The findings in this study are probably not news to you if you have PCOS, but it's nice to see your emotional PCOS finally validated with a scientific study.
480 women with PCOS participated in the psychological evaluation portion of this study.
Women who were not menstruating were more likely to have lower self-esteem, and to have a greater fear of being negatively viewed with regard to their appearance. These women also appeared to have an earlier onset of maturity.
High androgen levels and acne were associated with poorer body satisfaction. The greater the degree of hirsutism and BMI (body size), the lower the scores on psychological tests.
The obvious social explanations for these findings have been covered elsewhere. I believe that hormones have a huge part to play in these tendencies…I've worked in eating disorders and I've seen literally thousands of women lose the weight and remove the hair…and STILL be unhappy. Women with PCOS need help in understanding how hormones affect mood (and that hormones ARE mood) and to have access to qualified professionals who can help with that aspect of PCOS.
It's why I'm so happy Gretchen Kubacky and Anna Ahlborn are in the inCYST Network. They are here to help us better understand these conditions and what can be done to minimize any potentially negative influence they may have on your quality of life.: )
de Niet JE, de Koning CM, Pastoor H, Duivenvoorden HJ, Valkenburg O, Ramakers MJ, Passchier J, de Klerk C, Laven JS. Psychological well-being and sexarche in women with polycystic ovary syndrome. Hum Reprod. 2010 Mar 31. [Epub ahead of print]
This is the final installment of this series, but probably the most important one to understand. Weight fluctuates. Even when you eat exactly as you've been advised to. Even if you weigh and measure everything out. It just does. And it's not 100% tied to what we eat. We cycle as humans, and those cycles are reflected in our weight.
We weigh more in the evening than we do in the morning. Of course we do, there's food in our bellies, and there's water we've drunk! In the morning we're dehydrated and hungry. So it is counterproductive to weigh in the morning as well as the evening and assume that any conclusion that the evening weight reflects how much fat we've gained or lost…is logical. I can't stop you from doing that…but I can tell you it isn't a scientific…or self-esteem promoting…technique.
If you have lost your menstrual cycles, it's important to remember that as they return, they will affect your weight. Your weight can fluctuate between 1 and 10 lbs. throughout the month. Every woman is different in this respect. Part of that is fluid, and many women (unfortunately, myself included) experience constipation as part of their PMS. It just happens, and it's a reflection that your body is working just as it should.
I used to notice when I worked more exclusively with eating disorders, that weights would often cycle a couple of months before the period actually returned. It was kind of like the reproductive system was ramping up and taking running starts at menstruating, and eventually got there. Since my clients didn't have the period to validate that this internal process was what was happening, it was hard for them to live with the temporary weight shift.
So in addition to, as I mentioned in the last post, being sure you compare a Monday weight to a Monday weight, etc., you may do best to compare a Monday weight from week one of your four week cycle to the Monday weight from four weeks earlier.
Most of my clients actually notice that they lose waist inches before they lose real weight. That's a really good sign the rest will follow. But you are going to have to look up from your scales and focus on the more important information in order to see that for yourself.
If you're addicted to getting on and off the scale multiple times in a day, perhaps you should hand your scale to a friend for safe keeping. It's not the most accurate indication of how you're doing with your nutrition plan. Really, all it's telling you is how hard the earth has to use gravity to keep you from floating off into space. Really? Really. Maybe it's time you gave up your astronaut fantasy and focused on what is important.
If your mood is stabilizing, your hormones are cycling, your cravings are dissipating, and your energy is better, that's what matters most. Take care of that…and the rest will follow.
I've had this conversation with two different clients recently and it occurred to me it's a phenomenon likely to be more common in women with PCOS, because of their focus on carbohydrates, than even the average dieter. Figured a blog post would be helpful to others.
Both of these clients shared with me that they went on low carbohydrate diets and did very well on them, until a few weeks into it, when, for whatever reason, they"fell off" the plan and started eating carbohydrates. And within a few days they'd gained a few pounds and felt more than a little discouraged…not to mention bloated.
