Thursday, July 08, 2021

PCOS and stuff

[This is another rambling, personal post about health and, while it may seem specific to me, enough women suffer from PCOS (anywhere between 1 in 10 and 1 in 4, depending on the source) that it could be relevant to others as well. As always, feel free to skip it and wait for the next recipe!] 

In late 2020 and early 2021, it seemed like I was suffering from a few very minor health issues here and there, and my complaints were split between a few health practitioners with their own specialties. Then, right before the new year, I got some lab work that showed an increase in my cholesterol and my blood sugar (the latter was all the more out of left field considering that I never even had any signs of gestational diabetes); plus, there’s 20 pounds I never lost from my last pregnancy and I’m carrying it in my midsection instead of the pear shape I’m used to. I started wondering whether all my minor ailments and these new lab results were connected, and perhaps I needed a doctor who had an overview of the whole thing. So, I connected some dots on my own (unregulated PCOS? potential hypothyroidism? they are correlated, after all) and brought my concerns to my gynecologist at my annual visit; he agreed with some of my hypotheses and added some questions of his own (potential Hashimoto’s disease?). He wrote me a prescription for birth control to handle some of my symptoms and recommended I see an endocrinologist to rule out other stuff. 

So, I found an endocrinologist specialized in diabetes, metabolism, and thyroid disorders. He ordered more tests and concluded that my numbers are “borderline” (hypothyroidism, maybe Hashimoto), but at this point, they do no warrant such a diagnosis and do not require treatment beyond a diet change. He also brushed off my PCOS since I’m on birth control. Essentially, his diagnosis was that I’m getting older and my metabolism is slowing down, both of which are admittedly true. The nurse practitioner told me I need a low-carb diet, and I should eat more protein to feel full. This is already more helpful that simply being told “Try to lose weight” or “Just eat less” when, really, I’m hungry. It’s still a big adjustment! I was turning to whole grains to keep me full, but now I’m told that scrambled eggs would be better for me than oatmeal. Except I’m not going to cook eggs every morning, and besides, what should I eat as a side to the eggs if toast is off the table – yeah, I still have a lot of questions. 

Then, just a few days after that appointment, the Engineer forwarded me an article on CNN stating that women with PCOS are more at risk of complications from COVID-19 than the average patient, and… it wasn’t that fact so much as ALL THE COMORBIDITIES mentioned in that article that really got my attention. The PCOS itself puts me at risk for insulin resistance and Type II diabetes, obesity, inflammation, endometrial cancer, and a whole bunch of other things (like high LDL and low HDL, according to the Office on Women’s Health). This is in addition to possible symptoms like menstrual irregularities, obesity, hirsutism and male-pattern baldness (because of excess androgen hormones) that I already knew about. 

It turns out that PCOS is typically treated as a reproductive disorder, but it’s actually a metabolic disorder and the anovulation is just a symptom. It should really be renamed, because PCOS makes it sound like it’s strictly a reproductive disorder, and even the endocrinologist specialized in metabolism didn’t seem aware of its ramifications! 

As you know, I do my best to use reputable sources, but there’s still a lot more scientists can learn from this disease, even though PCOS was first reported 300 years ago this year and is “the most common hormonal condition for women of reproductive age” (Cleveland Clinic). It turns out that simple calorie restriction is not a good solution for patients with PCOS (or for those with insulin resistance in general), and I really should focus specifically on a low-carb diet. There are also symptoms like being hungry a few hours after eating and craving carbs that are more specific to those patients than to the general population (hence my sweet tooth?). At this point, this all makes sense to me, because I tried Noom for several months two years ago and even though I was consuming the amount of calories that should have had me going down to my goal weight, I was still stalled at more than 10 pounds over it for months and I eventually quit the program (which was overwhelming anyway). 

There are more symptoms and risks that no healthcare professional had discussed with me (some of these check out for me, some don’t): sleep apnea, depression, anxiety, inflammation, metabolic syndrome (Mayo Clinic); boils (Cleveland Clinic); acne, dark skin patches, skin tags, pelvic pain, fatigue, heart attacks and cardiovascular disease in general (PCOS Awareness Association); plus deficiency in vitamin D, magnesium, and iron (though these are also common in the general population). 

Here’s something that really stood out, given my lab results: according to the Office on Women’s Health, more than half of women with PCOS will develop Type II diabetes or prediabetes (insulin resistance) by age 40, and they will often have high levels of LDL and low levels of HDL cholesterol (whereas the opposite would be desirable). The CNN article I linked to above also quoted a doctor as saying that if two women both weigh 100 kg (roughly 212 lbs.), and one has PCOS but the other doesn’t, the one with PCOS is more likely to develop Type II diabetes – proving that the issue isn’t simply linked to her being overweight, but to the underlying condition. 

All this to say that I’m reading up on low-carb diets and have joined mailing lists of/bought cookbooks by registered dieticians specialized in nutrition for PCOS. (I’m avoiding some of the ones who are Instagram influencers and seem to me to be trying to make money through sensationalist means rather than consultations or online classes.) This is all still new to me, but I’m trying to navigate it as best as I can. In parallel, I’m reading The Menopause Manifesto by Dr. Jen Gunter and also learning a lot from that (because admittedly, the risks of some of these conditions just increases with age and/or menopause, regardless of a PCOS diagnosis).

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