Special Considerations: Nutrition and Exercise for PCOS Belly

The belly is a popular part of the body that drags women to the gym, especially women who are frustrated with their PCOS.

I have met so many women who had become completely hopeless in their fitness journeys because of the setbacks that came with their PCOS-the main one being the struggle to lose weight and keep it off.

When dealing with PCOS, the first thing a woman may notice is that typical fitness trends will not work and may actually even cause unwanted weight gain.

The next thing that you may notice is how many people are not really familiar with what needs to be done to help someone with PCOS meet their fitness goals.

This is where I come in to give you the simple truth…

You can meet all of your fitness goals, but you need to take your journey slower than most people would and not try to force the same amount of intensity that you may see other people doing.

I know it almost sounds too simple, but the simplicity is honestly part of the problem.

With the fitness industry promoting fast results by way of crash dieting and unhealthy exercise habits, it is really hard to get people to understand that the best way to meet your fitness goal is to slow down, listen to and respect your body.

This is extra important and applicable to people with PCOS.

My goal is that after you read this blog you feel more confident in your ability to listen to your body and approach your fitness journey with a more integrative mindset.

To help you with this, this is the information that I’m going to be reviewing in this blog:

What is PCOS?
Why is belly pooch common in PCOS?
How can I manage inflammation in the diet?
How can I eat to reduce body fat?
Lifestyle changes for PCOS
Exercises for PCOS belly
Personal trainer PCOS

This blog is already going to be so full of information, so anything extra that I may have for you I will link throughout and I will recap all of that information at the bottom.

Now let’s get into helping you meet those fitness goals!

What is PCOS?

PCOS Definition

PCOS is an acronym for polycystic ovary syndrome.

This is a condition specific to people with uteruses, and can develop at any point in a person’s life.

The most common symptoms associated with PCOS cysts on the ovaries and irregular menstruation.

Uncontrolled PCOS often results in an inability to maintain a healthy body weight and fertility issues.

How PCOS Happens

PCOS is the result of a hormone production imbalance.

A person with PCOS will produce unusually high Androgen hormones, which are commonly referred to as male sex hormones because they tend to be higher in men than women.

The higher production of these hormones often leads to symptoms such as:

Growing facial and or body hair
Losing menstruation or having only a few periods a year
Experiencing extreme inflammation and sometimes pain between the hips
Uncontrollable hunger signals and a very difficult time losing weight
Low adaptability to stress and poor mood control

As is indicated by the name, this condition is also notorious for the production of ovarian cysts which can contribute to inflammation, pain, fatigue, and an inability to endure stress.

Why is Belly Pooch Common in PCOS?

What is PCOS Belly?

PCOS belly, also commonly referred to as the fupa, is essentially the part of the belly between the hips that is above the pubic area.

It is common in my experience for women with PCOS to direct attention to this area first when talking about fitness goals.

This is because people with PCOS tend to have a bulbous and firm belly area.

It often pokes out to the front a lot, and it is also uncomfortable to wear clothes on top of so these women might be especially uncomfortable in high waisted clothing.

This PCOS belly is partially related to fat gain, and partially related to inflammation of the ovaries, uterus, and hip area.

What causes inflammation?

PCOS is known to cause general total body inflammation, with emphasis on inflammation of the female sex organs.

Because PCOS also tends to come with an imbalance in gut health, it can also cause inflammation of the intestines as well.

Please get more information on gut health in my gut health blog.

Things that can exacerbate the inflammatory response in people with PCOS:

Eating inflammatory foods
Physically overexerting the body
Irregular or inadequate sleep schedules
Lifestyle stress
Illness or infection
Food sensitivities and allergies

What causes fat gain?

At the end of the day, fat gain happens because you have consumed more calories than you have burned.

Unfortunately with PCOS and similar conditions, this does not always translate directly into try to eat less and move more.

Here are some considerations when pondering what causes fat gain in people with PCOS:

The chronic fatigue can make maintaining regular activity very difficult, which can then slow the metabolism and further reduce energy levels.
The high sensitivity to stress can affect insulin levels and energy usage- this often puts people with PCOS at higher risk for diabetes.
The gut health and hormone imbalance often causes disrupted hunger and fullness signals. People with PCOS might not feel normal signals for hunger or for fullness, which causes irregular eating habits.
The effect of this hormone imbalance on the moods and the mental health tends to be substantial and effect motivation to adhere to a fitness journey.

