On Tuesday, my endocrinologist e-mailed me with the results of the OGTT I did last week. Turns out my (and her) early optimism was in vain. While the blood sugar levels came back absolutely normal this time (75/131/101) as opposed to last time (71/97/107), my insulin levels were elevated, which means I have insulin resistance.
Insulin resistance and PCOS (polycystic ovary syndrome) are closely linked and negatively impact each other. This means that effectively, you end up in a vicious circle where your insulin levels keep rising, making you gain more weight (which in turn worsens the IR), and the insulin levels also make your testosterone levels rise, in turn making the PCOS worse.
Luckily I do not have all the issues of IR: my blood sugar levels are normal, as are my cholesterol and triglyceride levels, my body is pear-shaped, not apple-shaped, with a WHR of 0.78 – all good things. But let’s face it, this still sucks. At the same time, at least now I know, and can do something. And it does explain certain things. Like why I gained so incredibly much weight this year. While my life style is certainly to blame as well, I was surprised at how quickly and how much I gained.
Part of me is also mourning the healthy person I thought I was. I always thought of myself as a healthy person. I never got sick much. Turns out I wasn’t healthy, I just didn’t know it. Knowing that I am at risk for developing diabetes, that several things in my body aren’t working the way they’re supposed to makes me sad, scared, angry, and disappointed all at once. And you know, part of me is wondering if the reason I have PCOS and IR is that I am overweight. Could I have prevented this from happening? I don’t know.
My doctor gave me some advice in terms of life style change. The main goal is to lose weight in order to improve my IR. To do this I basically have to keep a diabetic diet:
- a low-caloric, balanced diet
- rich in fibers, e.g., vegetables
- avoid fatty foods and alcohol
- avoid ‘bad carbs‘ (refined or processed carbohydrates)
- eat 5-6 small meal portions a day
She also suggested I work out 3-4 times a week for 45 minutes. All in all probably what most people should to in order to lead a healthy life style, I suppose. I will definitely try to stick to her suggestions as best as I can. Though the 1000-1200 calories, I am really not sure how that is going to work out for me. This is my plan:
- I already bought whole wheat pasta on Tuesday instead of the regular type as I know that is one easy way to improve my diet. I don’t like whole wheat pasta that much but I will have to get used to it.
- I am going to make sure only to buy whole grain bread from now on, which will not be that hard, because a) Germany has awesome whole grain bread, and b) I love whole grain bread.
- I will definitely cut down on unhealthy snacks; my goal is simply to stop buying most snacks and to exercise better will power when walking past the candy bowl at work.
- I will try to cut down on portion sizes for breakfast, lunch, and dinner, and have 2-3 snacks in between instead to make up for the 5-6 meal portions.
- I will eat more vegetables. I actually do not mind vegetables at all, but I am often too lazy to prepare a salad or to cook with vegetables. This is a change that I really don’t mind, as there are so many veggies I love eating, I just have to make a little more effort and time for cooking.
- I will start working out regularly again. I am planning on starting running again so I can do a 5k in Munich in October. I also signed up for Zumba which is finally going to be offered here in the fall. I also thought that simply going for walks might be a good way of getting a move on. I live out in the country, among fields that are just waiting for me to walk or run along.
By the way, if you are interested in reading more about my conditions, here you can find more information about PCOS and insulin resistance. There is also a very informative article explaining the link between PCOS, IR, and Metformin here.
I’m really sorry about your diagnosis. I know that, obviously, you were hoping for different results. I like how realistic and optimistic you are, though, about what may happen and what you can do now to prevent it. That’s honestly quite admirable.
When I was steadily losing weight (between 1-2kg per week) when I first started eating less and working out more (which I seriously have to get back to, I’m gaining weight again and it SUCKS), I did 1200 calories a day tops and as little fat as possible. I wasn’t told this by a doctor, though – I had read a dietary book that had inspired my brother to loose 40kg. I don’t think it was very healthy, necessarily, but it worked – and at times that’s all I really cared about (as I’ve explained here before). The number was based on the assumption that the female metabolism requires 1500 calories a day (unless you’re doing manual labor, or anything like that) and to lose weight, you have to take in less calories than you are eventually going to burn. — It *is* extremely low, and personally I began to feel like I suddenly couldn’t eat anything anymore because even the most healthy foods can still be high on calories. I think your doctor probably knows best, though, right?
No, I actually disagree with that. I have done a lot of reading on how much one should be eating and unless you are tiny (in size and height) or a child, 1000-1200 calories is definitely under your BMR. Especially when you are overweight, you have a higher BMR than a thin person (simply because it takes more energy to move a bigger body, and for all the bodily functions). I have been a member of a weight loss forum for many years and members there regularly post about getting bad advice regarding weight loss from their doctors – doctors are not nutritionists.
