Is PCOS or a Hormone Imbalance the Reason You Can't Lose Weight?

POV: You're swiping through TikTok feeling hopeless over how your annual "new year, new you" diet has crashed and burned once again. You've tried everything, but no matter how much kale you eat or how many spin classes you take, you can't seem to drop the pounds as easily as you once did. You feel bloated, lethargic and uncomfortable in your body.

Then a person with a dewy, glowing face with perfectly chiseled features and long, brown Dyson Airwrapped hair who looks as if she could be a frontrunner on "The Bachelor" pops up on your TikTok For You Page. As she shows off a rainbow of avocado toasts, chia seed pudding cups, smoothies and "nice" cream sundaes, as well as her weightlifting ability, "World's Smallest Violin" by AJR plays.

Through fast-moving text and images you learn this glowing girl was once bloated, worked out constantly and ate healthy but kept gaining weight, just like you. Then she figured out how to balance her hormones, and now she says she has "more energy, results from workouts, improved digestion, less brain fog, a regulated cycle, better hair health, less inflammation, clearer skin, less bloat, fewer mood swings and better sleep."

Sign me up, you think.

This is Gracie Norton. She has more than 11 million likes on TikTok, where she chronicles her polycystic ovary syndrome (PCOS) journey. She did not respond to requests to be interviewed.

Do you believe you have PCOS based on TikTok?

Obviously, you should do your homework before following the advice of a social media personality.

"I do not recommend getting nutrition advice from an unlicensed professional. To appropriately take care of your body's unique and individual needs, it is best to be under the care of a highly trained and licensed individual," said Lana Butner, M.D., a naturopathic doctor in New York City and the author of the "PCOS Recipe Booklet." "You do not know if these influencers are given kickbacks for the products they promote, nor if they are aware of the quality or longevity of ingredients that go into these products as well. It's a dangerous game that social media is allowing so openly and it's truly frustrating to educated professionals."

If you're already following PCOS TikTok recipes without being properly diagnosed with the syndrome, you should be OK. Eating a blood sugar-balancing diet focused on protein and healthy fats with or without a PCOS diagnosis is never a bad idea and is one of the healthiest ways to eat for a majority of people, Butner said.

What is PCOS?

PCOS is a hormonal disorder that affects 5 percent of women in the United States and can happen at any stage of reproductive life. It can lead to higher levels of male hormones, which can affect how a woman's ovaries work.

Some signs of PCOS include irregular periods or no periods at all, difficulty getting pregnant, and excessive hair growth (hirsutism) on the face, chest, back or butt. PCOS can also make it hard to lose weight.

If you suspect you have PCOS, a doctor can properly diagnose you through bloodwork, explained Amber Dixon, a dietitian and the CEO of Elderly Assist in Chicago.

How is PCOS tied to difficulty losing weight?

Not all patients with PCOS gain weight, but when weight gain does happen with PCOS, it's usually sudden and occurs with barely any changes to the patient's lifestyle, exercise routine or dietary intake, Butner said.

"The biggest connection with PCOS and the inability to lose weight is that those women with PCOS have insulin resistance. This is the very frustrating problem that makes hunger out of control and weight loss extremely challenging," explained Kimberly Gomer, M.S., a registered dietitian with a master's in nutrition and the director of nutrition at Body Beautiful Miami.

"Insulin helps us to metabolize food and store it as energy," Dixon explained. "If we don't have enough insulin, we'll be unable to use the calories from our food for energy. They will just get stored as fat instead."

"Belly fat is where we most see insulin resistance," Gomer added. "As excess fat in the waistline increases, it contributes to insulin resistance."

Feeling tired or foggy-headed after a meal is usually a sign of insulin resistance. Insulin resistance occurs when muscle, fat and liver cells can't use glucose from your blood for energy, so your pancreas makes insulin to make up for it. This spikes your blood sugar levels and is the root cause of prediabetes and diabetes, Gomer explained.

More than 100 million Americans have insulin resistance. People with insulin resistance tend to be sensitive to processed foods and unprocessed carbohydrates, which can spike your insulin levels, raise your blood sugar and drop your energy level. Insulin can be balanced and stable energy can be created in your body from calories from whole foods, with a focus on protein, vegetables and carbohydrates your body can tolerate, Gomer said.