In my experience, people with PCOS often continue to gain weight, or their body just refuses to lose weight until they find some sort of balance with their condition.

How Can I Manage Inflammation in the Diet?

Inflammation is the first thing that I like to address with PCOS clients because it is usually the symptom that is most in the way of our ability to increase intensity.

Once we can find a way to manage the inflammation, we can then gently encourage the body to adapt to more controlled stress to build conditioning.

Inflammatory foods to avoid

Typically I am not one to start anyone’s nutrition habits with restrictions.

I feel that restrictive eating is not the most mentally healthy approach, but in the instance of people who are dealing with PCOS it is definitely the first thing that needs to be approached for their own safety.

They are all foods that are known not only to cause inflammation but also to contribute to hormone imbalance.

In consideration of your own safety, if you have PCOS I recommend that you avoid:

A surplus of animal products and especially dairy products which are known to be riddled with additives and hormones.
Foods that are high in processed and simple sugars, such as cookies, brownies and ice creams.
Foods that are deep fat fried or high in trans fats.
Sugar-free sweeteners which are known to contribute to the risk of diabetes.
Processed foods and especially those that are high in sodium and preservatives.
Foods that you know you have a sensitivity to, or have observed that they make you bloated or feel inflamed.

You may on occasion consume some of these products and that is okay, but they should not be a part of your daily diet.

*Whether you have PCOS or not these are some general nutrition recommendations that I feel everyone should take*

Hydration

In my experience, people with PCOS can have a hard time remembering to drink water because of feeling so bloated.

Sometimes they find themselves actively avoiding drinking water: I have been told by clients with PCOS that they might feel sick when trying to force themselves to drink water.

If this is the case, I recommend speaking with your doctor and implementing more natural diuretics into the diet where possible.

If a client is not feeling sick but still just not remembering to drink water, I might make a few of the following suggestions:

Keep water readily available at your desk or in your workspace
Try splitting your water intake into multiple smaller bottles a day and add a little fruit to each bottle to flavor it a different flavor
Drink from one large bottle that has all of your daily water supply and set alarms in your phone that indicate how much water you want to have finished by a certain time
Start and finish every day with 20 oz of water
Drink a glass of water every time you do something else that is regular in your day such as using the bathroom or taking a lunch break

The goal is to at the very least not allow yourself to get dehydrated despite feeling less signals for thirst.

Anti Inflammatory foods to add to your diet

There are many foods that are known to naturally help reduce inflammation that can be easily added to the diet for people with PCOS.

The serving size for each of them varies, and there are multiple ways to apply these ingredients to your food so take some time to do a little extra research.

Here’s a list of some of the most popular anti-inflammatory foods:

Turmeric
Cocoa
Ginger
Leafy green vegetables
Seeds and nuts
Dark red fruits and vegetables
Avocado and avocado oil
Olive oil
Fatty fish

Most of these foods should be accessible to everyone year-round, and there are various ways to apply them to the diet and meals, snacks and even beverages.

How Can I Eat to Reduce Body Fat?

Nutrient timing

Nutrient timing is something that I preach every chance I get.

Nutrient timing is simply the idea of eating balanced snacks or meals every two to four hours or on an organized timing schedule to ensure that you are consuming a steady flow of nutrients throughout the day.

The reason that I speak of nutrient timing so often is because it is very common for all women to do the alternative, which is to not eat all day and then sit down to a large meal at the end of the day.

I personally believe this to be related to the typical female conditioning that teaches a woman to put everyone else before herself.

Whatever provokes this habit, this habit can put a woman at a higher risk for imbalanced gut health, diabetes and hormone imbalance.

Considering that these are things that people with PCOS already deal with, it makes sense to avoid any habits that would further contribute to this.

Eating on a regular schedule will also help your body boost your metabolic rate to encourage more fat burn.

Calorie intake

The general recommendation for weight loss is to eat in a caloric deficit as that is what is going to cause your body to burn fat.