For example, my basic metabolic rate is 1567 calories (you can find out yours here). That means I should not be eating less than 1567 calories per day. With little activity (a PAL of 1.4), I have a total metabolic rate of about 2200 calories. When you eat too little (under your BMR), you put your body into starvation mode and effectively wreck your metabolism – it will utilize everything you feed it super-efficiently as otherwise it’s not getting enough nutrients. That means when you start eating more again, your body still utilizes that food super-efficiently and you gain weight more easily (even though you are eating normal amounts of food). Unfortunately plenty of people, even doctors, still believe in the 1200 calorie diet.
The only question is that because my metabolism isn’t functioning normally as it is, that may be an exception. That is something I am not sure about. But my diet should not be only low-caloric but also healthy and balanced, and somehow for me 1200 calories and healthy don’t go together at all.
But for people with a healthy metabolism, 1200 calories is not enough. I don’t want to sound harsh, but please, Kat, don’t do that do your body. You can find loads more tips on this German weight loss forum if you are interested. Many of the posters there are very knowledgeable about nutrition and which ways of losing weight are healthy.
I am planning to go to nutritional counseling sometime soon, and hopefully get some more information pertaining to my specific situation.
No no, you’re absolutely right and you’re not being harsh at all.
I didn’t really want to get into it (because I don’t want this to suddenly turn into a forum of Kat’s Problems 
) and so I just shortened my concerns to, “I know what I’m doing is not necessarily healthy.” What I neglected to mention is that the original diet (the one my brother did) requires that once a week you eat without regard to calories (still healthy, still not *extremely* fatty) and in normal portion sizes; your favorite meals; anything. And since this is a long-term plan to reduce extreme overweight that you’re supposed to stick to for at least half a year or longer, the body doesn’t enter the starvation mode because it never truly gets used to “only 1200 calories all the time” and doesn’t change its entire efficiency system etc. because before it can dial back the metabolism to work with 1200 calories only, there’s a day inbetween where you eat more. That is the theory of it, anyway, and it worked perfectly for my brother – and he’s back to eating much more now (in terms of calories) and still working out a lot and the body has re-adjusted to that as well right away without any weight gain. (Of course, things are very different for men and women in this regard so that’s something to keep in mind.) I mean- I’m not doing a very good job at explaining the science behind this weight-loss plan but it made sense to me when I read the book – exactly because it looked at the science of how our bodies actually work. (Which I would hope is how doctors approach the issue, yes?)
What you said about the starvation aspect of it is a very crucial point, though, and I’ll definitely check the links you posted because I haven’t been doing as good a job as my brother as far as doing these regular “re-feed” days and so my metabolism is in fact *very* messed up already. (Especially over the last couple of months, I haven’t had any regularity in my diet at all and my body doesn’t know what the hell it can rely on anymore. — That sounds like a silly thing to say but it’s true, I think.)
Thanks for the links!
I’m glad you didn’t take my comment the wrong way. I do maintain my belief though that eating, say, 1700 calories every day is better/more balanced, and keeps you happier (and the diet more sustainable) in the long run than eating 1200 on six days and then re-feeding on the seventh. Even though maybe you might eat so much on the seventh that the total is the same.
The thing with doctors is, they are all specialists for something, and don’t necessarily know everything about other specialties. E.g., my GP said the results from my first OGTT were perfectly normal, even though they were not, simply because she was just looking at the values, not at the chart. Which is something she would have known as an endocrinologist. Luckily they knew they were a little outside their comfort zone and gave me a referral. And well, an endocrinologist is not a nutritionist …
Which book is that, though, that you got this plan from?
By the way, my name on that forum is ‘Kaybee’ if you ever come across any of my posts.
And I really don’t mind your long comments at all. If it helps you, keep doing it. It is also interesting for me to see things from a different perspective.
I would really, really encourage you to get a second opinion on the 1000-1200 calories per day recommendation. I have read, and doctors have confirmed, that in no circumstances should you consume less than you basal metabolic caloric needs. Ever. Everything else makes sense. Just not the calorie recommendation.
Is it possible you misunderstood her?
Hey Mandy, thanks for your comment. I definitely didn’t misunderstand her as I got her diet advice in writing, but I am not planning to follow the advice specifically regarding the 1000-1200 calories. I made an appointment with a nutritionist through my health insurance for next month so I will hopefully get some more info then, and right now I am using MyFitnessPal to track calories and have a goal of 1630 a day (which is a little over my BMR). I would probably be hungry all day if I only ate 1000-1200 calories every day.
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