehydroepiandrosterone (DHEA), yet this process seems to be disrupted in PCOS. Women with PCOS have been found to have more DHEAS, indicating an issue in this necessary conversion.

As a result, this could be one key feature in the overproduction of testosterone. Elevated testosterone may also be linked to insulin resistance.

Women with PCOS treated with insulin-sensitizing medications, like Metformin, have seen lowered levels of insulin and testosterone while improving the function of the ovaries. Through targeting insulin resistance, testosterone was lowered, making it appear that the two are closely linked.

It has further been documented that women with high testosterone phenotypes of PCOS have a higher risk for developing insulin resistance, compared to PCOS phenotype (D) without high testosterone or healthy women. There have even been connections found between women without PCOS, but with high testosterone, and a higher risk of insulin resistance, reiterating the connection of high testosterone and insulin resistance.

Of note, free testosterone levels may be more indicative of insulin resistance than total testosterone levels.

Inflammatory PCOS Symptoms

Several inflammatory markers have been found to be higher in women with PCOS, such as aldosterone or C-reactive protein. In addition, other hormones have been found to be low, such as omentin-1, released by fat cells and responsible for stimulating insulin release to handle sugars. Remember insulin resistance?

pcos inflammation

Omentin-1 is actually anti-inflammatory and protective to the cardiovascular system. It appears that women with PCOS have an imbalance of high pro-inflammatory compounds and low anti-inflammatory compounds.

As white blood cells have been noted to be elevated in many studies in women with PCOS, it’s thought that high testosterone is closely related. Androgen receptors (a place for testosterone to bind to) have been abundantly found in leukocytes and neutrophils (types of white blood cells), possibly connecting high testosterone to chronic, low-grade inflammation shown by elevated white blood cells.

It seems that higher body fat only worsens the inflammatory state, further unbalancing hormones and compounds in the body.

Fat tissue or PCOS belly fat worsens this inflammation, while high testosterone throws off the general balance and functions of fat tissue, releasing cells that contribute to (you guessed it) insulin resistance.

Essentially, the imbalance in carbohydrate and fat metabolism and alterations in hormone production and inflammatory markers, leads to PCOS belly fat.

It is quite possible that these three factors are interconnected, further worsening each other in a vicious cycle.

PCOS Bloating vs. PCOS Belly

What is PCOS Bloating?

Bloating is a normal function of the digestive system and may look like:

pcos bloating or pcos belly fat
  • increase throughout the day
  • decrease overnight
  • increase after a meal (temporarily)

When bloating is not normal is when it’s paired with abdomen distention (you look like you have a “food baby”), pain, nausea, heartburn, excessive gas, changes to bowel movements, persistent feelings of fullness, or the bloating/distention does not go away.

Women with PCOS have an increased risk of also having irritable bowel syndrome (IBS), which can lead to abnormal gut symptoms.

Read my blog on bloating PCOS for more information!

What is PCOS Belly?

how to lose abdominal fat pcos

Whether in a lean or larger body, you may experience a PCOS belly shape, meaning you have more fat carried around your midsection. This could look like the “apple shape”.

This type of fat is harder to lose, particularly due to the imbalance of insulin, testosterone and inflammatory markers, as described above.

Women with PCOS also face another disadvantage, which is an accumulation of visceral fat, or fat around the organs, which can lead to health conditions such as metabolic syndrome, cardiovascular disease and even several types of cancer (prostate, breast and colorectal).

How to Lose Abdominal Fat with PCOS?

It’s clear – women with PCOS face numerous metabolic challenges to losing weight and the “PCOS belly”, but that doesn’t mean losing abdominal fat is impossible.

Best Way to Lose Weight with PCOS

Should weight loss be fast or slow? Of course, the slower you lose weight, the more sustainable it will be. I’m sure you’ve heard of people who cut carbs and lost a bunch of weight quickly, but does that weight loss tend to stick?

best way to lose weight with pcos

Unless the root habits are being addressed, maintaining weight loss from such a “crash diet” is near impossible.

