So, I am a woman with ‘lean PCOS’ (Polycystic Ovarian Syndrome). What this means, technically, is that I fall into the 1 out of 3 women who have PCOS who are not overweight or obese. For this, I am both proud and lucky. Proud because I am able to manage a healthy lifestyle with this condition. Lucky because I’ve had some genetic ‘help’ doing this. The reasons for having excess weight with PCOS are deep-rooted, complex, and multifactorial, with a strong genetic component.
Lean PCOS vs PCOS: What’s the Difference?
Not everyone fits the stereotypical image of a woman with PCOS: being overweight or obese, having acne and facial hair. Some women have few outward signs but internally, insulin still wreaks havoc on several of our bodily systems. It does help to try and achieve your own healthy BMI as weight has a ‘dose dependent’ relationship with metabolic changes, meaning the more weight you gain, the greater the chance of metabolic disturbances.
Why is Weight Management With PCOS So Difficult?
One significant challenge with PCOS is that, for most of us, our body is resistant to insulin. This means that your cells aren’t responsive to the level of insulin being produced, so the pancreas produces more and more insulin in order to achieve the desired effect.
Insulin is a hormone whose job is to store fat, an evolutionary adaptation that was helpful for women in prehistoric times when food was scarce. In our current ‘obesogenic’ environment, where food is plentiful and processed, this adaptation is a drag because our body works hard to store fat, particularly in the abdomen.
Abdominal fat contributes to insulin resistance by producing substances that decrease your body’s sensitivity to insulin, one of the vicious cycles of PCOS. It’s like insulin resistance and abdominal fat are always on a car ride together, one might be the driver, but the other is always along for the ride. If that isn’t bad enough, insulin resistance distorts your satiety and hunger hormones causing mixed signals so that you feel that you can’t eat intuitively because you are always hungry.
Therefore, the secret to managing PCOS is to make the body sensitive to insulin. Seems simple, right?
PCOS and Insulin Resistance
The path, though, to finding the way to make your body sensitive to insulin is anything but simple. It’s hard work and a lot of trial and error.
Most people have a moment that serves as a wake-up call for them. Mine was in college. In high school, I took the birth control pill and played team sports every season which helped me maintain weight and decreased the symptoms of PCOS.
Once I got to college, I was unable to participate in sports due to my part-time job. That, and the addition of the carb-laden college food, caused me to be overweight for the first time in my life.
Here is the part where I am lucky:
Genetics plays a huge role in your weight set point. My entire family is lean, so I have genetics in my favor, and for that I am eternally grateful as many women with PCOS who are overweight or have obesity are genetically inclined to have a higher set point/BMI. Here is where the ‘proud’ part comes in.
I found a way to control the stuff that I can control: what I eat, how much I move, and what I do to relieve stress. Chronic stress not only increases inflammation in the body but contributes to many of the diseases that I’m trying to prevent: diabetes, high cholesterol, and others.
Wondering how to increase your chances of conceiving with PCOS?
My Life is Different Because of PCOS
It is what it is.
When I was first diagnosed, I couldn’t process the enormity of the condition, so I just ignored it. You know when you have a blister on your foot because you chose to wear the cute, but uncomfortable shoes? It bothers you for days, the skin underneath feels raw, tender, vulnerable. It gets better when you wear comfortable shoes, and once it’s better you think “I’m going to go back to my cute shoes.”
So, you do and reopen the blister and the whole process starts over again. Eating whatever I want is like wearing the cute shoes: unsustainable and harmful over time, leaving me irritable and unhappy. Eating to fuel my body (and to prevent my insides from being a metabolic disaster) is like wearing the comfortable shoes.
When I wear the cute shoes, I enjoy every moment knowing there will be a price to pay. How steep the price depends on how long I wear the shoes before realizing the comfortable ones are best, even if they are not cute and no one else my age is wearing them. Still with me?
I also need to have regular check-ups with my doctor because I’m still at risk for high cholesterol and the accumulation of bad lipids in the blood stream, even with a healthy weight. I am still at risk for impaired glucose tolerance and its evil stepsister, type 2 diabetes mellitus. Also, I don’t ovulate regularly, so I needed help conceiving (but I did conceive successfully, carried, and delivered, 4 children).
My best advice? Mostly wear the comfortable shoes but keep the cute ones in the closet for special occasions.
What About the Day-to-Day PCOS Management?
After much experimentation, I know what foods are good for my body and which aren’t. I’m talking about how foods makes me feel as opposed to how it makes me look. This is a big, but necessary, shift that you need to make when you have PCOS. The foods I eat dictate how I feel that day and often the next day as well. My comfortable shoes include ‘slow’ carbs (brown rice, quinoa, sweet potato), healthy proteins, and fats.
