Losing weight with PCOS is hard to do, yet it's one of the first things that a doctor will recommend to help improve symptoms and fertility. Understanding metabolism, BMR and unique advantages related to PCOS can help set a course of losing weight successfully and increasing your metabolism for the long term.

[00:00:00.650] - Caitlin Johnson, RD

Welcome to the PCOS Answers Podcast with Caitlin Johnson, your functional medicine dietitian. This podcast is a private podcast only available through the PCOS app. It will provide practical science-based answers to all of your PCOS questions, and every episode will leave you with something you can do today to help your PCOS. I'm so glad you're here right now, in real-time, as I'm recording and releasing this episode. It's just fresh into the new year.

[00:00:30.410] - Caitlin Johnson, RD

It's early January, and if you're anything like most of the world, you may have set some health goals for this upcoming year. And usually, that revolves around or has some sort of goal related to weight loss. This is also something that's particularly relevant in the PCOS crowd because it's usually a main method of treatment that is prescribed to us. Your doctor tells you that you have PCOS, he offers you a prescription for metformin, potentially birth control, and then he tells you if you lose weight, your cycle will improve, your symptoms will improve. And while he's not wrong, if you lose weight, your cycle and symptoms can improve and even your fertility can improve.

[00:01:15.250] - Caitlin Johnson, RD

Weight loss is actually something typically pretty hard to come by for somebody with PCOS, and it's usually not any type of news flash that we need to lose weight. And we've typically tried all the things to lose weight. So I want to start into a multiple-episode series on weight loss with PCOS, and I want to start with talking about metabolism. I recently published a new blog article, a health article within the PCOS app called Increasing BMR. It's one of the best ways to lose weight with PCOS, and this is really true.

[00:01:50.610] - Caitlin Johnson, RD

But let's go over just some of the basics. If you're somebody with PCOS, you've probably thought sometime in your life, why is it just so hard for me to lose weight? I really feel like I have a much slower metabolism than other people. For me, when I was diagnosed with PCOS, I should have been losing weight. But instead, in about a three month period, while training for a half marathon and running 25 plus miles a week, I had gained £60.

[00:02:20.080] - Caitlin Johnson, RD

And it just did not make sense. If a metabolism was going to work and calories in and calories out mattered, then I should have actually lost weight in that period of time, not gained it. So in medical terms, the metabolism is basically the process that your body uses to change food or drinks into energy. Calories and metabolism are often kind of talked about an interrelated. I don't want to say interchangeable, but in kind of like a codependent way.

[00:02:52.950] - Caitlin Johnson, RD

So I want to define calorie too. Calorie is just a unit of measurement. We could honestly call it anything. We could call it I'm looking out my window right now. I could call it a tree, I could call it a box.

[00:03:05.340] - Caitlin Johnson, RD

I could make up a word.

[00:03:09.290] - Caitlin Johnson, RD

What is that? Well, it's a calorie. It's a unit of measurement. It's a way for us to say this food has this much energy in it, or you require this much energy to just continue surviving. If you don't eat for a great period of time, your body will no longer work.

[00:03:26.920] - Caitlin Johnson, RD

It will use all of its resources up, and then it will die. So we need to eat energy, and the energy that we measure is calories. So when we talk about metabolisms, we're usually talking about how much calories does our body burn in a day? We often talk about eating to either meet our calorie requirements or to offer something called a calorie deficit, where we eat underneath the energy that our body needs to survive and do the activities that it does. This is literally how people prescribe weight loss.

[00:04:01.860] - Caitlin Johnson, RD

They say, move more so you increase your metabolic needs, how many calories you should be eating, or eat less. So your body activity should remain stable, but you're eating less, so you're having less calories to perform the same amount of work for your body. Now, the problem with eating less and moving more is that your body knows how to adapt. It's very good at that. Its primary goal is to keep you alive, keep you living.

[00:04:32.120] - Caitlin Johnson, RD

Its primary goal isn't to add muscle. Its primary goal isn't to reproduce first. You have to stay alive to do any of those other things. Okay? So it will adapt to a decrease in how many calories you're eating.

[00:04:47.940] - Caitlin Johnson, RD

It will adapt to an increase in the amount of fiber that you're eating. Which fiber has calories in it? We just can't really break those apart and use them ourselves. It will adapt to increases in energy, and so it will try to become more efficient in any body process that it can to use less calories to do that same body process if you're moving more and not eating more. So I want to talk a little bit about this term BMR.

