Musing

So, my weight has stayed pretty stable the last month, but I’ve also been a bit more lazy, so I can’t really claim it as a plateau. I’ve been bouncing between 140 and 143, and I’ve actually had my period, so on that front things seem good. In terms of my laziness, I spent some time at the other half’s family’s house, drank alcohol, didn’t track calories as rigorously. That being said, I didn’t gain weight, so for that reason, I’m happy.

As per usual for me, I’m working around an injury with my exercise, another reason my weight hasn’t been dropping. With the metabolism you get with PCOS it’s hard to wind up at a calorie deficit without exercise. At least I’ve maintained, and the nice thing about keto is that I haven’t been starving the whole time. That’s where I’ve failed in the past, with injuries. I would be hungry, constantly, and losing nothing. It felt like torture. Now, I’m happy to keep on keeping on.

I do have to wonder, occasionally, if I will ever make my ‘goal’. Weight is just something I’ve struggled with, for so much of my life. What would it be like to be a person who didn’t have that constant fight? I don’t doubt that I will have to struggle to stay at my goal weight. I know hitting some mystical number on the scale isn’t going to cure me. I know I will have to constantly keep an eye on my weight, so that it doesn’t start to creep back up.

Still, and I am loathe to use this page as my personal therapist, I do wonder who I will be, as a person, when I’m not actively losing weight. Weight loss has always seemed like such a huge part of my identity. Ever since puberty, I’ve been trying to lose weight. How do you separate out something that has been part of you for 15 years?

That’s all for the moment. For now, I am staying motivated, and putting myself back into strict weight loss mode. Those shoes, at least, are familiar.

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Doctor’s visit

Got my blood test results back, everything was good, except my LDL was a little high. From what I’ve heard about very low carb diets, this evens out in a couple months, so I’m not too concerned.

My doctor was insanely pleased with my results otherwise. He was really pleased I’d lost sixteen pounds since I saw him, and seemed pleased with my diet. He told me to keep doing exactly what I was doing, until he saw the slightly elevated LDL, then he told me to cut the fatty foods. But honestly, it leaves me with nothing! So, I’m ketoing on. I’ll see where I am in six months.

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Progress

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142.75

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153

Sometimes I find progress to be so slow as to be difficult to measure. It is hard to just keep on keeping on, when you feel like you have little to nothing to show for it. Still, I feel like I can actually see a difference now, which is great. I’m short, so a not too dramatic drop on the scale can actually make quite a visible difference. My bum is definitely smaller, anyway.

Still, it’s hard, this long, slow slog to a healthy weight. I’ve been trying very low carb, which I’m finding much easier, along with my normal habit of calorie restriction, and I’m a lower weight than even while marathon training with a calorie deficit that was obscene. So, yay! I had a blood test this week, and I see my endocrinologist next week, so I will probably write about the results then.

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BMR and PCOS

So I read an interesting abstract from a study about BMR(basal metabolic rate) in women with PCOS. Have a look if you’re interested.

I’ve always known my BMR had to be lower than average, or I simply wouldn’t weigh as much as I do, or spend as much time exercising in order to lose weight, but I’d had no idea it could be that different. The numbers reported in the study are the ADJUSTED BMRs, so they’ve already accounted for activity level.

It does make sense. If you look at the difference they saw in women with PCOS + insulin resistance, and normal women, it’s a difference of 752 kcalories a DAY. That is huge. Even if you look at the PCOS women without IR, it’s still 278/day. That means, if you’re eating what the average woman should be eating to maintain her weight(1868 kcal a day, here), you’d be overeating by 1946 kcalories a week if you didn’t have IR and 5264 kcalories a week if you did. A pound of fat has about 3500 kcalories, so the non-IR PCOS woman would be gaining half a pound a week, and the IR+PCOS woman would be gaining 1.5 POUNDS a week. So, in a year, the PCOS woman without IR would have gained just shy of 29 pounds, and the PCOS woman with IR would have gained a staggering 78.2 pounds.

That makes many things from my past attempts to lose weight make a lot more sense. When I wasn’t trying to control my borderline insulin resistance, losing weight was a joke for me. I would cut my calories down to 1200-1400/day, and exercise on top of that, and I’d be lucky to lose maybe half a pound to a pound a month. Each week, I’d try and burn 2000-3000 kcalories through exercise, so let’s do some math.

Let’s look at the numbers for the PCOS+IR woman. It gives an adjusted BMR of 1116 +/- 106 kcalories. That means that, when adjusted for activity level, the women with PCOS and insulin resistance would need to eat between 1010 and 1222 kcalories a day to maintain their current weight. So, let’s assume, as I am borderline for insulin resistance, I fall somewhere between the bottom of the non-insulin resistance PCOS women and the top end of the PCOS+IR range. The bottom for the non-IR women is 1460, so halfway between is 1341 kcalories a day.