You have to experiment with which particular foods in each category work for you (hence my unfortunate ‘turkey jerky phase’). Most of what is offered at restaurants or when I travel doesn’t work for me. For example, the continental breakfast. This ‘breakfast’ is a warzone for women with PCOS, filled with landmines such as pastries, bagels, and sugary yogurt. So, I’ve become that person who brings her own package of nuts and nutrition bars.
If I don't prepare and just eat what is available, I find myself dozing off around 2-3 pm, having trouble focusing and being irritable the rest of the day (reopening the blister). I’ve learned to become fully prepared with my own food and am happily surprised if the food at my destination is PCOS-certified.
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And I’m annoying at restaurants. For example, I decline the breadbasket before they even bring it to the table (because I have trouble turning down warm rolls). And I don’t care that I seem like “that person” because I realize that it’s usually not worth the physical response that my body gives me when I eat poorly.
You may wonder what my cute shoes are: French fries.
Do I Resent PCOS?
Do I wish that I could eat what everyone else is eating and not gain weight or contribute to the likelihood that I will get diabetes? H*ll yes! When my college roommates were scarfing down pizza and not gaining a pound, I wished I had a voodoo doll of each of them so I could stick pins in it and let them experience the discomfort that I was feeling.
But this was the deck of cards I was dealt. I’m proud of how I handled a life-altering challenge and feel like I can handle anything. I have learned to pick up cues from my body that tell me whether what I am doing is good for me vs. not good.
And, sometimes, I choose the cute shoes. But I do it with the knowledge that they are a special treat, then get back on track. I am now in my forties and many people tell me I look much younger -- my years of healthy eating and exercise have attributed to this.
Let’s talk about exercise for a minute. Physical activity, regardless of what form that takes for you, is the greatest insulin-sensitizing agent even if it doesn’t result in weight loss. When I was in college and tying a shirt around my waist to conceal my butt and stomach (known as SOFA - shirt over fat a**), I used to force myself to run to “lose weight.” I now do it because it grounds me, allows me to process ideas or issues uninterrupted, and for me, it’s a form of stress release. I run because it makes me feel physically empowered and increases my confidence. If running isn’t your thing, you can swim, join a class, or just walk. Just moving makes a difference.
Stress release is so important. People have different ways of managing stress. My way is to think of drinking from a bottle. (Not that bottle! Although that’s tempting at times...) Here’s what I do:
Whenever I have a really good moment, memory, or sensation, I ‘bottle it up’ so that I can draw from it later. For example, snuggling with my cats; having a great conversation with a friend; the feeling I get after accomplishing something; the feeling I get when I first jump into a pool and feel the cool water. Then I create a place inside me where I store this feeling. When I really need it, am frustrated, resentful, angry, or just stressed, I tap into it. I use visualization and breath to recreate that peaceful, calm, and empowered moment. This, like any new habit, takes practice, but it works for me. For you, it might be journaling, going outside, gardening, reading a good book, or listening to music. They all work.
I’m Not like Other People. I Have PCOS, and I’m Healthier Because of It
I’m am not like other people “my age,” a comment I’ve heard numerous times by many and various health care providers. And, I agree. I’m better. I’m a more disciplined, resilient, stronger version of myself. I have faith in my ability to get to the other side in difficult situations. I value my health and make time to do activities that fill my tank. I don’t let having PCOS rule or define me. I found courage in the battle just like these celebrities who have been open about their PCOS.
Recently, I went to my internist for a visit, and she wanted to “clean up” my medical history, deleting the problems and illnesses that I no longer have. She wanted to delete PCOS because "clearly I am not suffering from it anymore.” Well, that’s true, I am not suffering from it, I’m living better because of it.
And, I asked her not to delete it.
While PCOS does affect me only at certain times, it will always be a part of my life. But I will be living with it, not weighted down because of it. And I wear my “living with PCOS” as a badge of honor, hopefully inspiring others to do the same.
So, maybe today you put on your comfy shoes and eat well and exercise and fight insulin resistance. Maybe today, you dig out your cute shoes and eat fries, binge-watch Netflix and “fill your bottle.” Whichever you choose is the right decision for you that day, then you move on tomorrow to living healthfully again.
As Elizabeth Gilbert says, “Embrace the glorious mess that you are.”
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About Monica Moore
As a nurse practitioner, Monica received advanced nursing education in addition to being a registered nurse. She is a fully licensed registered nurse and Advanced Practice Nurse Practitioner in the state of Connecticut and is certified by the board of the American Academy of Nurse Practitioners. Monica’s nursing work experience spans nearly two decades in the field of fertility treatment. Monica’s passion lies in taking care of the whole patient. Monica works with patients and stresses the importance of integrating comprehensive care – including yoga, acupuncture, massage therapy and nutrition – with fertility treatment.