[00:05:17.890] - Caitlin Johnson, RD

BMR is really just an expression of how much energy it takes for you to do all the body processes you have to do while you're at a full rest. Okay? So you're still breathing, your heart is still beating. You have to maintain a certain body temperature. Your fingernails will grow while you're at rest.

[00:05:38.480] - Caitlin Johnson, RD

Your hair will grow while you're at rest. Okay? It takes about 60% to 70% of our total calorie intake just to maintain our basal body needs. Okay? But your BMR is not how many calories you're burning in a day.

[00:05:56.150] - Caitlin Johnson, RD

There are three things that contribute to how many calories you burn in a day. And your BMR is just one of those three. The other two are your physical activity and something we call the thermic effect of food. It sounds super sciencey, but it's actually a pretty simple thing to understand. I'm going to start with the thermic effect of food.

[00:06:17.290] - Caitlin Johnson, RD

This accounts for about five to 10% of the calories that you actually burn in a day. Calories are just a measurement. We just call them calories, okay? Your body needs to work to get that energy, though. Your body has to break apart the food, grab the nutrient, send them around your body.

[00:06:38.350] - Caitlin Johnson, RD

It has to get the food into your mouth, and you have to chew. You have to then swallow. Your stomach has to kind of squish the contents around and mix it with gastric juices and then send it into your small intestine, where it gets broken apart and then passed over into the cells of your small intestine and then into your circulation. That takes a lot of work. It takes energy to do all of that.

[00:07:01.660] - Caitlin Johnson, RD

Even though you're getting energy from your food, it takes energy to break that apart. Have you ever heard the term that celeries have negative calories? They aren't negative calories. They actually have calories in them. It just takes your body more calories to break them apart than it does like what you're actually going to gain from the celery itself.

[00:07:23.870] - Caitlin Johnson, RD

Now, this is not me advocating that you should just eat only Celery because it'll take your body a lot of work to eat it and get the nutrients from it. And that, in and of itself, will put you into calorie deficit. Celery is great. Super great. Super tasty.

[00:07:39.210] - Caitlin Johnson, RD

I love it with peanut butter on it. It's no longer a negative-calorie snack. However, it just goes to show you this idea of the thermic effect of food. It costs money to do work. It costs calories to get the calories and the energy from your food and distribute it around your body.

[00:07:59.530] - Caitlin Johnson, RD

Now, physical activity, makes up 15% to 30% of your total energy expenditure in a day and your total energy needs in the day. So you walk to your car, you carry groceries in, you pick up a small child, you go for a run, you do some weightlifting. Physical activity doesn't just mean exercise, okay? This is the area that most people tend to focus on when they're trying to lose weight. It's either eat less or move more.

[00:08:30.530] - Caitlin Johnson, RD

I want to pose to you that we should actually also be focusing on your basal metabolic rate. So this is the third piece of the pie, and it takes up 60% to 70%, sometimes 75% of your total energy needs for survival. So since this is the biggest portion, one very smart question would be, how can I increase this? How can I make this spend cost more so that the calories that I'm eating, takes up a bigger portion of them? How can we increase your BMR?

[00:09:05.210] - Caitlin Johnson, RD

Now, one of these ways you'll have probably heard before, and one of these ways you actually may not have, one of the most efficient ways to increase your BMR is to increase how much muscle you have. Muscle requires a lot of energy okay? It takes in more calories than fat tissue does. So if we can increase your lean body mass, your muscle tissue, we can make your body require more calories to just maintain its own body composition and its own needs. Now, you actually have a really great advantage for improving or increasing your lean body mass.

[00:09:45.480] - Caitlin Johnson, RD

And that advantage is testosterone. Testosterone helps signal that you can create more body mass. It's partly why men have more muscles and gain more muscle more quickly and more easily than women do. They tend to have more androgens, well, this thing that becomes a major hurdle and symptom driver and frustration in PCOS, we can actually use it to our advantage in this one particular way and help signal that it's okay and safe too. While we're strength training and doing weight resistance type activity, we can increase our lean muscle mass and increase our BMR, increasing our total metabolism.

[00:10:27.370] - Caitlin Johnson, RD

The other great thing about strength training is that we're using that testosterone. And so that testosterone kind of gets flushed through our system more easily. So the more strength training exercise that we do, the lower antigens we actually have. And there's another mechanic to that in that as we increase our lean muscle tissue, we actually can become more insulin sensitive. And as that happens, our liver makes more of a protein called sex hormone-binding globulin, which can grab hold of androgens and kind of turn them off.