Again, because people with PCOS are so sensitive to stress, this is another place where general recommendations may not be the full information needed to achieve weight loss.

Most people who are looking to lose weight are suggested to eat in a caloric deficit of 200 to 500 calories a day.

People with PCOS however, are encouraged to eat at maintenance calories, or eat what they burn each day, and swap out ingredients to increase the nutrient density of the calories that they consume.

Once you are able to increase the controlled stress on your body, you can start with up to 200 calorie deficit a day and see how it feels for your body.

I never recommend that a client with PCOS go over a daily caloric deficit of 200 calories because of the risk of stressing out their body.

I encourage a slow and patient weight loss approach for clients with PCOS.

As an anecdotal observation I will offer this:

I have noticed in my clients with PCOS that they will often start to find regulation in their menstrual cycle during their fitness journey.

When they first start menstruating regularly and predictably, they often feel the phases of their cycle pretty intensely.

I have described feelings of phases of the menstrual cycle in last week’s blog, How Your Menstruation Affects Your Fitness.

This is relevant to caloric deficit because I have noticed it to be a necessity with my PCOS clients as they start menstruating again, that they cycle their fitness habits with their menstrual cycle.

This means that at some point of the cycle they may naturally eat in caloric deficit without being prompted to, and that at other parts of their cycle they may eat in a caloric surplus based on what their body is asking for.

I always encourage attention to be put on nutrients (instead of calories) and respect for their body signals.

Macronutrient balance

Macronutrients are the nutrients that we consume in the largest quantities.

The three macronutrients are protein, carbohydrates and fats.

The specific amount of each that you should consume each day is unique to you and your lifestyle and activity levels.

What you should know is that you need to aim for balance between all three of these macronutrients and good quality sources of these nutrients.

It is common in the fitness industry for people to try to completely remove an entire nutrient from their diet such as low-fat diet or keto, which is a no carb diet.

The application of keto to PCOS somewhat makes sense, due to PCOS causing sensitivity to sugar.

It is, however, an unnecessarily dramatic diet to take for PCOS.

The truth is that some carbs can actually be very beneficial to people with PCOS, but because the keto diet villainizes all carbs, you will miss out on helpful nutrition by following keto.

The low or no fat diet is an outdated diet that was once popularized with the rationale that if you didn’t eat fat you wouldn’t have fat on your body.

The reality is that a low to no fat diet causes depression, hormone imbalance, nutrient deficiency and many other problems that contribute to fat gain.

So instead of following a diet trend that asks you to remove an essential nutrient, eat healthier sources of all macronutrients in the following guidelines:

10 to 35% of your daily calories in protein
20 to 35% of your daily calories in fat
45 to 65% of your daily calories in carbohydrates

If you need help figuring out what types of carbohydrates are good for you to eat with PCOS, check out my Carbohydrate Blog.

Lifestyle Changes For PCOS

Organizing your sleep schedule to manage PCOS

Sleep is an important thing to regulate for people with PCOS because they are often very fatigued but their sleep schedule can get so off-kilter that it disrupts and stresses out other parts of their lifestyle.

Having a relaxing bedtime routine is helpful to making sure that you get to sleep at a healthy time every night.

A bedtime routine can include any of the following and more:

Turning off screens
Reading a book or magazine
Taking a bath or shower
Stretching
Meditating
Listening to relaxing music

Getting to bed around the same time every night is going to help your body create a sleep schedule that will give you the energy to do the workouts necessary to reach your fitness goals.

By prioritizing your body’s ability to rest and heal, you are going to accelerate your progress towards your fitness journey.

Reducing stress for PCOS

Stress is one of the biggest things that can exacerbate the symptoms of PCOS.

This can be physical stress as well as emotional, mental, workplace or any other type of stress.

Because of this, you will notice that stress relief is one of the most commonly talked about things in PCOS.

Helping yourself find ways to manage your stress levels before it impacts your body is one of the most beneficial things that anyone can do for their health whether they have PCOS or not.