If I was eating 1300 kcalories a day, that would give me a calorie deficit of 41 calories a day. Since a pound of fat is 3500 calories, that means it would take me 81 days(just shy of two months) to lose a pound, if I wasn’t exercising. Let’s assume I was burning and average of 3000 calories a week through exercise, in addition to my dieting. That would give me a weekly calorie deficit of 3287, just under a pound of weight loss a week. Since I certainly wasn’t losing a pound a week, I assume my BMR actually fell in the IR+PCOS range.

If you’re at the bottom of the PCOS+IR range and eating 1300 calories a day while burning 3000 calories a week through extra exercise, you’d have a weekly calorie deficit of 970. That means you’d burn a pound in 3.6 weeks, which is much closer to what I was actually doing.

What is 3000 calories of exercise? It’s a heck of a lot. It’s running 30 miles a week. I was running between 20 and 30 miles each week, so let’s say I averaged 2500 calories burned each week. That would mean I would have had a net calorie deficit of 470 calories a week, and that it would take 7.2 weeks to lose a pound, which was pretty close to my reality.

Now that I’m taking metformin, things are a bit easier, but I’m still not losing weight as quickly as non-PCOS women do. I keep my calories at around 1300/day, and when I’m consistent with my exercise, I can lose a pound a week, sometimes even a pound and a half, which is huge for me. It also puts me some where between the low and median ranges for the woman with PCOS BMR.

I feel like this is hugely important information for a woman with PCOS, and it seems surprising to me that I’m just finding it out. Of course dieting doesn’t really work for me and I can gain weight without even trying. At least I’ll do okay if there’s ever a famine!

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Taking meds

I feel conflicted about the medicine I take for PCOS. I suppose that’s because I forget the myriad problems PCOS causes and simply focus on my weight.

I feel like weight loss should be fairly simple. If you expend more calories than you use, you will lose weight. The issue being, that doesn’t actually work for me. I know, it should. I hate talking to people on weight loss forums, etc, because I will explain what I’m doing and get accused of cheating, of not tracking properly, etc, etc.

I know what you’re supposed to do to lose weight. I’ve worked with nutritionists and medical professionals. I maintain a calorie deficit that should ensure I lose two pounds a week, and I lose half a pound a month. My nutritionist always said that was normal for PCOS, and I just had to tough it out and would eventually see results. Of course, I would get to about six months of this practice and just get fed up. One part of the equation, either diet or exercise, would slip, and I would wind up gaining instead of losing and that would be it. I would be back to my wicked ways, with the scale creeping up.

What I tend not to think about is the damage that PCOS does that isn’t so visible. It puts me at risk for heart disease, diabetes, endometrial cancer, myriad fertility issues…

My Mr pointed out something about the medication that makes me feel a bit better about taking it. It’s not a weightloss drug(which it isn’t, it’s a diabetes medication), it just puts me on even footing with everyone else. I have to put in the hard work to actually lose weight, which I am. It just feels like a bit of a cop out, like I’m giving up.

That being said, I enjoy actually seeing the number on the scale move. Yes, I’m working, hard for it, but holy hell, is it satisfying. I feel like it is going to be much easier to stay motivated if I keep losing. Of course, I’m prepared to plateau, to stall. I’m not going to let it derail me. If it’s any less than six solid months of plateau, I know I can make it!

As an aside, I think I do pretty well for someone with PCOS. I’m always, trying to lose weight or not, an active person. If I ever completely stopped exercising and started eating everything, I know I would easily shoot up to 190 lbs, instead of my all time high of 175. So, even when I’m not completely focused on my weight loss efforts, I still keep moving. Heck, on my medication, I actually lost 5 lbs over the last six months, while not exercising as much and not counting any calories. So that spells out the difference for me, between having insulin resistance and not. In a period where I would have gained 10-15 lbs when my insulin levels were wacky, I lost 5 lbs. It makes me think I might actually be able to maintain a weight loss and eventually not be required to completely focus on diet/exercise to maintain a healthy weight!

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Scared and trying to figure myself out

I’m losing weight, and it terrifies me.

So, I have PCOS. If you don’t know what it is, it’s poly-cystic ovarian syndrome. Basically, it’s hard for me to lose weight, I don’t really ovulate and my hormone/insulin levels are wacky. They don’t know what causes PCOS, and it’s a diagnosis of exclusion. Because of that, you get women with a whole host of symptoms who all meet the criteria for PCOS. Some lean women have pcos, though that’s less likely.

