PCOS and the Facts

https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance#:~:text=Experts believe obesity, especially too,is linked to insulin resistance.

https://my.clevelandclinic.org/health/diseases/8316-polycystic-ovary-syndrome-pcos

I dont have, never have had PCOS, so i don't know anything about it.
I have a friend who has it. She says when she gains weight she has more symptoms, when she loses weight her symptoms get better.

ddsb1111 wrote: »

Corina1143 wrote: »

https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance#:~:text=Experts believe obesity, especially too,is linked to insulin resistance.

https://my.clevelandclinic.org/health/diseases/8316-polycystic-ovary-syndrome-pcos

I dont have, never have had PCOS, so i don't know anything about it.
I have a friend who has it. She says when she gains weight she has more symptoms, when she loses weight her symptoms get better.

Hi Corina, thanks for the links. This is what jumps out at me and lead me to believe being overweight caused/causes PCOS:

Experts believe obesity, especially too much fat in the abdomen and around the organs, called visceral fat, is a main cause of insulin resistance.

Researchers used to think that fat tissue was only for energy storage. However, studies have shown that belly fat makes hormones and other substances that can contribute to chronic, or long-lasting, inflammation in the body. Inflammation may play a role in insulin resistance, type 2 diabetes, and cardiovascular disease.

So, if we aren’t over fat we won’t develop the hormonal imbalance, the insulin resistance, or the inflammation? It seems like there’s more to it, isn’t there? (General question )

Second link states
The exact cause of PCOS is unknown. There’s evidence that genetics play a role. Several other factors, most importantly obesity, also play a role in causing PCOS

So, those with insulin resistance are more likely to get PCOS. Insulin resistance and a hormonal imbalance, such as the release of more androgens, can be caused by too much fat around the organs, and creates inflammation. But, genetics can play a role, obesity can play a role, and insulin can play a role. It’s like a carousel.

I think you might be crossing Insulin resistance with PCOS. They are related, but not the same thing.
IR causes a build up of blood sugar. The blood sugar build is often stored in fat around the middle/obesity. IR can cause weight gain. Losing weight can help control IR.

PCOS often occurs with Insulin Resistance but having PCOS does not automatically mean you have IR.
Or vice-versa. High probability but not absolute. Both are hormone related issues and an imbalance in one, can sometimes aggravate or flare the other.

If you have a hormone issue that impacts PCOS (androgen), being overweight will normally cause the symptoms to be much worse. Many people who become obese then get diagnosed with PCOS, because the weight gain caused the hormone issues to worsen. The symptoms get worse so people go to the doctor. --The foundation of PCOS was probably already there--but the weight gain made it noticeable. More of a linked relationship than a cause-effect.

ddsb1111 wrote: »

Corina1143 wrote: »

https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance#:~:text=Experts believe obesity, especially too,is linked to insulin resistance.

https://my.clevelandclinic.org/health/diseases/8316-polycystic-ovary-syndrome-pcos

I dont have, never have had PCOS, so i don't know anything about it.
I have a friend who has it. She says when she gains weight she has more symptoms, when she loses weight her symptoms get better.

Hi Corina, thanks for the links. This is what jumps out at me and lead me to believe being overweight caused/causes PCOS:

Experts believe obesity, especially too much fat in the abdomen and around the organs, called visceral fat, is a main cause of insulin resistance.

Researchers used to think that fat tissue was only for energy storage. However, studies have shown that belly fat makes hormones and other substances that can contribute to chronic, or long-lasting, inflammation in the body. Inflammation may play a role in insulin resistance, type 2 diabetes, and cardiovascular disease.

So, if we aren’t over fat we won’t develop the hormonal imbalance, the insulin resistance, or the inflammation? It seems like there’s more to it, isn’t there? (General question )

Second link states
The exact cause of PCOS is unknown. There’s evidence that genetics play a role. Several other factors, most importantly obesity, also play a role in causing PCOS

So, those with insulin resistance are more likely to get PCOS. Insulin resistance and a hormonal imbalance, such as the release of more androgens, can be caused by too much fat around the organs, and creates inflammation. But, genetics can play a role, obesity can play a role, and insulin can play a role. It’s like a carousel.

