PCOS Bloating and Weight Gain: 2 Key Strategies and Causes
We often get asked why losing weight with Polycystic Ovary Syndrome is so hard, and what causes the bloated or ‘PCOS big belly’.
Diet is an important tool to manage bloating and weight loss, and to feel better within yourself during hormonal fluctuations. However the internet is awash with frankly a lot of un-helpful PCOS diet plans. There’s a lot of confusion around which foods to avoid, what carbohydrates to eat, and what causes PCOS bloating, (even in the less qualified Nutritionist community). Women all to often find themselves flitting from one recommendation to another, trying different things but not really progressing much with their symptoms.
We explore the science-based fundamentals behind the causes of PCOS bloating, whilst calling on our In Real Life experience from working with a diverse range of PCOS women. We believe the key to helping your PCOS symptoms is to understand what your unique set of causes are.
Jump To:
Polycystic Ovarian Syndrome - The Real Life Symptoms & Struggles:
The Bloating: Why do we bloat with PCOS
The two key causes: gut / insulin
Other potential factors: constipation and hormones
PCOS Bloating Treatment
The Best diet to manage bloating in PCOS
The best supplements
The Best Tests: track your glucose
A Success Story
Help for your PCOS bloating and weight gain
Link to other blogs:
Polycystic Ovarian Syndrome - The Real Life Symptoms & Struggles
There are a lot of uncertainties around diagnosing PCOS, and some of our women are unclear on whether they truly have PCOS or not. It’s not always so clear cut, and in some cases the diagnosis is in passing during an ultra sound. Despite this, you may have strong PCOS-like symptoms.
From our perspective, this is when functional medicine is the ideal approach, as we ‘care’ less about the diagnosis, and more about whether you have hormone imbalance symptoms - and then rooting out exactly what’s out of balance in your unique body. The reason why some diets you have tried may not have worked for you, is often because they are generic, and may therefore be unsuitable or even pointless for you. In some cases, the diet may have been right, but the approach incomplete or not the right one for you.
NHS lists of PCOS symptoms can be a little cold or generic, so here we’ve tried to illustrate symptoms in the words of many of our real life ladies. This is the truth of the struggles.
For those ladies who are uncertain of their PCOS diagnosis, focus on helping your symptoms.
Feeling very fatigued in particular before or after your periods
Excessive sadness or feeling emotional or sensitive, which is worse at various points in the cycle
A particular type of acne which often centres under the chin or sometimes across the jaw line. The acne can appear different from what you experienced as a teen, have worsened, or be new symptom
Excessive hair loss, with new hair growth in annoying ‘male’ places
Unexplained weight gain, or simply an inability to loose weight. In some cases, even in an extremely low calorie diet, there’s been a lack of weight loss. Whilst some people experience obesity and significant weight gain, this depends on early life diets, how much willpower is applied, genetics and a range of other factors.
Of course irregular or long-cycle periods or even absent periods
The Bloating: Why do we bloat with PCOS
There are 2 Key Causes for Bloating with PCOS:
Bloating 1: Wind, caused by IBS or IBS type symptoms: Bile and Gut Bacteria
Bloating 2: More belly fat tissue: tendency to lay down fat around the middle due to excess insulin
1. Bloating due to IBS or IBS type symptoms
The relationship between PCOS and gut health is strong. It’s not yet been well explored in mainstream healthcare but the science is starting to be there. Furthermore in our clinic, we get excellent results in normalising period-regularity and PMS type symptoms by working on the gut. Stool tests often reveal many issues with gut bacteria - and problems digesting fats.
What the science says.
A recent meta-analysis (summary of many studies) showed that the risk of IBS in women with PCOS is twice higher than non PCOS people. PCOS patients are more prone to experience gastrointestinal (GI) disturbances such as irritable bowel syndrome. Of course ‘IBS’ is a pretty meaningless term, and we’ll dig a little deeper into the symptoms and exactly what’s going awry in a moment.
Why do women with PCOS experience IBS with Bloating and Wind
We’ve found there to be two key factors: 1) Bile issues, and 2) Gut bacteria imbalances.
Bile Issues
This is a really interesting area, and one that we find to be super common in our PCOS ladies, and is an area we focus on quite a bit. It’s hard to test for and we’re only talking about (usually) a functional issue here, although some of our PCOS ladies may have come to us with gall stones already diagnosed.
