Guest post by Dr. Brooke Kalanick
We all say it: just listen to your body, but how do you actually do that? Teaching women how to listen to their own hormone talk is at the heart of the work I do because this is how we stop fighting ourselves and getting into hot water with our health. Working with many, many women over the past dozen years, one of the biggest problems I see is women depleted, exhausted, stressed, and pushing themselves into further hormonal disarray.
While modifying nutrition, in particular your carb intake, based on the hormonal clues of appetite, cravings, energy, and sleep (my acronym ACES) is often job one for PCOS, in this article, let’s talk about heeding your hormonal messages when it comes to exercise.
How to Adjust Your Exercise If You Have Adrenal Issues
Hold on a sec; why are we talking about adrenal issues? This is PCOS Diva after all!
It is because you don’t just have PCOS, you have a lot of hormones! If you have PCOS, you undoubtedly have more than one hormone out of balance, and cortisol is probably first on the list. The advice you see for one hormone is often completely counter to that for another hormone, so what is a girl to do?
You honor your most delicate hormonal imbalances first. Simply follow this hierarchy:
Wondering what other issues you have beyond PCOS? Getting more testing through your provider or a functional medicine doc is a good idea. You can also glean a lot from taking my quiz. But know that cortisol issues go hand in hand with both of the root causes, fundamental issues with PCOS: inflammation and insulin resistance.
When it comes to cortisol, there can be problems with having too much or too little. Both are common with PCOS.
Low cortisol or Adrenal Fatigue is better described as HPA (hypothalamus-pituitary-adrenal axis) dysfunction or a discoordination between the messages the brain sends to the adrenal glands. Adrenal fatigue is a bit of a misnomer as the gland is not so much too tired to do its job as the term “fatigue” implies, but rather a woman has lost her ability to adapt to and cope with stress.
It basically gets harder to keep cortisol output on is normal circadian timing, and we end up with times of high or low cortisol overall or low or high at one point or another during the day.
Note: True adrenal insufficiency is an autoimmune condition called Addison’s disease where there is an antibody attack on the adrenal glands much like the antibody attack on the thyroid in Hashimoto’s. This is perhaps true “adrenal fatigue” and it is not the functional problem we’re talking about in this post. Addison’s disease sufferers will ultimately be low cortisol and often need to use cortisol replacement therapy.
A lack of ability to handle stress is exactly what a woman with cortisol issues is thinking: “Wow I’m handling life pretty poorly right now! My sleep has changed for the worse, my period and PMS are more gnarly or less predictable, my skin is a mess, my digestion is off-kilter and I’m either wired and/or tired most of the day – and always at the least inopportune times (i.e. tired but wired at bedtime, dragging in the morning or afternoon, etc.).” Often all your PCOS symptoms will be worse when your adrenals need support.
Cortisol is the other side of your blood sugar equation: insulin lowers it and cortisol raises it, so you can see why women with PCOS have issues with cortisol.
Here are the main symptoms of high and low cortisol. Although testing is the best way to determine exactly what’s going on with these hormones, these will give you a lot of insight:
Symptoms of High Cortisol Include:
- Can’t fall asleep at night, feel tired but wired at bedtime.
- Puffy look, all over but can usually be seen in the face
- Wake achy and stiff with a low appetite in general or cravings for carbs
- Intolerance to exercise, difficulty recovering from workouts, and healing from injuries
- Difficulty losing body fat, particularly around the middle
- Cravings for sugary/starchy and fatty foods.
Symptoms of Low Cortisol Include:
- Low energy
- Shaking, etc. between meals or as time for the next meal approaches. You feel like a different person after getting some food.
- Sugar or caffeine cravings, often between meals
- Difficulty sleeping through the night
- Low blood pressure (below 120/80) and sensitivity to bright lights and sunlight
- Digestive issues including IBS like symptoms of alternating constipation and looser stools
- Sluggish fat loss from “fat loss exercise” such as metabolic training, sprints, met-con, etc.