I did research on this a while back to help friend and believe there needs to be a distinction here between PCOS from genetic and hereditary traits and dysfunction and Insulin resistant PCOS.

One form of PCOS is basically from birth, most likely inherited from the mother. One type is called congenital adrenal hyperplasia (CAH) there's a couple of classifications but generally these aren't detected until later in childhood or adolescence with the other pretty much detected from birth, which is more rare. Some women will have abnormalities in the genitalia, thinning hair, a deeper voice that kind of thing caused by the over producing androgens, which is basically testosterone. Another enabler is called luteinizing hormone (LH) and it produced in the brain from the pituitary gland and is involved in ovulation, progesterone production, testosterone production, basically it messes with the reproductive system and stimulates the adrenals. Other genetic factors of androgen production are the adrenal glands and the actual ovaries, which both can overproduce androgens and insulin is also connected with the adrenals, which seem interesting the adrenals keep coming up, anyway. Most of these are medicated using birth control, metformin and androgen reducing drugs simply because they don't know of another way, and it's still the normal pathology, or at least the last time I did any deep research on this.


Anyway, PCOS as it relates to insulin.

Like it been stated, obesity doesn't cause PCOS but around 70% of women that have PCOS are overweight or obese. The connection or the effective mechanism is elevated insulin levels and not to be confused with elevated blood sugar, these are two totally different things. If a person is basically consuming what would be described as a Standard American Diet, which is fairly high in refined carbohydrates and sugar then pancreatic insulin production is cranking out a lot of insulin every day for years and it's this chronic elevated production that contributes to the mechanism of PCOS. The likelihood that that same person will put on weight is almost a given based on the magnitude of studies that confirm this and over the course of elevated insulin production will and does cause dysfunction of cellular insulin receptors and more insulin will be needed to keep blood glucose at base line. Of course if a person has some genetic form of PCOS then IR will definitely exasperate the condition, no doubt about that.

So, when we consume carbs and sugar they're in basically 2 forms, one being glucose that is used for immediate energy (ATP) for most cells in the body, especially our muscle, and our brain. The other sugar molecule is fructose which actually doesn't effect insulin at all and isn't used as ATP and gets metabolized by the liver.

This is where things go sideways. Visceral fat, the metabolically active fat, is exclusively produced from fructose metabolism in the liver and the liver stores these sugars as triglycerides and released as VLDL lipoproteins. On of the first signs of excess fructose metabolism is fatty liver, which is now quite common among children. Visceral fat is also very inflammatory and why that association exists, and the host of other metabolic disorders like IR, diabetes, hypertension, heart disease, obesity and PCOS. As it relates to PCOS is, insulin increases the sensitivity of the adrenal cortex that activates adrenocorticotropic hormones that increase and pump out androgen which also mucks with the menstrual cycle and that's basically the pathogenic route it takes. Also people that are of normal weight can still have been pumping out too much insulin and have insulin resistance and/or diabetes, and could also have PCOS, it's actually quite a large minority. This is all from my notes of a few years ago and of course just my opinion as well.

Re: being harder to lose weight with PCOS - my understanding from reading these forums is that women with PCOS may have a lower BMR and need a lower baseline of calories. So if the system tells you to eat X to lose a pound a week, you actually need X - 250 (for example.) It seems hard because the base calories are wrong for you. Once you get that dialed in, it's simpler (but not necessarily easy )

There are a few women here who need higher baseline of calories. Ann is one. @springlering62 do you think you are an unusually efficient calorie burner like Ann or you lost weight faster than expected and had to increase your calories several times because you became super active?

If I were a woman with PCOS and a lower BMR / not losing weight on the expected amount of calories, I would compensate by exercising more and not logging it.

But women also have to be careful to not be this person:

http://www.bodyrecomposition.com/research-review/dietary-restraint-and-cortisol-levels-research-review.html/

...a group of women who scored higher on dietary restraint scores showed elevated baseline cortisol levels. By itself this might not be problematic, but as often as not, these types of dieters are drawn to extreme approaches to dieting.