Living with PCOS

Drew Lederman was diagnosed with PCOS after years of growing up with irregular periods, hormonal acne, weight fluctuations, digestive issues and hair loss. She learned she had insulin resistance PCOS, which meant her body wasn't responding to hormone insulin as it should. This condition caused her to gain 25 pounds in just six months.

Lederman tried every weight loss hack from pharmaceuticals, fad diets and supplements to workout trends, but nothing worked for her.

"I was extremely frustrated. I was doing everything right and yet I couldn't get the results that people online were seeing," explained Lederman, CEO and co-founder of Resist Nutrition, based in New York City.

Finally, after consulting doctors and dietitians, Lederman discovered the low-calorie "fitness foods" she was eating in an attempt to remedy her symptoms, in combination with her stressful lifestyle, were messing up her hormones, making her gain weight and flaring up her PCOS symptoms.

Managing PCOS

Lederman learned ingredients in "fitness foods" such as sugar alcohols, gums, refined sugars, fillers and whey protein were inflammatory and messed with her hormones and gut health.

"Cutting [fitness foods] out helped immensely. But the changes really came when I added in more fiber, protein and healthy fats to my diet," Lederman explained.

"The focus should be on improving insulin resistance to regulate its effects on the body," said Sarah Musleh, M.D., an endocrinologist in Miami and the co-founder of Anzara Health.

Musleh recommended a diet that is low in sugar (less than 30 grams per day), high in fiber (more than 30 grams per day), with little or no processed food and beverages. Exercise, including both cardiovascular and resistance training, should be done at least three to four times per week, she said.

It is possible to have a hormone imbalance without having PCOS, Butner said.

"Hormones range from thyroid and estrogen to testosterone, neurotransmitters like dopamine serotonin, GABA and glutamate, and insulin, among others," Butner explained.

What are the signs of a hormone imbalance?

Bailey Brown experienced symptoms similar to those of Lederman about two years ago, when she quickly gained 30 pounds despite working out intensely as a Pilates, barre and cardio instructor and eating a diet she thought was healthy.

"I started to notice that instead of feeling energized by my workouts, I felt burnt out and depleted after," said Brown, who is the creator of the Align app, a Pilates and nutritional program, and is based in Los Angeles and Sydney. "My skin was breaking out. I was painfully bloated after every meal. I felt exhausted no matter how much I slept, and my moods were all over the place.

"Doctors kept telling me I was 'healthy.' They said the things I was concerned about—bloating, breakouts, moodiness, fatigue—were all 'normal' and not something to worry about," she continued. "But deep down, I think I knew something wasn't right within my body."

Managing a hormone imbalance

Unlike Lederman, Brown doesn't have PCOS and wouldn't find out what was wrong with her until she stumbled upon an article about endocrine (hormone) imbalances.

"Eventually, I went to an endocrinologist for hormone testing and the results confirmed my fears. My hormone levels were well outside what was considered normal for a woman my age," Brown explained.

Similar to Lederman, Brown learned the actions she was taking for "wellness" and weight loss, such as intense workouts and intermittent fasting, were actually causing her more harm than good. Today, she finds an anti-inflammatory, whole food, unprocessed diet of proteins, healthy fats, high-fiber carbs, vegetables and fruits, as well as syncing her nutrition and exercise to her menstrual cycle, makes her feel her best and keeps her hormones in check.

"Everybody is different and everyone's individual hormone balance is as well, so there is no one-size-fits-all diet that's appropriate for everyone. It's worth taking time to see how your body responds to certain foods by eating mindfully or working with an expert," Brown suggested.

Other factors impacting your ability to lose weight

Some medications, such as birth control, can make it harder for people with PCOS or a hormone imbalance to lose weight.

"Birth control pills require an increased amount of insulin production, which can cause weight gain over time if someone isn't careful about making sure they're eating enough healthy foods in moderation, instead of just relying on the pill alone, which doesn't provide any nutrients at all," Dixon said.

Other factors that may cause you to gain weight include eating more food than you realize, exercising more than usual to lose weight, which actually could lead to weight gain from muscle mass, and thyroid issues, Dixon said.

"Our thyroids are responsible for our metabolism, in addition to our bowel movement regularity, hair/skin/nail health, our thermoregulation and our energy production," Butner added. "When a thyroid becomes 'sluggish,' it means that all of these processes start to slow down, and as you could imagine, once these slow down, weight can start to add up, no matter how hard you are working out or how strict you are sticking to healthy eating patterns."