- Difficulty recovering from exercise, low tolerance to intense exercise in particular
With any of these symptoms, your stress mechanism is losing its ability to be as robust and coordinated as it was when you were younger. Who can remember staying up for days on end during college finals, sleeping in for a few days, and you were as good as new? Fast forward to having a newborn baby in your thirties and you feel you never recovered from the sleep deficit (Ahem, Dr. Brooke….). Or you went on an aggressive exercise regimen like CrossFit or a ton of spinning and dropped weight easily, but that same plan ten years later leaves you achy and exhausted with lackluster results. Or merely feeling like you have a low fuse for any type of stress as time’s gone on. These are just a few examples of stress coping abilities going downhill.
There is a lot of talk now on healing your adrenals and working with adrenal fatigue, and most of it centers around reducing stress. That’s all fine and good, but how do you work out during this healing phase? Do you just sit on the couch until you’re better?
That is stress in and of itself, so my answer is no. Yet at the same time, you can’t push a system that’s lost its ability to cope with stress as exercise indeed stresses. So what to do?
Here’s how to manage exercise as you work to heal your stress mechanism:
If you are suffering from low cortisol your biggest risk with exercise is over-training. You want to avoid metabolic conditioning, spinning, CrossFit and boot camp, HIIT, intense metabolic training, sprints, etc. Avoid anything that relies on a good cortisol and adrenaline output to complete and get results– you just don’t have it, so you won’t get the same results, and you will not give your system time to heal.
You do want to walk. Walk, walk, walk. Walking helps normalize the cortisol response, so it’s great whether you’re high or low. Keep strength training, just not with a lot of metabolic work. Focus on heavier lifts with low reps such as 5×5 or 3×6 protocols of big lifts like squats, bench presses, deadlifts, rows, and overhead presses. Think more traditional strength training with plenty of rest, big exercises, full-body movements, and heavy but low intensity and volume.
If you’re dealing with high cortisol issues you also may want to tone down the metabolic training to 1-2 very short sessions per week and keep up the walking. Avoid hour-long metabolic classes such as spinning and many CrossFit and boot camp-type classes. You’ll do much better with shorter metabolic sessions once or twice per week as to not continue to drive the high cortisol output. Focus on higher weight, lower intensity, more rest type strength training. You most definitely want to keep training as high cortisol can quickly erode muscle mass.
Limit long-distance cardio. Cardio is not the devil; it has its place, but because it drives cortisol without triggering of fat-burning hormones like growth hormone (the way more intense training does), you’re driving stress without getting the same fat-burning benefits. It’s inefficient at best, and when you’re running high-stress hormones, you’re adding more fuel to the fire.
For those of you who love those long runs or bike rides, don’t worry, they won’t be gone forever. Get your stress response normalized, and then find a way to keep those exercises you love in your life in a healthy way that works for you. The problem is continuing certain activities that drive cortisol for at least a period of time simply won’t give you a chance to get your brain and adrenals communicating more effectively. If you can take a break and handle multiple sources of stress, you’ll be able to fit them in in a more balanced way in the future, just give yourself a chance to heal.
You also may want to train earlier in the day, especially if you feel wound up at night and have a hard time falling asleep.
With both cortisol issues, you want to make lots of time for recovery: rest days, rehab work, walking, gentle yoga, meditation, etc. Tone up your stress management skills, and be careful if exercise is your go-to stress reliever (it certainly is mine!). When you feel that urge to go train again, go for a walk instead.
Also with both cortisol issues, you need to prioritize sleep and do your best to solve sleep problems.
Use ACES (Appetite, Cravings, Energy, and Sleep) to monitor your cortisol recovery.
Appetite can be low with low cortisol and low or high with high cortisol. Watch for it to become more normal.
Cravings with low cortisol are often for sugar and stimulants. Watch for the desire for them to feel more under control. Cravings with high cortisol usually are for both starchy/sugary and fatty foods (pastries, fried foods, ice cream, chips, etc.). Keep an eye on those to feel less tempting.