For me, I gained weight when I hit puberty. Speaking to a friend  who has recently qualified as a Physician’s Assistant(my best friend/neighbor since we were about 6), she finds it ‘shocking’ how glaringly obvious my PCOS is to her now. I guess my sudden weight gain of about 20 pounds sticks in her mind more than mine. For me, I always remember being a bit pudgy, even when I wasn’t(as a 10-year-old, for example), so when I weighed 135-140 at 14 even though I was ridiculously active it didn’t seem weird to me, just typical me being pudgy. By the end of highschool, I was typically 150. By the end of college, when I had tried to lose weight, I was jumping between 145 and 155.

By the middle of college, I’d been diagnosed with PCOS, after coming off hormonal BC resulted in a complete cessation of my already incredibly infrequent period. I went through a ridiculous number of tests, then was told I had something I’d never heard of before, oh and by the way, it’ll be hard to have children, and there’s no cure.

I tried the medication they suggested(metformin), but the life of a college student in New York City wasn’t exactly conducive to regularly scheduled meals three times a day as the drug required and I wound up going off it. For a while, I just stuck to hormonal birth control which poorly controlled my symptoms.

Fast forward a few years. While a grad student, I tried to see a new endocrinologist, but my GP was so miserable and awful, I just couldn’t face talking to him so I went a few years without specifically treating my PCOS. Then I moved to where I am now, got a new, much nicer, GP, and he happily sent me to an endo. My new endo got me back on the original drug, which I again hated. Because I hated it, he switched me to a different version(metformin extended release, rather than the normal metformin), which is much, much better and didn’t really exist the first time I tried the drug.

That was six months ago. Up to that point, I’d been ‘dieting’ for about 6 years with very few results. If I stopped obsessively calorie counting and exercising, I would jump up to 170/175. My militant eating and exercising kept me at a still way too fat 160/165. I was burnt out and so freaking tired of hearing the same tired, old ‘eat less, exercise more, you’ll lose weight!’ It just didn’t work like that for me.

I’ve always been an active person. I whitewater kayak, I run, I hike, all because I love these activities. Every weekend finds me doing something active, at least one day. If I wasn’t doing that, I would easily go up to 190 lbs without meds.

Anyway, when I finally got on these meds again, I stopped doing my tons of exercise, and stopped being compulsive about tracking my eating. I didn’t weigh myself. I went through Christmas and New Years eating anything and everything I pleased. When I went back to the doctor, I fully expected to have gained weight. My clothes were still fitting, so I knew it couldn’t have been too bad, but I was completely shocked when my doctor greeted me with smiles and announced that I’d lost five pounds. I admitted to him how I’d been lazy and over-indulged at the holidays. He was still happy, but told me to put my nose grindstone and see how I did over the next six months.

I guess the 5 pounds I lost while sitting on my butt has re-energized me. I’m tracking my food and exercise again, this time with MFP(I used sparkpeople for a few years, but don’t like how it doesn’t adjust your daily calories to account for exercise) as well as Fitocracy, for the points aspect that I enjoy.

I’ve started weighing myself again, and it’s weird. I’m actually losing weight, something I never expected. I weighed in at the doctor’s(January 4th), I was at 160, with clothes on, so I assume I was about 158. When I weighed myself this morning, I was 154.75. That’s just over 3 pounds in less than a week. I’m dropping steadily, for the very first time in my life. Even if I say my scale hits lower than the doctors, I did weigh in on it at 157, so it’s at least a 2 pound drop. It’s shocking, and terrifying. Will I actually be able to lose weight this time? The only thing that will hold me back now is my own will power, and that is scary. Why if I, not my body, fail? What if I can’t keep up the necessary momentum to really commit to this lifestyle change? I’ve done it before, but usually burn out after six months or so without seeing any results from my grueling hard work. Will actually losing the weight allow me to see this journey through?

I guess it’s the possibility of failing that I find the most scary. In the past, I’ve been able to say, ‘Fuck this. I’ve been eating and exercising to the point that I should be losing 2 pounds a week for six months and I’ve lost… 4. I’m done.’ What if that happens again? What if I lose a few pounds now, then plateau? What if I have no one to blame but myself? For not trying as hard as I should, for giving up too soon? That terrifies me.

In terms of my general eating habits, I always eat pretty healthily. I don’t eat fast food, or even eat out very much(once a month at most). The vast majority of  my meals are prepared, from scratch, in my kitchen. Once I have lost weight, if I do, will I be able to increase my calories without gaining?

I’ve got so many questions that only time can answer, and I don’t like it. I feel cut adrift, lost, with no landmarks in unfamiliar territory.

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Just me

I’m Alie and this is just me documenting my latest effort to lose weight with PCOS. Thanks for reading!

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