In this relatively large study, it was found that in ladies with known PCOS, two types of bile acids were much higher. One of those acids, deoxycholic acid, is linked to how the body stores fat and and regulates insulin. Bile was also seen to be affected by testosterone which is often high in PCOS, so this appears to be a both cause AND effect scenario.
How do you know if you have bile flow issues?
Gut Bacteria imbalance in PCOS - a consequence of bile flow issues?
To make things even more confusing, a poorly functional gallbladder/bile flow create an imbalance in gut bacteria and potentially SIBO (due to a lack of clearing of small intestine bacteria with bile which is naturally strongly antimicrobial. This allows bacteria that naturally always tries to get into wherever they can, to hang around here causing problems). AND - vice versa, i.e an imbalanced gut microbiome can drive gallstones and a sluggish bile flow. If you feel thoroughly confused at this stage, don’t worry - you don’t need to understand how all this is connected, this is what we’re trained in and here for.
Could Gut Bacteria also be part of what CAUSES PCOS?
We wont cover this point in any great detail here, but it’s an important part of the picture. Gut bacteria may have a role to play in driving PCOS, and the research supporting this idea is mounting. Watch this space, as we believe this is an area that will grow in recognition. Or at least it should, but this depends on someone throwing some money at researching this area.
New research has found that there seems to be a link between PCOS and some of the chemicals made when good bacteria in the gut digest fibre from food. These chemicals influence the metabolic and hormonal aspects of PCOS and when their production is increased through fibre intake, it seems to improve PCOS symptoms.
In this review, researchers discuss how polyphenols, the colourful stuff in foods may support PCOS
We’re also starting to see interesting studies on how the vaginal microbiome could even have a direct impact.
2. Belly Fat: PCOS and Insulin Resistance
This is a more established theory and is well accepted. Some consider PCOS in fact to be a metabolic disorder closely tied to insulin resistance. This means that many PCOS cases have excess insulin (normally a response to food and sugar). In one review, one study discovered that excess insulin affected 65–70% of women with PCOS. But the numbers were higher in those that were obese (BMI >30) at 70–80%, and lower in the leaner PCOS women (BMI<25) 20–25%. This makes perfect sense as insulin typically tends to make it harder to lose weight.
Insulin resistance (a word to describe excess insulin) typically drives the body to lay down more fat specifically around the middle, and you may experience a widening waist, or a tighter trouser band. Sometimes the fat is more internally in the abdomen and less obvious.
It’s important to note however that insulin is often not directly measured by health professionals and could vary a lot from person to person as the above studies suggests, and this is why it’s important to make any treatment personalised. A diet to reduce insulin resistance may be ineffective if you in fact don’t have this issue. Either way, managing blood sugar is THE most important dietary objective you should have if you have any kind of hormone imbalance, together with constipation.
Why high insulin is a problem and what you might experience
Insulin is produced in response to blood sugar, i.e eating.
Excess insulin can cause food cravings, tend to drive weight gain around the belly, and block fat burning. This is when you can’t seem to lose weight no matter how little you feel you eat.
Excess insulin may also cause blood sugar ‘crashes’. These can make you feel pretty uncomfortable; with hanger, intense carbohydrate or sugar cravings, low mood or irritability. Depression or low moods can also occur.
High insulin is not just a symptom of PCOS—it is also considered to be major driver of the condition. High insulin can impair ovulation and cause the ovaries to make excess testosterone.
What causes the high insulin?
Aside from PCOS, a diet too high in bread, sugar, fast food or processed carbs can drive up insulin. Over eating or snacking too much (don’t forget to count your latte or your birthday office cake) is equally a common factor. It’s thought that it can be pre-existing and possibly be a driver. But in some cases, perhaps the PCOS is driving up the insulin. This has not yet been established.
One study says that genetics or obesity is to blame, but the picture is likely more varied and complex, involving both lifestyle and genetics. As we uncovered above, there is poor clarity on ‘what came first’ in the causes of PCOS. Note that we say ‘causes’ as oppose to cause. It’s very unlikely from our personal perspectives that we’re just looking at one single isolated cause. That is completely working on its own. And exactly the same for all women. This tends to be the medical model of looking at things (and perhaps the reason we don’t know what causes ANY of our modern diseases, such as auto immune, cancer and everything else non-viral or genetic?). In fact, when you spend all day working with real people, focussing on imbalances in our different body systems and how they operate together, this idea seems almost preposterous even.