Energy should become more level, with fewer periods of highs and lows, fewer slumps like in the morning or evening, and less feeling all wound up at bedtime. Energy should also not drastically change when you eat. If you come alive after eating, that is often a low blood sugar and low cortisol indicator, and because high cortisol so often occurs with insulin issues, watch for that post-meal coma as well.
Sleep should even out. You should see less trouble falling and staying asleep as cortisol comes back into balance and you correct the uncoordinated rhythm and timing of the brain-adrenal axis.
Low thyroid is the next most delicate hormonal imbalance, along with autoimmunity such as Hashimoto’s. There is a significant correlation between PCOS and Hashimoto’s, so be sure you’re getting tested for both TPO and TG anti-bodies as well as your usual thyroid screen. If you are a woman with PCOS and Hashimoto’s, there are some special exercise considerations that I cover in my downloadable book, Guide To Exercising For Your Hormones, which you can get here for 30% off using the code PCOSDIVA.
Training Modifications For PCOS
I talked about the variance in body types with PCOS and my framework for understanding the differences in this article. The lean type tends to be more resistant to putting down body fat and is great at taking in nutrients into the muscle. While the commonly called heavy type is great at storing fat in fat tissue and less effective at getting nutrients into the muscle tissue. This is all due to each PCOS woman’s degree of insulin resistance and what tissues she is more resistant to (i.e. muscle vs. fat).
We are constantly in a state of remodeling. Our hormones work throughout the day to build us up or break us down. It’s a dance of repair and using of resources, building up and breaking down, anabolism and catabolism. This is true of all of the humans, but the effects are more dramatic in women with PCOS.
Many women with PCOS feel they get bulky from training easily and struggle to lose fat. While this gets a bit confusing, remember that insulin resistance plays a role in PCOS to varying degrees, but all PCOS women tend to be more anabolic, more in a buildup mode, therefore overall creating muscle and fat more easily than their hormonally balanced girlfriends.
So, for the woman with PCOS that feels she puts on muscle easily and tends to feel puffy or bulky when she does strength training, it’s time to do a couple of things to get better results:
Next, consider more exercise. Adhere to your cortisol and thyroid constraints above, but if those are balanced, then remember that the more insulin resistant you are, the more you are trying to build up, so the more exercise you will tolerate. It doesn’t need to be crazy intense, but just try to add more activity in general. Do loads of walking and even some of that longer duration, boring cardio is often very helpful to women with insulin resistance and PCOS.
When it comes to strength training, if your adrenals are doing ok, you’ll do well with metabolic conditioning and HIIT. If they are struggling a bit, as is often the case, I often recommend 2 more traditional, more rest, strength training sessions per week and one metabolic training session per week. On the other days, try a balance of cardio that works for you between HIIT and longer, steady-state cardio. And always do lots of walking.
For the leaner, more fat-resistant PCOS types, you do have to watch a constant cortisol push from exercise. You’ll tolerate the metabolic conditioning and HIIT worse than your heavier-type counterparts. You’ll do well with heavier weights, 2-3 x per week, and a lot of walking.
To learn more or get my strength training templates and guide to how to adjust for all these hormone issues, you can use the code PCOSDIVA for my guide to training for your hormones for just $25. Find out more here.
Now before you rush off to the gym to manipulate your hormones and PCOS, I want to take a minute to remind you of something I’ve learned the hard way: embrace the body you have.
You’ve got PCOS, and that often comes with it a certain amount of wishing your body was different. I share my journey with that here – I hope it’s helpful.
A licensed Naturopathic Doctor (ND), Dr. Brooke attended Seattle, Washington’s Bastyr University, where she earned a Doctorate in Naturopathic Medicine and Masters in Acupuncture and Chinese Herbal Medicine.
Dr. Brooke takes a balanced approach to health, using both conventional and alternative therapies. Metabolic nutrition, fat loss resistance, and fitness remain her area of focus and in her Manhattan clinic she primarily treats women with Hashimoto’s Hypothyroidism and PCOS – as well as other female hormone imbalances.
With these women she works to reset their hormones, their heads, and their habits, so they can finally feel at home in their bodies. Learn more about Dr. Brooke on her website, and connect with her on Facebook and Twitter.