Here's a little fact you don't often hear in weight loss advice or discussions. Not all weight that you gain, or lose, is fat. Some of it is water. Some of it can even be bone, if you severely restrict your intake for long periods of time, as with an eating disorder.
And some of that weight…can be your own body's carbohydrate stores.
When you are eating enough food to meet your daily needs, your body stores some of it as carbohydrate, in liver and in muscles. The function of this stored carbohydrate, is to help keep your blood sugar levels high at times when no food is directly coming into the system. Your brain relies almost entirely on carbohydrates to function, and the body has evolved with this"storage tank", so to speak, to be sure the brain never, ever runs out of energy.
Carbohydrate that is stored for this purpose is called glycogen. The body uses water to help store glycogen. And for every gram of carbohydrate you store, there are 3 grams of water alongside of it.
So what do you think happens when you suddenly switch to a low-to-non carbohydrate diet? All of the carbohydrate you've stored in your liver and muscles has to break down in order to keep your brain running. The weight loss is rapid, because you're losing 3 times as much water as you are other weight. It feels good when you look on the scales, because we're so cultured to believe that all weight shifts are coming from fat.
And what do you think happens when you eat carbohydrate again? The weight shift moves in the opposite direction, and 3/4 of what you gain is actually water. But again, because you're likely focused on fat if you're dieting…you visualize that what you've gained is more of that stuff.
Have you ever heard of carbohydrate loading, that athletes do before an endurance event? When you diet and bounce back with a high carb binge, that's exactly what you're doing! Here's a description off of the Internet that describes a carbohydrate loading protocol, from the Mayo Clinic website: ■Step 1. About a week before the event, reduce or maintain your carbohydrate intake at about 50 to 55 percent of your total calories. Increase protein and fat intake to compensate for any decrease in carbohydrates. Continue training at your normal level. This helps deplete your carbohydrate stores and make room for the loading that comes next.
■Step 2. Three to four days before the event, increase your carbohydrate intake to 70 percent of your daily calories — or about 4.5 grams of carbohydrates per pound of body weight. Cut back on foods higher in fat to compensate for the extra carbohydrate-rich foods. Also scale back your training to avoid depleting your glycogen stores. Rest completely for a day before the event. And…no big surprise…here, farther down the page, are the potential risks associated with this protocol:
■Weight gain. Much of this weight is extra water — but if it hampers your performance, you're probably better off skipping the extra carbs.
■Digestive discomfort. You may need to avoid or limit some high-fiber foods one or two days before your event. Beans, bran and broccoli can cause gassy cramps, bloating and loose stools when you're loading up on carbohydrates.
■Blood sugar changes. Carbohydrate loading can affect your blood sugar levels. It's a good idea to consult your doctor or a registered dietitian before you start carbohydrate loading, especially if you have diabetes I remember when I was working on my master's degree in exercise science, we were taught that the bloating and weight gain from carbohydrate loading could be so extreme and uncomfortable, that athletes should not even attempt to use it for a crucial race if they had not tested it out prior to know how their body would react.
So see, it's not your body, your PCOS, or anything weird about YOU that causes you to gain weight when you eat after restricting. It's exactly how ANYONE's body will react when pushed to extremes.
Try living somewhere in the middle, with a moderate, healthy carbohydrate intake…and see what it does for your weight, your body, and the bloating.
If your PCOS has you struggling with weight, chances are, you have an ongoing battle with the scales. I encourage you to give up that battle.
First of all, when you are in good shape, chances are you are going to be able to carry more weight than a woman without PCOS and look leaner than someone without PCOS. As the photo here suggests, the only thing the scales tells you, at any given point in time, is how much you happen to be resisting gravity at the moment you measure yourself. It really is not an indication at all, of who you are as a person.