[00:10:59.400] - Caitlin Johnson, RD

So strength training and increasing lead muscle mass can actually improve androgen levels in multiple ways. The other way that we can increase your BMR is to eat more. Now, that's a shocker to you, I bet, because as you decrease your caloric intake, your body tries to become more efficient at doing its job. If you eat less, your metabolism slows down. Period, end of story.

[00:11:27.210] - Caitlin Johnson, RD

If you eat slightly more. Now, I'm not saying like, go eat an extra hamburger and milkshake at the drive-through, but if you eat 150 calories more every single day, not adding 100 to 150 calories more every single day. So today's 150. Tomorrow is 300. Now, if you just increase by 150 calories for the next month or so, you actually may not gain any weight, especially if you're doing some sort of regular physical activity.

[00:11:57.180] - Caitlin Johnson, RD

Your body will say, hey, there's more energy available. Let's just be a little bit more efficient with it. Now, there are people on Instagram that are, I see it every day, eating less. And a calorie deficit can't not work here. That double negative.

[00:12:13.440] - Caitlin Johnson, RD

It can't not work. It will always work. Calorie deficits will work until your metabolism meets your input. Okay? So you could cut 500 calories from your intake today.

[00:12:25.790] - Caitlin Johnson, RD

You could eat less, and that would work for weight loss for a period of time. But eventually, your body will adapt and become more efficient at the processes that it's trying to do. Because there's less energy available, it doesn't feel safe. So it's going to kind of down-regulate everything. One of the ways that it does this is through thyroid hormones and once this happens, it's really difficult to reverse.

[00:12:51.180] - Caitlin Johnson, RD

So dieting can actually have a really negative impact on your metabolism overall. So if we can instead focus on strength training and body composition changes in increasing your BMR without a major decrease in calorie intake, we can have long-term sustained weight loss or weight stability at a healthy weight for PCOS. One concern that I hear from women with PCOS is that strength training is going to make them really bulky. And this is a huge misconception in kind of the fitness and health industry at large. It takes a massive level of strength training exercise, very small amounts of carbohydrates, and just a lot of toning and zeroing in on physique training to obtain kind of that muscle mass like a woman bodybuilder.

[00:13:51.530] - Caitlin Johnson, RD

It takes so much protein intake as well. And I am a huge advocate of increasing your protein. I'm talking about hundreds and hundreds of grams more protein than I would ever recommend to someone with PCOS to build that type of muscle tissue regularly two to three times a week. Strength training with moderate amounts of weight that are still difficult for you are not going to turn you into this huge hulk type body physique. In fact, as your body uses the testosterone in the system and hormone levels change and improve, you will have over time lower levels of androgens and it's less likely for you to continue building that high level of muscle tissue.

[00:14:37.010] - Caitlin Johnson, RD

Many women bodybuilders with that kind of look that so many people are concerned about having, are actually doing things for their hormones to increase androgens to be able to obtain that type of physique. But I will say, I think in general, we should be really excited about adding strength as women mental strength, emotional strength, mental emotional flexibility, but particularly physical strength and metabolic strength. And that is really improved by increasing BMR and increasing your lean muscle tissue. So let's look at that as an advantage and something that's working in our favor rather than being something that we're really trying to avoid or are kind of staying away from strength training because we want to avoid that specific look. One of the most efficient ways for you to increase your BMR is to strength train and focus on large muscle groups.

[00:15:40.580] - Caitlin Johnson, RD

So think of the muscles from your shoulders to your knees, both on your front and backside. These are the largest muscle groups that you have and they require the most amount of energy or calories. That doesn't mean that you shouldn't do things like a bicep curl or focus on functional strength and movement, but lifting weights and using the big muscle systems that you have. So do squats with a little bit of weight resistance or just start even with your own body weight. This is a great way to increase muscle tissue in those larger muscle groups and become more metabolically strong, having a higher metabolism.

[00:16:25.690] - Caitlin Johnson, RD

I really believe that working with experts in the realm of physical fitness and strength training is not just imperative, it's essential, especially if you want to avoid injury. So if you can, and if your budget will allow, or you have a friend that might be an expert in one of these areas, having somebody help you with your form, spotting you in exercises, can be really helpful. So that you can have a length of journey and not jump straight into weightlifting and then really hurt your knee or your hip or your shoulder or something. So I spoke briefly about increasing your BMR. Also has something to do with something outside of exercise that food matters too, and over-restricting calories can have a negative effect on this.

[00:17:18.220] - Caitlin Johnson, RD

But I want to focus a little bit on protein. You cannot build tissue out of nothing and you cannot turn fat into muscle. That doesn't work. You lose fat, you gain muscle. They don't come from one to another.

