I’ve got chronic PCOS and have been going to an endocrinology clinic for the last g-d knows how many years. IANAD. I’m part of the 50% of women with PCOS who have experienced huge weight gain without significant diet or lifestyle changes. My consultant, who is also a leading research scientist in the area (or so he tells me), has explained that although the relationship between PCOS and weight gain is not entirely clear, that most women who have PCOS and weight gain are likely to also be insulin resistant. It’s not clear which came first - the PCOS or the insulin resistance. I feel very strongly that the PCOS came first, as do all the women with PCOS that I know, as I had not experienced IR symptoms until well into my period of weight gain.
Insulin resistance, in layman’s terms: food is converted by the body into glucose and used for energy. In insulin resistant people (also see diabetes 1 and 2), the body cannot process the amount of glucose in the blooodstream, as the body can’t react properly to insulin in the blood and so convert all the glucose. So you have two results here - A. the person can’t gain energy from all the food eaten, so in effect the body’s gas supply isn’t working. That person feels tired and sluggish. B. the body is left with a large amoubnt of glucose floating around in the blood, unused. By and by, this glucose is carried in the blood to the liver, where it is directly converted into fat.
Or something. I’m not 100% clear on the details. All I know is that at 16, I had been a junior county athelete and swimmer, and was eating a terrifically healthy and low-fat vegetarian diet. My periods then stopped and by the time I was 19, I’d put on over 100lbs without a SINGLE change in my diet. I had become less active due to the weight gain making physically uncomfortable to exercise (I used to walk everywhere, but now my back goes out after 10 minutes walking), I used to get terrible hypoglicemia attacks whenever I went to the gym and actually passed out once or twice, and I could not get enough energy to do more than drag myself to work and back. In other, more fun symptoms, I also grew a beard and put on about 30lbs in muscle weight due to the amount of testosterone my body was suddenly producing.
My clinic referred me to another clinic in London, who tested me on various exercise machines and diagnosed that I need to consume less than 800 calories per day with at least 30 minutes CV exercise per day in order to lose weight. I’m currently managing to maintain my weight by sticking to a strict low GI (low glucose) diet of around 1000 calories a day and exercising daily, but weight loss is out of the question as I can only maintain a diet of 800 calories a day for a couple of weeks before my body starts screaming at me and my pets begin to look edible, nay delicious. Calories in/calories out works for MOST people, yep. Some of us? Nope. If I exercise more, I simply put on more muscle and do not lose fat weight. Weight loss surgery is probably my only long-term option, as more and more doctors are recommending to PCOS women with obesity.
A perhaps interesting aside - some recent research suggests that the massive increase in women aged 40 and under reporting PCOS symptoms is probably due to the changes in the modern diet in the 60s, including common use of pesticides and hormones in farming techniques. So it’s not like PCOS women even did anything to bring this on themselves. It’s why PCOS women should eat organic wherever possible.
Hormones are fun. I was planning to be a professional dancer at 16. These days? I’m happy when I manage 45 minutes on my cross trainer. I know diets and I know exercise, probably a lot more than the thinner people telling me I just need to eat less and work out more.