A review of the research showed that while a larger calorie deficit (25%) resulted in greater weight loss, it didn’t differ in fat loss compared to lower deficits (20% and 10%). The higher deficit (25%) instead resulted in more muscle loss, while the lowest deficit (10%) preserved more muscle mass and targeted fat loss. Interestingly, fat loss between all groups was similar1.

So, if you want to hold onto that valuable muscle, slow loss is preferable.

Slow weight loss means losing half a pound to a pound per week and some weeks not losing at all. That is the nature of weight loss.

Many long term studies on weight loss maintenance point to behaviours that help keep the weight off such as:

  • Having healthy foods available
  • Eating breakfast daily
  • Prioritizing protein
  • Eating enough vegetables
  • Monitoring their weight regularly
  • Reducing emotional eating (potentially with the additional help of a therapist)
  • Finding consistency on the weekends and over holidays
  • Regular movement (especially walking!)

PCOS Diet Plan

There’s a variety of nutrition tips to help with weight loss, so let’s dive in!

food for pcos

Food for PCOS: Balanced Plate

If your goal is to lose weight or eat healthier, a simple visual is a balanced plate:

  • ½ plate veggies
  • ¼ plate proteins
  • ¼ plate carbs

Regular Meals

In addition to the balanced plate, following a regular meal pattern can be important, particularly for women with PCOS.

That’s because women with PCOS tend to have alterations in their hunger and fullness cues, making them feel hungrier more often and have a harder time feeling full.

Regular, as well as balanced meals, can help with this problem.

Regular meals usually mean eating every 3-4 hours. If you have a larger gap between meals, then a healthy snack could fit that void.

Protein

Eating enough protein is essential for weight loss and weight management. Not only does protein help you build muscle, but it also helps keep you full.

Try to get enough protein each day and spread it evenly throughout your day.

pcos protein

Focus on high-quality proteins such as:

  • Lean poultry/meats (skin and visible fat removed)
  • Fish and seafood
  • Eggs
  • Dairy (milk, Greek yogurt)
  • Soy (tofu, edamame, tempeh)
  • Legumes (beans, lentils, chickpeas)
  • Nuts and seeds

Low Carb Diet for PCOS?

Carbs Are Part of a Balanced Plate

Carbs are not the problem. Or maybe they are – if you’re avoiding them.

Portions do matter (refer back to the balanced plate), but so do the quality of the carbs.

pcos carbs

If you’re avoiding added sugars, pop or cake, then maybe you’re on the right track. If you’re avoiding all carbs, including sweet potato, whole grain bread or quinoa, then we need to talk.

Carbohydrates provide energy, fibre and fullness to meals. Do you ever notice how salad and chicken just doesn’t hit the spot sometimes? Carbs complete the balanced plate and are beneficial to your health.

Repeat after me: “Carbs are beneficial for my health!”.

Read more in my blog post: 5 Reasons Women With PCOS Should Stop Avoiding Carbs.

PCOS and Sugar: How Much Sugar is Too Much?

Best Sweeteners for PCOS

As many women with PCOS are insulin resistant, their bodies may have a harder time handling the sugars that enter their body.

There is no best sweetener for PCOS, rather there is a best portion and/or alternative.

Artificial sweeteners may be a good option for women with PCOS, as they don’t provide calories and more importantly – they don’t impact your blood sugars.

Health Canada has approved a number of artificial sweeteners including:

  • aspartame
  • acesulfame-potassium
  • erythritol
  • Neotame (NutraSweet)
  • Sucralose (Splenda)
  • sugar alcohols (polyols) such as sorbitol, isolmalt, lactitol, maltitol, mannitol and xylitol
  • thaumatin

Reducing Added Sugars

Added sugars are the sugars you want to watch (leave fruit alone!)

pcos and sugar

Added sugars could be called:

  • Table sugar
  • Glucose
  • Sucrose
  • Fructose
  • Maltose
  • Dextrose
  • High-fructose corn syrup
  • Honey (yes, honey too!)
  • Maple syrup
  • Brown sugar
  • Molasses
  • Invert sugar
  • … the list goes on

The recommendations for added sugars are to keep them below at least 10% of total calories, or 5% if possible.