Other potential factors for Bloating in PCOS
Other potential causes for bloating in PCOS can be constipation and a sore tummy around the periods themselves, however this is not covered in this article.
PCOS Bloating - Treatment
So - what to do! Given what we’ve just said above, the objectives are two fold:
Reduce insulin, and
Improve digestion.
How-To manage your PCOS Bloating and Weight Gain with Diet
Diet for reducing PCOS bloating
Fat digestion
If sluggish bile is a problem for you, there are a couple of things you can do. 1) Focussing on reducing insulin with a low sugar diet, and 2) and adjusting how you eat fats.
How you consume fats
We find that those who struggle with digestive fats do better on plant fats, worse with saturated animal fats, and worse still on processed vegetable oils (also known as sunflower oil and rapeseed oil. Yes these are highly processed). This isn’t necessarily true for everyone but you can experiment.
Spreading your fat intake out across the day can make it easier. So a little fat with every meal as oppose to lots in one sitting.
You need circa 60grams of fats a day, so don’t go fully low fat. This can send your blood sugar (and hormones) haywire. Ideally these recommendations should be personalised, tested for and managed by a professional, so never stay on a restricted diet for a long time without checking in with a professional. We offer free advice HERE if you want to run something past us or have a query.
How do you know if you have problems digestion fats?
See if you feel worse after consuming the following foods:
Cakes and creamy sauces. Anything else with a lot of cream in it. You may suspect it to be dairy but it may in fact be the fattier dairy only
Fish and Chips and other deep fried foods
Lamb stews
For some people oily fish such as salmon and mackerel filets
Gut Bacteria
Ensure you go to the toilet regularly (daily and must be ‘complete’) to keep the gut microbes balanced. If you can’t do this via sufficient hydration and enough vegetables, get in touch and we’ll give you some supplements that can help.
Other than that, your microbiome needs fibre and colourful plants. The How-To:
Fill a third of your plate with vegetables with lunch and dinner
Ensure you go beyond the ‘lettuce and tomato’. There are lots of other veg out there, buy a new one to try every week. Set yourself a challenge.
Stop buying beige. Go for colour! Black sesame seeds instead of white, black rice instead of brown rice, purple grapes instead of white. Frozen cherries instead of cake. Kale instead of lettuce. Polyphenols, compounds found in dark red and purple foods were even found to reduce insulin, Luteinising Hormone, and BMI in women with PCOS compared with placebo in a meta analysis! This is pretty remarkable.
Eat raw/unpasterised Kimchi and sauerkraut. Make your own kefir which is bursting with bacteria. Water kefir if avoiding dairy
Note that if you have severe IBS caused by SIBO or fodmaps, you may struggle a little with increasing vegetables, fermented foods or wholefoods. Get in touch if this is you and we’ll give you some pointers. You’ll likely need a bit of a gut treatment first, which we can’t give generic advise about.
Walnuts, hazelnuts and almonds
PCOS Bloating due to Insulin
The answer to this is a low glycemic diet. We can simplify this to: Less white flour, less sugar, no hidden sugar. Being since lists are useful, here’s a list of foods to avoid:
Bread, excessive white pasta
croissants
pastries, cakes, biscuits, etc
Oat milk latte’s (yup sorry. Can send your blood sugar sky high if you’re sensitive)
Sugar, sweets. A few squares of dark chocolate a few times a week is ok. Don’t eat on an empty stomach
Flavoured (i.e sweetened) yogurts (switch to greek yogurt with berries and nuts)
Sweet drinks! All types including fruit juices. We’re not fan of zero sugar either as this has been associated with obesity and diabetes
Most people need to instead eat more:
Fish and root vegetables such as swede, parsnip, beetroot. Seeds such as pumpkin seeds, sesame. Sprinkle on salads. Baked sweet potato and butternut squash. Choose dark green leaves over pale lettuce. Roast your root vegetables with onions and garlic with a tahini dressing perhaps.
Beans, lentils such as a dahl or lentil soup. Make a ‘rice salad’ with black rice, quinoa and other whole grains. Remember that this may be tricky if you have a significant gut bacteria imbalance as above.
If you’re unable to switch to these foods and they make you feel worse, your digestive health needs attention first. We’d recommend one of our programs that can deal with your digestive issues and PCOS at the same time. Note that health pictures such as these are complex and whilst you may be able to feel a bit better from changing a thing or two, this will not do much to change the underlying issues, which takes a little time to unravel.