[00:17:31.010] - Caitlin Johnson, RD

You can pull blood sugar from fat tissue. It's an incredibly inefficient process. And your body will try to improve your blood sugar levels using other things first, if it can. But your body, to create lean muscle tissue, needs to be eating adequate protein. And when I say adequate protein, if you're doing strength training, it's probably more than just like a palm size of protein three times a day.

[00:17:55.450] - Caitlin Johnson, RD

You're going to need to really be focusing on protein at snack times, maybe even including something like collagen or a protein shake into your day. And this can help with blood sugar balance too. But if you are doing a lot of strength training and undereating and under-eating protein specifically, you're not going to build muscle tissue. Your body is going to be incredibly stressed and it's going to start pulling from stores and nutrients that you don't want to mobilize. So increasing your protein intake, if you're starting to increase strength training, is incredibly important.

[00:18:27.810] - Caitlin Johnson, RD

And you will see as these things shift and your body composition changes, this will impact insulin resistance and it can lower androgen levels can also help you feel more satisfied after eating because adipose tissue, as you decrease it, your body is more receptive to leptin. And leptin is that hormone that tells you, I'm full, I'm satisfied, they don't need to eat anymore. And so many of us struggle with cravings that are related to high levels of insulin, blood sugar, irregularity and leptin levels, and a level of leptin resistance. And if we can improve our BMR, we actually see this kind of metabolic abnormalities that are not so great with PCOS improve. Now, there are lots of factors that affect your BMR that you can't change.

[00:19:16.530] - Caitlin Johnson, RD

You are female, you are the age that you are. We can't go back in time. We can't control your genetics. We can't even control whether you have PCOS, but we can use that to our advantage when we're talking about our BMR. So as people age, our androgen and our specifically our testosterone levels decline.

[00:19:37.030] - Caitlin Johnson, RD

Whether you're male or female, this happens. And as those levels decline, so does our lean muscle mass, which is our most metabolically active tissue. As people age, they also tend to become less active, and that also impacts our total metabolic burn. But when we're talking about our BMR, it's this lowering of androgens lowering of lean muscle mass that impacts our BMR. So if we want to go into our later years in our aging process, the most metabolically active, we'll be able to maintain a metabolism for a much longer period of time.

[00:20:13.350] - Caitlin Johnson, RD

Having a higher metabolism going through perimenopause into your menopause and postmenopausal years into aging can be incredibly helpful. Like, you want to start high if we're going to start removing from it, you don't want to start with a 1200 calorie diet going into those years, and then that slowly decrease. It's going to be very difficult. So increasing in our metabolism can be really helpful. Now, this question that we began with or this thing that you may have been thinking about your whole life, like, do I have a slower metabolism than other people?

[00:20:46.990] - Caitlin Johnson, RD

You actually likely do. If you spent your entire life feeling like you don't burn calories, like your friends, like you look at pizza and you gain weight and they look at pizza and they stay stable, you're not wrong. So there's one study in particular that looked at 128 women that had PCOS and 72 women that didn't. And they controlled for things like body mass index, and they found that women with PCOS had a significantly lower basal metabolic rate compared with those that did not have PCOS. It was also interesting in that particular study, they also looked at skeletal mass in lean body mass, and those were actually lower in women with PCOS.

[00:21:28.990] - Caitlin Johnson, RD

Now, you may hear that and go, I thought you just told me that testosterone can help me gain muscle. Well, it can, but without activating that testosterone with strength training, it will not do it just on its own. In one study from 2009, it was found that women with PCOS have an average BMR. So this is your basal metabolic rate, not your total metabolic berm that people with PCOS that also have insulin resistance average a BMR of about 1116 calories. A person with PCOS that didn't suffer from insulin resistance had a BMR of about 1590 calories.

[00:22:10.770] - Caitlin Johnson, RD

So almost 500 calories more compared with somebody without PCOS that had a BMR of about 1868 calories. So a person with PCOS that has insulin resistance now, which makes up 60% to 70% of us, has about 750 fewer calories in their basal metabolic rate than somebody without PCOS. That is a huge difference. So if you and your friend look at the same pizza and eat it. And your friend doesn't have PCOS and you have insulin-resistant PCOS, yes, that is more likely to yield weight gain if it's consumed in a diet that overall is more calories than you need to exist and survive.

[00:23:02.330] - Caitlin Johnson, RD

As we diet, over time, our BMR will also decrease. And since women with PCOS are prescribed weight loss and tend to struggle with their weight and have tried many multiple diets in their lifetime, that can also impact your BMR and your ability to lose weight. Let me explain why. When you lose weight, you don't just lose fat, you lose lean muscle mass, too. So if Sally tries to lose weight and she's £200 and she loses £10, some of that was lean muscle mass might be two and a half to £3, £2, maybe water, maybe five or so pounds of fat.