They throw in a lot of intense exercise, try to cut calories very hard (and this often backfires if disinhibition is high; when these folks break they break) and cortisol levels go through the roof. That often causes cortisol mediated water retention (there are other mechanisms for this, mind you, leptin actually inhibits cortisol release and as it drops on a diet, cortisol levels go up further). Weight and fat loss appear to have stopped or at least slowed significantly. This is compounded even further in female dieters due to the vagaries of their menstrual cycle where water balance is changing enormously week to week anyhow.

And invariably, this type of psychology responds to the stall by going even harder. They attempt to cut calories harder, they start doing more activity. The cycle continues and gets worse. Harder dieting means more cortisol means more water retention means more dieting. Which backfires (other problems come in the long-term with this approach but you’ll have to wait for the book to read about that).

When what they should do is take a day or two off (even one day off from training, at least in men, lets cortisol drop significantly). Raise calories, especially from carbohydrates. This helps cortisol to drop. More than that they need to find a way to freaking chill out. Meditation, yoga, get a massage... Get in the bath, candles, a little Enya, a glass of wine, have some you-time but please just chill.

kshama2001 wrote: »

Meditation, yoga, get a massage... Get in the bath, candles, a little Enya, a glass of wine, have some you-time but please just chill.

Unless you are neuro-spicy like me and all of those things make my skin crawl and set off anxiety.
Blasting song on repeat, long dog walk, and a hyper fixation on a word puzzle does it for me--most of the time.

Just in case --'regular relaxation tools' make you more anxiety-ridden like me.

A little relaxation never hurts anyone. Just our relaxation tools may vary.

ddsb1111 wrote: »

my understanding from reading these forums is that women with PCOS may have a lower BMR and need a lower baseline of calories. So if the system tells you to eat X to lose a pound a week, you actually need X - 250 (for example.) It seems hard because the base calories are wrong for you. Once you get that dialed in, it's simpler (but not necessarily easy )

I keep seeing this in the threads too, and after everything I’ve read it seems fair to feel that losing is harder. But I can’t seem to find any current research. I don’t know why, I just want to see it. I used my own data as a baseline so I had no one to compare myself to but me so it definitely felt simpler. Not easy, but simpler.

When what they should do is take a day or two off (even one day off from training, at least in men, lets cortisol drop significantly). Raise calories, especially from carbohydrates. This helps cortisol to drop. More than that they need to find a way to freaking chill out. Meditation, yoga, get a massage... Get in the bath, candles, a little Enya, a glass of wine, have some you-time but please just chill.

Couldn’t agree more. Like anyone else who grew up in the 80’s-90’s, we jumped from extreme diet trend to extreme diet trend, meanwhile binging between the next best thing. It sucked. The likely answer all along was pick one, choose a reasonable rate of loss, and sail away 😆 (sorry, had to).

After adjusting for age and BMI, there was no difference in BMR between PCOS women and controls. BMR was also comparable in a secondary analysis comparing PCOS women with and without insulin resistance.

I read this too! It was quite awhile ago now, and part of why I was confused on the facts. You can read that it’s harder all day long but I want them to show me how they know. Then a couple small studies like this pops up and you start to reconsider what you think you know or believe to be true. With the amount of women diagnosed with PCOS we should be investigating this further.

Keep in mind that that specific study looked at BMI.

Health conditions IMU largely affect body weight through metabolic effects (which would show up in BMI), fatigue, appetite, water retention. If - pure speculation for example purposes - PCOS suppresses energy level thus suppresses NEAT, that could result in the average woman with PCOS needing a lower goal for any given body weight outcome.

Also, buried in the "average woman" concept is variation around the mean. Variation around the mean applies to population averages (the average of pretty much everyone), and it also applies to symptoms or side effects of health conditions. If (again making up numbers) the average woman with PCOS requires 250 calories fewer daily than the average general population woman, that doesn't mean every woman with PCOS requires fewer calories than the average woman. It's about probabilities, not "for sure gonna".

(snip)

I was doing research on cancer, not PCOS, but found suggestions that there's a circle of high estrogen causing you to gain weight more easily, fat produces estrogen, estrogen makes easier weight gain, etc.