Secondly, if you haven't exercised much in awhile, because of your testosterone levels, when you start to exercise, you will put on muscle more easily than the average woman. This is going to work in your favor, over time, because muscle mass is your very best weapon against insulin resistance. If you freak out and stop exercising because you have gained weight early on…you have missed the point! If you have gained weight but lost inches, you are on the right track. Hang in there. It will all fall together, if you are consistently exercising.
Thirdly, something your body will do, as an adaptation to regular exercising, is start to store glycogen to fuel that exercise. Glycogen is a stored carbohydrate that your body becomes proficient at storing to help your blood sugar and energy levels stay stable during your runs/swims/spin classes. Every gram of glycogen that you store in your muscles and liver is stored with 3 grams of water. This water is important water, as it is released while you exercise and it helps keep you from becoming dehydrated while you're working out. A well-trained athlete can carry about 10 extra pounds of glycogen and water that simply is not there if you are not regularly training. But it is not fat, and it is not bad weight, and without it, you likely will feel miserable because you are not well fueled or hydrated.
If you have been restrictive with your diet, and you work out pretty hard…and then you go have a regular meal…of course the scale will jump! Your body is doing what it is supposed to do, start storing fuel and water for the next workout. The absolute worst possible thing you can do is try to control these fluctuations by cutting your calories.
Honestly, I can't even remember exactly when I last weighed myself…I think it was sometime last summer and I can't even tell you what the scales said when I did. I know my clothes fit pretty much the same as they usually do, and when they have been a little tight it's been right before my period and it resolves after about a week, and I know that is normal so I don't stress about it.
If you're not at that level of comfort with body yet, if you can't envision even being there, I'd like to ask you to do at least this:
-If you must weigh yourself, only compare Sundays to Sundays and only compare Sunday mornings to Sunday mornings.
- Once you have enough data points, only compare the Sunday after your period to another Sunday after your period.
The surest way to set off unnecessary exercising, or restrictive eating that is sure to set off a binge later, and to sabotage your overall progress in the long…is to weight yourself multiple times daily and assume that the numbers you see are 100% based on calories in and calories out. Anything you do in response to multiple daily weigh ins, is not based in proven exercise science or nutritional math. It is emotional and disordered.
The more you hear that from us, and the more you recognize that anything you do in response to disordered ideas about nutrition, calories, and exercise, the better chance you have at recognizing that these thoughts and feelings are based on anxiety. When you fight anxiety with responses that can help the anxiety, rather than behaviors that may actually DRIVE the anxiety cycle (think playing with the dog, participating in a hobby, reading a book that has absolutely nothing do do with self help, food, infertility, or hormones) that is when your weight actually starts to stabilize.
I just found this abstract in Pub Med. The full article is referenced at the bottom. I would love to hear any and all comments from readers about this issue!
Resource allocation towards fertility treatment has been extensively debated in countries where fertility treatment is publicly-funded. Medical, social and ethical aspects have been evaluated prior to allocation of resources. Analysis of cost-effectiveness, risks and benefits and poor success rates have led to calls of restricting fertility treatment to obese women. In this debate article, we critically appraise the evidence underlying this issue and highlight the problems with such a policy. Poor success rate of treatment is unsubstantiated as there is insufficient evidence to link high body mass index (BMI) to reduction in live birth. Obstetric complications have a linear relationship with BMI but are significantly influenced by maternal age. The same is true for miscarriage rates which are influenced by the confounding factors of polycystic ovary syndrome and age. Studies have shown that the direct costs per live birth are no greater for overweight and obese women. With changing demographics over half the reproductive-age population is overweight or obese. Restricting fertility treatment on the grounds of BMI would cause stigmatization and lead to inequity, feelings of injustice and social tension as affluent women manage to bypass these draconian restrictions. Time lost and poor success of conventional weight loss strategies would jeopardize the chances of conception for many women. Pandey S, Maheshwari A, Bhattacharya S. Should access to fertility treatment be determined by female body mass index? Hum Reprod. 2010 Feb 3. [Epub ahead of print]
