Inflammation, PCOS,
and Your Weight

Contrary to what you may think, body fat is not simply an inert storehouse of unused calories encasing your body and organs.

Actually, your fat cells are metabolically very active. For example, they produce hormones (such as estrogen) and other signaling molecules that have far-reaching effects throughout your body.

The signals that are sent and received by your fat cells will influence how much fat you retain and how easy or difficult it will be for you to lose weight. Some of these signals are created as the result of inflammation.

What Is Inflammation?

Body Fat Causes Inflammation

Fat-Immune System-Inflammation Link

SOCS and Leptin Resistance

Resistin

C-Reactive Protein

Oxidative Stress

Vicious Cycle of Diet-Inflammation-Weight

How to Break the Vicious Cycle

A number of studies indicate that PCOS women who are overweight tend to be in a state of chronic inflammation.(1,2,3,4)

Even adolescents with PCOS symptoms of high insulin and testosterone have elevated white blood counts, suggesting that the immune system is aroused and an inflammatory process may be occurring.(5) The white blood count is elevated even more when birth control pills are taken.

Chronic inflammation appears to play an under-recognized but central role in the pathology of PCOS and obesity.

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What Is Inflammation?

Inflammation is part of your body’s response to injury or infection. It is a byproduct of the body's attempt to heal itself. Usually, you are aware of inflammation by its classic signs of redness, heat, swelling and pain. However, there is a very complex, hidden, powerful biochemical process that results in these classic signs of inflammation.

Inflammation is not always as obvious as pain or swelling. It can occur at a low, unnoticeable level. This is referred to as sub-clinical, chronic inflammation. In other words, the inflammatory biochemical process is occurring, but you are not aware of it. Chronic, low-grade inflammation is what we are concerned about in dealing with PCOS and weight problems.(6)

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Body Fat Causes Inflammation

You can think of your fat cells as an endocrine and secretory organ, just like your ovaries, thyroid, adrenal glands, liver, hypothalamus, or any other organ or gland in your body.(7) Fat cells produce a bewildering array of biochemicals that influence what goes on in your body.(8)

One family of biochemicals produced by your fat cells are "cytokines", many of which are involved in the inflammatory process. They include leptin, adiponectin, tumor necrosis factor alpha (TNF-alpha), interleukin-6 (IL-6), to name a few. Most cytokines promote inflammation while some others inhibit inflammation.

The more fat cells you have, especially around your middle, the more cytokines you will produce and the more likely it is that you are promoting inflammation.

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Fat-Immune System-Inflammation Link

Your fat cells increase inflammation in another way, by attracting a type of white blood cell known as a macrophage, which produces inflammatory cytokines.(9) Macrophages are scavenger cells. Their job is literally to gobble up foreign organisms and cellular debris.

Macrophages seem to be drawn to body fat because fat cells tend to leak and break open, especially in people with abdominal obesity. Macrophages move into the leaky fat tissue in order to clean up debris and then they themselves begin to release inflammatory factors. Macrophages appear to be a major contributor to inflammation.(10)

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SOCS and Leptin Resistance

To limit the damage produced by inflammation, your body produces anti-inflammatory biochemicals that are triggered by the inflammation itself. This is a compensating mechanism that attempts to maintain a balance in the healing process.

When pro-inflammatory cytokines enter a cell to initiate or promote a biochemical processes to increase the inflammatory response, the cell simultaneously produces anti-inflammatory chemicals called "suppressors of cytokine signaling", or simply "SOCS". SOCS molecules suppress the cell's response to inflammatory cytokines. Two SOCS molecules, SOCS-1 and SOCS-3, are able to interfere with a cell's ability to respond to leptin, which increases leptin resistance.(11,12) SOCS-3 also blocks the response to insulin, which increases insulin resistance.(13,14,15)

Some researchers believe that SOCS production is an important cause of leptin resistance and consequently contributes to the development of obesity.

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Resistin

Fat cells and macrophages (a type of white blood cell) produce a hormone called resistin. Resistin appears to cause tissues -- especially the liver -- to be less sensitive to the action of insulin and thus lead to increased blood sugar levels. There is a strong association between elevated levels of resistin and obesity and diabetes.