Best Supplements for PCOS bloating
Because PCOS is complex, the type of supplements we use in our programs are not suitable for us to recommend generically. PCOS requires a whole-body approach, targeting each persons unique imbalances. Saying that however, some nutrients are cornerstones and it’s a good start:
Zinc - Discount Code: LAG15 (15% off).
Vitamin D - Discount Code: LAG15 (15% off) - supplement from October until you can get some sun in the spring. Ideally test with a home test around Dec/Jan if you’re topped up well in the summer.
Ripe Papaya (make sure it’s ripe. Circa half a small one a day) to increase gut transit if you need. OR, what most people prefer is an easier format that you can also carry with you, and it also really helps digestion overall: Papaya sticks - Discount Code: LAG15 (15% off)
Feeling Confused? Drop us a line with details of your current symptoms and we’ll give you a free assessment.
The Best Tests for PCOS, bloating and Weight Gain
By far, the most relevant test you can do right now is glucose tracking. It’s free if you request a free trial from Freestyle Abbot. Whilst the device is made for diabetics originally, it’s an excellent tool for looking at how well your insulin is regulating your blood sugar and how your diet is impacting your blood sugar/insulin.
If you have already glucose tracked via the Zoe program
GLUCOSE TRACKING SAMPLE
Whilst you may have tracked your glucose already, unless you reviewed your data, the information may not be super useful to you. Zoe reports on a ‘healthy’ scale, but this is simply a comparison to other parts of the population and the US, which as we all know are not necessarily metabolically healthy. We’re not interested in where you sit in the spectrum of the rest of the population. We want to know whether your blood sugar is optimal, whether it serves you well or whether it’s likely to be at a level where it may trigger some of your symptoms.
Want some help with interpreting the glucose tracking data?
Data is the most meaningful when you’re able to understand how it relates to your condition, how you feel and your diet. You will absolutely gain benefit from tracking your glucose anyway, but if you want a professional (real human) to assess your glucose data, you can book a session here.
Other useful tests for PCOS
Option 1.: The Mini Gut Microbes to assess microbiome and pathogens
Option 2: Well Woman Test check up although if you’ve had a recent GP blood test you will likely have had many of these markers checked already. More of a general health check, not specifically for PCOS but could still be useful.
Top of the range option: Functional Blood test. By far, this is our favourite option. Includes insulin, HbA1C and C-peptide - all blood sugar balance markers. This test is just brilliant also at looking at overall body imbalances and we think it’s a brilliant test!
Want to understand how you can help yourself?
Complete our 2minute FREE review to receive your assessment.
More on weight gain, belly fat and insulin resistance
We won’t go into this big topic in this article, but the health and status of your insulin and blood sugar is a huge factor (and the most common we would say) in weight gain that ‘keeps on creeping’, and you can read more about this topic here:
Why i recommend everyone tracks their glucose for two weeks, and watch their health issues melt away
Get Unstuck With Your Weight Loss in Just a Few Guided Steps
Learn why you can't lose weight, despite fasting, Zoe or keto
A Success Story
A Success Story S.B, Female Aged 32 with chronic constipation, sugar cravings, on/off ‘puffyness’ and low mood
Female aged 29 with significant hair loss, GP suggestion of PCOS but no cysts identified. Zoe glucose tracking revealed ‘normal’ glucose, however on re-testing baseline glucose (blood sugar) appeared higher than optimal, and we worked with the diet to improve this. This client was vegan, so choosing the right type of carbohydrates in the right balance with other macro nutrients was key.
Her digestion was not great, with bloating and constipation. She experienced pain in the gallbladder area and behind the right shoulder after some meals (of course this should be investigated by a GP). Phosphotidylcholine for 14days significantly improved the discomfort. The constipation was dealt with via diet and supplements, and ongoing client maintenance.
The outcome
Periods gradually returned to a 28day cycle after circa 3-4 months of working together. The bloating was reduced to 10% with occasional flairs. The client was set up with how to continue to work on her gut health herself so she can continue to improve and protect her digestive health going forward.
Conclusion
PCOS is a highly complex and individual syndrome, that requires a whole-body and personalised approach. Bloating is commonly experienced, and the way to address it depends on what’s going on for that person. Tests can be really helpful, highlighting areas that need the attention and creating a clearer path of approach and the right diet.
How we could help you regain control of your PCOS symptoms
We’re here to help, whether you just need some pointes for your own research, a full handholding programs that moves you forward, and just someone that listens, we’re here for you :).
Where to start?