What that could look like on a 2000 calorie diet:

  • 5% of calories: ~25 grams or ~6.25 teaspoons daily
  • 10% of calories: 50 grams or ~12.5 teaspoons daily

Sources of added sugar:

  • 1 cup (250mL) orange juice = 5.5 teaspoons of sugar
  • 1 can (355mL) pop = 10 teaspoons of sugar
  • 1 medium double double from Tims = 5.25 teaspoons of sugar
  • 1 medium hot chocolate from Tims = 10.75 teaspoons of sugar
  • 1 Boston cream donut from Tims = 4 teaspoons of sugar
  • 1 large Oreo blizzard from DQ = 32 teaspoons of sugar
  • 1 small Oreo blizzard from DQ = 17.5 teaspoons of sugar

*Wipes a tear*

Healthy Fats for PCOS

We can’t forget the fats!

Fats have an important role in hormone production, as well as keeping us full and giving food flavour. Remember, women with PCOS need help balancing their hormones – so fat has to stay!

healthy fats for pcos

To eat more healthy fats for PCOS, include foods with monounsaturated and polyunsaturated fats. These come from plant sources like:

  • Olive oil and olives
  • Ground flaxseed and flaxseed oil
  • Avocado and avocado oil
  • Nuts and seeds

Fats from animal sources are higher in saturated fats. These are okay to include too (in smaller amounts), as they’ve been linked to heart disease. These include:

  • Fatty cuts of meat
  • Red meats (beef or pork)
  • Chicken skin
  • Marbled meats
  • Deli meats and processed meats like salami and pepperoni
  • Cheese
  • Dairy fat
  • *Coconut oil – also a source of saturated fats

Treat PCOS Inflammation with Anti-inflammatory Foods

pcos inflammation

Since PCOS is linked to chronic inflammation, an anti-inflammatory diet may help. Anti-inflammatory foods are higher in antioxidants, vitamins, minerals and fibre. It also tends to have more healthy fats and is an eating pattern that can manage calories more easily.

It’s important to remember sustainability when choosing a diet.

Read more about what foods to eat for PCOS in my blog post: What to Look For In A PCOS Meal Plan

Lifestyle

Health is more than just food.

Stress management, sleep, movement and more are also included in the pillars of health. Consider evaluating these aspects as well to achieve a balanced approach to health.

Read more about lifestyle advice for PCOS in my blog post: How to Treat PCOS: An Overview of Issues Affecting Success

PCOS Supplements

pcos supplements

Metformin can be used to control insulin resistance, though some women don’t respond to this treatment. Not all women with PCOS are the best fit for metformin, most doctors are prescribing metformin for those with higher blood sugar levels such as prediabetes, metabolic syndrome, and diabetes.

Read more in my blog post: Supplements for PCOS to Improve Insulin Resistance

Have you ever been frustrated with planning snacks for PCOS?

We know it can be difficult to figure out what is best for your unique needs. That’s why we created Powerful PCOS Snacks, a resource by dietitians that has the latest research and years of experience built into it. Here’s where you’ll find practical solutions to snack problems so that you can start thriving with PCOS today.

You’ll learn how to craft delicious snacks and meals around your lifestyle without feeling overwhelmed or having to guess at portion sizes, striving for perfection, and sacrificing pleasure in the process. With this guide, there won’t be any more guesswork – just delicious and empowering nutrition knowledge tailored specifically to tackle those challenges of PCOS!

Download our free resource now and start feeling confident about what snacks are right for YOU!


References:

  1. Henselmans M. “Weight Loss: Fast or Slow?”. Alan Aragon’s Research Review – April & May 2013 available from: https://alanaragon.com/aarr-index/ ↩︎

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