Resistin is a potent stimulator of inflammation.(16,17) In experiments, increased levels of resistin also appear to induce increased SOCS-3.(18) As we said, SOCS-3 contributes to leptin resistance and insulin resistance.

The amount of body fat you have may also increase resistin. While resistin in produced by fat cells, it is also produced by the macrophages that are attracted to debris leaking from fat cells. Increased macrophage activity could lead to more resistin.(19)

Although resistin levels are not elevated in all PCOS women, these women appear to be more inclined to produce resistin than those without PCOS.(20)

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C-Reactive Protein (CRP)

C-reactive protein (CRP) is a protein that is a general indicator of inflammation and is associated with being overweight. CRP is a fairly common blood test that you can get from your doctor. A high level of CRP is a strong predictor of future cardiovascular disease and stroke.

In a study at the Rambam Medical Center in Israel, 36.8% of PCOS women had elevated CRP whereas only 9.6% non-PCOS women had elevated levels.(21) Estrogen, which may be in excess in some PCOS women, is one of numerous factors that can increase CRP.(22)

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Inflammation, Weight and Oxidative Stress

A condition of "oxidative stress" exists when pro-oxidant factors in the body exceed the anti-oxidant factors. The result is an accumulation of unstable, destructive molecules called "free radical" molecules, which damage components of the cell membranes, proteins or genetic material by "oxidizing" them. This process is the same chemical reaction that causes iron to rust.

Oxidative stress can result from many factors, including exposure to poor quality diet, environmental pollution, alcohol, smoking, medications, trauma, toxins, excessive exercise, or inflammation, to name a few.

Oxidative stress it thought to be a primary cause of degenerative diseases and accelerated aging.

As a group, women with PCOS are more likely to experience oxidative stress than healthy women. For example, a study from the University of Harran in Turkey found an increase in oxidant status in women with PCOS. This increase was related to central obesity, age, blood pressure, serum glucose (blood sugar), insulin and triglyceride levels, and insulin resistance. In addition, their antioxidant status was found to be insufficient. The researchers said these findings suggest that oxidative stress may contribute to the increased risk of cardiovascular disease in women with PCOS.(23)

But oxidative stress does more than increase cardiovascular risk. It also promotes increased inflammation and induces insulin resistance.(24) It may also interfere with reproductive function.(25)

Oxidant stress is part of the vicious cycle of increased inflammation leading to insulin and leptin resistance and thus creating excess weight.

Women in general appear to be more likely to have oxidant stress than men, according to a research study conducted at the University of California at Berkeley.(26)

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Destructive Cycle of Diet, Inflammation and Weight

Click here to get more information about the link between diet, inflammation and weight. However, the relationship of diet, inflammation and weight is summarized here:

• A diet high in refined carbohydrates and other "fabricated" foods leads to both increased weight and increased inflammation.
• Excess weight itself causes chronic inflammation.
• Chronic inflammation contributes to more insulin resistance, leptin resistance, and other metabolic disorders. It also decreases favorable adiponectin and increases unfavorable resistin.
• Insulin resistance and leptin resistance stimulate accumulation of more weight, make weight loss more difficult, and induce hyperandrogenism (excessive levels of male hormones) and other symptoms of PCOS.
• The added weight induces more inflammation and thus more insulin and leptin resistance, which in turn prevents you from burning off fat stores, and causes you to store even more fat.

Here is the vicious cycle of obesity and leptin resistance: Extra fat produces chronic, low-grade inflammation. The chronic inflammation produces a chronic anti-inflammatory response, led by SOCS molecules. The SOCS response stops leptin from reducing obesity. So weight goes up, which causes more inflammation. And the cycle starts all over again.

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How to Break the Diet-Inflammation-Overweight Vicious Cycle

You can break this vicious cycle with three simple actions:

• Eat a healthy diet as described in The Natural Diet Solution to PCOS and Infertility ebook
• Get regular exercise.
• Remove or control sources of chronic stress.

The above measures will:

• Help you lose fat weight.
• Improve insulin resistance and leptin resistance.
• Reduce inflammation.

Click here for article footnotes.