PCOS is the most common cause of infertility in women of childbearing age. It is linked with various miseries including heart disease, diabetes, and obesity. None of this sent Carrie (name changed for privacy), then 27, to the doctor; it was something far more superficial. She grew a hair on her chin.
Though she didn’t know it, the ‘root’ of that hair could be tracked back more than a decade. At 17, Carrie lost consciousness for the first time because of low blood sugar. This problem was not unfamiliar; 3 close relatives also suffered from what they called ‘hypoglycemia.’ Through the years, Carrie learned to monitor her symptoms and eat when she felt woozy, which was pretty often.
Carrie’s blood sugar problems were an small part of a bigger picture she didn’t see. A ‘normal’ body’s pancreas will release insulin when blood glucose levels rise (after eating, for instance.) Insulin is a hormone the body uses to use glucose. Carrie’s body did produce insulin, but it’s ‘shutoff’ mechanism was faulty. So much insulin was released that her blood sugar levels fell drastically, starving her cells. What she and her family had always called hypoglycemia (low blood sugar) was, in fact, hyperinsulinism (high insulin) While low blood sugar caused immediate symptoms, the excess insulin her cells were bathed in worked its changes silently.
Excess insulin in the bloodstream creates a problem. Cells reduce their receptors in response to the excess, which makes them less able to absorb vital glucose. Glucose is then left circulating in the bloodstream so the body stores it as fat for later use, which is why weight gain is a common problem for PCOSers. The insulin, left unused by the cells, causes the ovaries to produce excess testosterone, often leading to abnormal hair growth, male pattern baldness and infertility.
Through her early twenties, Carrie didn’t notice any particular problems aside from her ongoing poorly managed blood sugar. At 25, though, things began to change. While she’d never been very thin, she’d also never had any difficulty controlling her weight. Now she began to gain about a half pound every month. On her 5’11” frame, half a pound wasn’t even noticeable, but after 12 months, she’d gained 6 pounds. It didn’t seem to matter what or how much or little she ate, she gained weight.
At 26, she began to notice that her always thick hair seemed to be thinning on the top and her weight gain continued. She mentioned the hair loss to her mother, who said she didn’t see anything. Since her hair wasn’t thin enough to be called ‘thin’ she didn’t give it too much thought. Not until she was seated at the table and her mother stood behind and finally, after a year of denials, agreed that Carrie was losing her hair. As bad as this was, she didn’t panic until two weeks later, when she found a hair on her chin.
“Then I panicked. I said, ‘I’m not going to be a woman with a beard! I’m only 27!'” Carrie recounts. “I made an appointment with my doctor that same day.”
Carrie was lucky, her doctor had a possible answer. She asked questions about other symptoms like weight gain, hair loss, missed periods and fertility. Then she sent Carrie for an ultrasound.
“I didn’t have to wait for the test results. I could see the screen as the technician did the scan and there were marble-like bumps all over my ovaries. I knew I had classic PCOS.”
PCOS is short for polycystic ovarian syndrome. A syndrome is a group of symptoms which often occur together. The symptoms common with PCOS include cystic ovaries, irregular periods, acne, infertility, thinning scalp hair, excessive body hair, uncontrollable weight gain or inability to lose weight, high blood pressure, skin tags, and hormone imbalances. Carrie’s doctor referred her to a gynecologist, which was normal procedure at that time. The gynecologist prescribed birth control pills to control the hair loss and told her to come back when she was ready to have a child. Carrie had tried birth control pills twice before and hated what they did to her body and mind. This time she stayed on them for 4 months. After spotting for the whole four months, she quit cold turkey. She had been told that the pills weren’t improving her health, only her symptoms, so she didn’t feel compelled to pursue that approach any longer.