[00:23:45.110] - Caitlin Johnson, RD

Well, let's say Sally goes back to her normal way of eating after this diet ends because she gets frustrated. It's not working anymore because her metabolism is downshifted. Well, now she weighs £190, let's say, but she, over time, is going to gain weight because she's eating more than she was before, and her metabolism is lower. But as she gains weight, she's not going to gain back the exact amount of lean muscle mass that she did, plus the fat tissue. More of it's going to come in as adipose or fat tissue.

[00:24:17.340] - Caitlin Johnson, RD

So at that same £200 after she dieted and returned to that weight, her body composition is not as favorable metabolically, okay? She has more adipose tissue and less lean muscle mass, so she's not going to burn as many calories at rest. Multiply that by two diets, three diets, and one diet a year between your twenty s and thirty s, and we can leave ourselves in really poor metabolic states. So impacting your basal metabolic rate, trying to increase it can be really helpful. If you want to calculate your basal metabolic rate, there are ways to estimate this online, and I spent much of my dietetic internship doing calculations like this.

[00:25:02.450] - Caitlin Johnson, RD

One of the most popular equations is called the Harris-Benedict Equation. But if you just Google BMR calculators, you'll find different options for this. If you have access to a university or a teaching hospital near you, there may be more accurate ways for you to tap into this information. Where it's not really an estimate. It has much more to do with your own body composition or a way for us to kind of estimate that or calculate it based on how much oxygen you're taking in and how much CO2 you're releasing.

[00:25:35.730] - Caitlin Johnson, RD

But things like a DEXA scan or using a Bod pod or even indirect calorimetry where you kind of lay down in a resting state and you're breathing through a tube and they calculate those things, you can get a fairly accurate calculation of your metabolic rates. Now, if you have access to a health club, a gym, or even a dietitian near you. There is also another way with bioelectrical impedance analysis. Probably the fanciest machine out there is called In Body. You stand on it and you hold onto these things and it sends kind of frequency through your body and calculates how much lean muscle mass, how much fat mass, and how much water is there.

[00:26:21.130] - Caitlin Johnson, RD

And then based on those things, it calculates kind of a caloric burn. Those are usually a little bit easier to get to. The machines are really expensive. So a lot of times if you're at a fancy gym, they might let you do a scan on it quarterly or even monthly as a part of your membership fee, or if you're doing personal training. But a lot of times those gyms will let you pay $20 or $30 and just walk in and have somebody help you run that scan.

[00:26:46.710] - Caitlin Johnson, RD

So that is an option that you could do. Now, I don't really think it matters that much that you understand exactly how much you're burning because I don't advocate that you count your calories and it doesn't really matter how much you're burning. If we increase your lean muscle mass, you'll burn more and that will leave you in a better metabolic state. And I really do believe you can tap into eventually your hunger cues and inability to keep weight maintenance just based on what you learn about your body, how you control your cravings, how you improve your insulin resistance, weight loss, and improve your BMR. But you will find that as you increase your BMR, you're not just going to enjoy something like weight loss or body composition change, you will see that your symptoms improve too.

[00:27:34.660] - Caitlin Johnson, RD

So if we zoom out and look at the bigger picture, there's more at stake than just weight loss. You can actually see hormone levels improve, reproductive organs turn back on cycle regularity, less acne, less hair loss, less hirsutism. So enjoy the benefits of what? Strength training and eating enough protein and eating enough calories for an increase in muscle mass and increase in BMR, thereby allowing you to also see the benefits in your PCOS symptoms and PCOS management and your long-term weight maintenance and metabolism as you age. Because these things aren't just important to see improvement in mental health, how you feel about yourself, and self-esteem, it also matters as you age.

[00:28:25.890] - Caitlin Johnson, RD

And things like cholesterol levels are important or inflammation levels are important, fatty liver disease, avoiding diabetes, et cetera. We want to impact those health parameters and conditions as well. And it's not just about having big muscles when you flex. It's not just about doing a pull-up. It's about being strong, metabolically healthy, and hormonally healthy.

[00:28:50.900] - Caitlin Johnson, RD

So I hope this episode was really helpful for you. We're going to dig into some other topics surrounding weight loss over the next few weeks. And I hope you'll stay tuned because I have a lot of really helpful, compelling information coming at you.

Ep 11: Metabolism, BMR and Weight Loss for PCOS