Try some of these popular stress relief techniques to help keep your stress levels low:

Remove yourself from stressful situations where possible
Partner up with a mental health professional so that you can have someone to vent to and someone who can provide specific coping mechanisms to you
Make it a point to go outside and be with nature to ground yourself
Be weary of your caffeine intake as that can increase your stress
Do breathing exercises as you feel stressed out or as needed
Do guided meditation as needed
Do deep stretching whenever you feel overwhelmed
Listen to affirmations or music that makes you happy to boost your mood
Journal or vlog to get things off your chest

Really anything that helps you feel like you are letting a huge weight off of your chest can be considered a stress relief technique.
So, just because it’s not on this list, that doesn’t mean that you can’t go axe throwing as a way to relieve stress.

Medical check ups

Medical checkups for blood work analysis and potential medication adjustment are essential with any medical condition, and PCOS is no exception.

You and your doctor should have something of a schedule by which you plan regular check-ups, and if that is not already set you can ask them to do so for check-ups every 6 to 12 months at least.

This will give you the opportunity to see how your habits are affecting your health and potentially reduce medication if possible.

Exercises For PCOS Belly

Exercise intensity and progression

As I mentioned above, exercise intensity for people with PCOS is something that needs to be handled with care.

Exercise intensity for people who are not conditioned and have PCOS needs to start very low, to the point that you should not have any muscle soreness after a workout.

The initial focus should be on building stability around the joints and mobility, especially around the hips, so that everything moves in the way that it is supposed to with the stability it needs to prevent injury.

After about six to eight weeks of this, it is usually okay to increase intensity for endurance training, which will teach your body how to withstand more time under tension.

After another six to eight weeks you may assess the potential for moving into strength training if that is in line with your goals.

If you need more time in any one phase, that is completely okay-let your body talk to you and tell you what it needs…listen to it so that you can meet your fitness goals.

Exercise duration and frequency

The duration and the frequency of the workouts that are performed by people with PCOS could be cyclical.

This is called periodized training and is basically the process of tapering the training intensity and frequency up and down over the course of 12 or more weeks, so as to improve performance without overtraining.

To help you better understand, check out this timeline example of a 6-month program:

(Weeks 1 – 4) 30 minute workouts – 3 times a week – one day of stretching
(Weeks 5 – 8) 45 minute workouts – 3 days a week – one day of stretching
(Weeks 9 – 12) 45 minute workouts – 3 days a week – one day of stretching – one day of mobility exercise
(Weeks 13 – 18) 60 minute workouts – 3 days a week – one day of stretching – one day of mobility
(Weeks 19 – 24) 60 minute workouts – 4 days a week – one day of stretching – one day of mobility

This would obviously vary wildly from person to person, but you can easily see that we have started with 30-minute workouts just a few days a week and gone up to 60 minute workouts 4 days a week with two additional functional days, creating a full and normal gym schedule.

As excited as you may be to start your fitness journey off with a it is actually more conducive to success that you start slow and taper up your intensity.

Exercise modalities

An exercise modality is basically the style of workout.

Examples include weight lifting and cycling.

Because of the reactiveness to stress, people with PCOS will probably want to start with certain modalities that will help them build the stabilization and endurance necessary to get into other parts of the gym.

I want to say that people with PCOS are capable of achieving most of their fitness goals including heavy weight lifting, but it’s just not something that you should start with.

That being said, here are some great modalities that you can start your fitness journey with if you have PCOS:

Yoga
Pilates
Barre
Tai Chi
Water exercise
Balance training
TRX training
Functional training

These are all exercise modalities that encourage slow controlled motions, joint stability, body awareness, and are not likely to impose a lot of stress on the body.

Personal Trainers For PCOS

Personal anecdote

I want to start off this section with a little story about one of my first clients-she is a big reason why I pursued the specializations necessary to become a Women’s Fitness Specialist…

I was doing physical assessments with this client and we had just finished postural assessments, mobility assessments, some gentle strength assessments.

We had finally gotten to the point of the cardio assessments, so I asked her to step on a treadmill.

She stepped on the treadmill and looked apprehensive, but I am used to people looking at the treadmill like that…

I started the treadmill, and as she started walking she also started crying.

I was very confused, so I immediately stopped the treadmill and asked her what was going on and if she was experiencing any pain.

She then explained to me that she had had a traumatizing experience on a treadmill while working with a previous trainer…

She told her last trainer that she had PCOS and he had told her that he was familiar with her condition, so she let him push her through a workout that ultimately ended up rupturing an ovarian cyst inside of her.