She did some research and found out that many women were being helped by reproductive endocrinologists, so she asked her GP for a referral. A reproductive endocrinologist is a doctor who specializes in the hormones related to reproduction, and Carrie’s RE was surprised that Carrie had sought help despite not trying to have a baby. What Carrie and the RE both knew was that uncontrolled PCOS is closely linked with serious disease including diabetes, heart disease, and stroke. The RE performed some tests, including a glucose tolerance test and looked over Carrie’s previous test results. Carrie requested a prescription for metformin (brand name Glucophage) because she’d seen that studies were showing good success. Metformin is a drug normally given to adult onset diabetics to control their glucose. At that time, the link between blood sugar, insulin, and PCOS was a new hypothesis. The doctor prescribed 6 months of metformin and told Carrie to come back after those six months.
Some people complain of severe digestive upset when they begin metformin, but for Carrie, the gastrointestinal side-effects of metformin weren’t too bad. While she took the drug, she had few issues with her previously problematic blood sugar. But she believed she could do more, more naturally.
“My father began a strict low carbohydrate diet in his mid 40’s to combat his hypoglycemia. It worked for him, but I knew I’d never adhere to such strict diet rules. I love carbs, and I really couldn’t believe that our bodies would function better on a diet with few carbs, knowing that humans evolved mostly as hunter/gatherers with a heavy emphasis on ‘gatherers.’ It was anti-intuitive.”
Browsing in a bookstore, Carrie discovered the Glycemic Index. A laboratory look at how different carbohydrates in different forms create different reactions in the body, the glycemic index ‘felt’ right.
“It just made sense,” she says, “I saw that I could eat more logically, and the findings fit in with my understanding of the historic human diet. Also, it didn’t require any drastic changes in my diet, so I knew I could do it successfully.”
She read The Glucose Revolution (www.glucoserevolution.com), by Jennie Brand-Miller and others. She immediately made changes in her diet, giving up jelly beans and boxed breakfast cereal entirely. She says that aside from those two foods, most of the other changes are hardly noticeable. After four months on the metformin, she quit that, too. She felt that with the changes she’d made in her diet, it really wasn’t necessary anymore. Carrie reports that in the 6 years since she started eating according to the Glycemic Index, her blood sugar issues have virtually disappeared. She stopped gaining weight and the hair on her head grew back as thick as it had ever been. Sadly, the excessive body hair growth is not as quickly affected; it will take years for the hair follicles to return to their previous state. She’s happy to relay that she hasn’t grown any new hairs since getting her diet under control.
But Carrie’s story isn’t a fairy tale, and it’s also not quite over. She didn’t lose the weight she had gained, though she admits it wasn’t really a focus for her. She was just happy to stop the weight gain and avoid a gastric bypass which several of her PCOS friends have undergone. She’d resigned herself to being healthy, but big. Then, the last piece of the puzzle slipped into place, quite by accident. About one year ago, she decided she wanted to plant a garden. A friend donated a spot of land and Carrie set to work, digging and clearing the entire area by hand. While it was good cardiovascular work, Carrie felt the results mostly in her upper body. At the same time that she started to notice her new muscle definition, friends began to comment about her weight loss. Soon she needed all new clothes and had to buy a belt to keep her trousers up.
“I’d always been really active, getting plenty of cardiovascular work, so I knew the difference was in strengthening my skeletal muscles. It felt almost effortless.” Carrie says, “I wasn’t trying to lose weight, I just wanted a garden.”
She estimates she lost about 30 pounds over a three month period (though she doesn’t weigh herself), and has kept it off for a year. Muscle tissue requires more calories than fat tissue, so Carrie’s more muscular body burned more calories even when resting. Also, many studies show that ‘resistance training’ improves the body’s ability to maintain good levels of insulin and glucose. Heaving rocks over the fence gave Carrie’s muscles the workout they needed to help her body get back to normal.
It is generally said that PCOS is not curable, but Carrie disagrees. She doesn’t consider herself as a PCOSer anymore, though she still carefully maintains her insulin/glucose levels. She says that if she went back to eating high GI foods on a regular basis, her PCOS would return, along with her increased risk of associated diseases. She hopes that her story gives hope to newly diagnosed PCOSers around the world.
Carrie leaves us with this take-away message, “It was a lot of small changes; everyone can do it. I don’t want to say it was easy, but it wasn’t hard.”