One of the links above stated that testosterone can contribute to weight gain. I’ll have to find and quote it because I was a little surprised by that, maybe I misread. Let me check. I’m more familiar with estrogen promoting fat storage, for obvious reasons. It’s still over my head too, but it’s clearer than before.

I wonder if testosterone contributes to weight gain by making it easier to gain muscle mass?

I also wonder why anti-estrogen drugs (of a couple of different mechanisms of action) are associated with a side effect of weight gain, if estrogen contributes to weight gain? (I know that weight gain can increase estrogen levels.)

kshama2001 wrote: »

(snip)

There are a few women here who need higher baseline of calories. Ann is one. @springlering62 do you think you are an unusually efficient calorie burner like Ann or you lost weight faster than expected and had to increase your calories several times because you became super active?

In my case, I suspect a good piece of the difference is having more muscle mass than average for my age/size. I'm no bodybuilder, but as far as I can figure out, the average woman my age/size would be expected (per statistics) to have body fat around 36% (estimated from BMI), whereas I think mine (from multiple estimating methods) is somewhere in the mid-20s. When I run a TDEE calculator that will take BF% estimate into account, I get a TDEE estimate that's closer to realistic.

I don't have PCOS, but I do have other factors that some here say make weight loss extra hard: Severe hypothyroidism (treated), menopausal status, older age (68). I long assumed that I had a "slow metabolism" because of things like that, and because I was athletically active, "eating healthy", and still staying seriously over-fat. Turned out that was not so.

I'm not saying that no one has factors that make things difficult. Honestly, I think it can be difficult for anyone and everyone, for a variety of reasons - but sure, more difficult for some than others. In one sense, if I'm that person . . . so what? I am who I am, and that's the raw material I have to work with. I think it's possible to get psychologically bogged down in "it's so hard because X". If so, that's not remotely helpful.

The challenge is to stay in the "what can I effectively do about this, and still achieve my goals" mindset, I think: Problem-solving, not catastrophizing.

I'd point back at the "variation around the mean" idea, too: If some situation (PCOS, hypothyroid, whatever) does have a "calorie burn penalty", the degree is likely to vary among individuals. The standard "follow the recommended calories for 4-6 weeks" experiment will sort out the actuality pretty well. Worrying about the statistical average doesn't improve the situation.

If I were a woman with PCOS and a lower BMR / not losing weight on the expected amount of calories, I would compensate by exercising more and not logging it.

(snip)

If it were me, I'd run that 4-6 week (whole menstrual cycle) experiment, and estimate my actual calorie needs if I could. That's pretty much what I did do, when it became obvious that my calorie needs were higher than MFP estimated. To me, one of the benefits of the MFP method (adding exercise calories separately) is the ease of adjusting when exercise load changes. Adjusting by doing unlogged exercise doesn't really help during times when, say, one can't exercise because of illness or surgical recovery or something.

Just my opinion, though.

I also looked at diets for my friend that had PCOS. It was pretty easy to see that most sources basically came down to reducing ultra processed foods like refined carbs and sugar which makes sense considering it's insulin that interferes with the hormones of the adrenal glands that then pump out androgens which is basically the pathology of PCOS, which is common sense really.

Of course any diet is only good if it can be adhered to so it's important to put priorities in an order that works for the individual and in saying that, there is no one diet that could be considered the best diet, even though the Ketogenic diet shows the best results but is difficult to adhere to, as an example of what I'm saying.

The basic algorithm is showing diets like the Mediterranean diet, low GI diet, Dash diet, pulse based diet, low carb diet, and the ketogenic diet. all of these remove UPF. For some reason the vegetarian diet had mixed reviews and suspect that that diet can still be high in refined carbs, sugar and UPF, so I suspect that's why I didn't see much.

Not to mention weight losses and exercise and the effects on insulin levels and storage protocols which does improve our insulin sensitivity, which basically facilitates the same metabolic result as reducing UPF, basically.

I have exhaustive notes on this but just thought I'd just get this out there for people that might find it helpful.