It happened on the treadmill while she was running-she tried to let her trainer know that she was experiencing severe abdominal pain and he encouraged her to run through it.

She didn’t get far before she had to jump off the treadmill to vomit and be rushed to the hospital.

This event literally shaped me as a trainer for a few reasons:

It made me realize that a trainer could traumatize someone, and it also made me realize the significance of this woman trusting me with her body despite having been traumatized before.
It was another example (and I had already had so many) of how clueless men can be to female specific afflictions, and what a need there was for female specific attention in the fitness industry.
It solidified what I already intuitively knew, but was questioning myself about applying to my training: my clients were the ones who knew what was best for their body and I always should respect that.

Now that the anecdote can serve for a little perspective, let’s get into some of my do’s and don’ts when looking for a trainer when you have PCOS…

What to avoid in a personal trainer

The process of picking a coach is unique to everyone because everyone needs a different thing from their coach.

Those with PCOS however need to be a little extra careful when seeking out a personal trainer because of how overtraining can affect your condition.

To help you navigate this, I wanted to start with some red flags in personal trainers:

They have a one-size-fits-all approach. Or they have a set workout program that all clients follow.
They have no specializations or experience in working with female specific conditions in clients working towards fitness goals.
They create an air of shame and do not permit flexibility in the workout program.
They do not listen to, or even ask for, your feedback or how you are feeling or enjoying your program or workouts.
They do not ask about other lifestyle habits such as sleeping or stress management.
They encourage extreme dieting or workout habits for any population.

People with PCOS need a partner to walk their fitness journey with them and help them navigate what their body is going through.

A personal trainer with the energy of a boot camp instructor is not going to fit well with a client who has PCOS.

If you are trying to achieve fitness goals while dealing with PCOS, I recommend seeking out a personal trainer that you feel really can respect and listen to you.

What to look for in a personal trainer

There are a lot of things that you can look for that will make an ideal personal trainer for someone with PCOS but I am going to give you my top five to make it easy.

Here are five things I think you should be looking for in a trainer if you are dealing with PCOS:

They should have specialized education beyond just being a certified personal trainer that gives them the qualification to work with you on all parts of your lifestyle including nutrition.
They should have experience, either firsthand or through people around them, in dealing with some type of hormone or fertility issue. For this reason I usually recommend other trainers with uteruses for PCOS clients.
They should offer an integrative and flexible approach to their fitness program for you. This means that they will help you with more than exercise and they will help you adapt your program on the days that you cannot keep up with what you are asked to do.
They regularly ask you how you are feeling during certain movements, when you are stretching, how you are feeling about the eating plan, etc. They want to know that you are feeling healthy and happy and they want all of your feedback.
They are able to admit when they cannot help you anymore and are comfortable referring you to a different health professional.

Essentially, you are looking for a fitness professional who is a little more educated than the average personal trainer and humble enough to admit when they are not educated enough.

This type of trainer is going to be the trainer who is very careful not to hurt you and is more likely to lead you to success than to the hospital.

What’s the takeaway?

It is possible to achieve fitness goals while you have PCOS.

It just takes a more gentle approach, which honestly, most people can stand to take a more gentle approach to their fitness journey.

Make small changes and give your body time to adapt to ensure success in your fitness journey with PCOS.

Here is a recap of the information that I linked throughout along with some additional information that you may enjoy:

Make sure you’re starting any fitness journey with the Essentials to Success.
Do a quick clean up on your diet with these Easy Food Swaps to reduce inflammation.
Check out the Carb Blog to learn about different types of carbs!
Learn more about your Fupa and how to take care of it!
Understand the phases of your menstrual cycle and how to Adapt Your Fitness Program to Your Menstruation.
Especially important to people with PCOS: check out how Alcohol Affects Your Fitness Journey.

This is an opportunity to get to know your body more intimately and learn to respect and nurture it!

This article was written by Elexis Smolak CPT, CNC, WFS founder of Adapted Fitness and Integrative Health and Fitness Specialist for Women. Learn more or schedule a virtual coffee at AdaptedToYou.com

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