As I posted a couple of weeks ago after four years of gaining weight without explanation, I was finally diagnosed with Poly Cystic Ovarian Syndrome (“PCOS”). Based on the diagnosis, my reproductive endocrinologist sent me for an entire battery of blood work to determine treatment options. Two hours, five different draws and twenty-one vials of blood later, I felt as if I had donated several pints of blood. Then I had to wait to hear the results. In the interim I jumped into the Atlantic Ocean to raise funds for Mystic Aquarium (and was the highest fund raiser, booyah), had arthroscopic knee surgery, spent a few days recovering and got back on the bike four days post surgery (again, booyah).
After two weeks of waiting, I finally had my follow up appointment yesterday. I was hoping for a magic bullet. I wanted to doctor to tell me that my glucose and insulin numbers were a disaster, that my cholesterol was a mess and that I was pre-diabetic. All of these things would have meant pharmaceutical interventions (likely in the form of Metformin) and the added side effect of weight loss, the best side effect in the world. While my hormone levels confirmed the PCOS diagnosis, I exhibit none of the secondary side effects. My insulin and blood glucose levels are fantastic, I have very low overall cholesterol and very high HDL (“good”) cholesterol and my cardiovascular health is fantastic. The doctor attributed my high volume of exercise combined with my rather meticulous diet for controlling all of the normal secondary side effects of PCOS. I am fat; I am in excellent health.
While most people would be ecstatic to hear this news (“hooray, I’m not diabetic”), I was devastated. I don’t want to be fat. I want to be fast and body composition is my biggest limiter. The doctor recommended oral birth control pills to help regulate my hormones, but I told her I’m not going to risk additional weight gain that often accompanies oral contraceptives. She then recommended an IUD, which I am having inserted next month. I again expressed my concerns about weight. While my hormone imbalances are likely contributing to my weight gain (in fact I started gaining weight when I went off birth control four years ago), as an endocrinologist she doesn’t have anything she can do to help treat this particular “symptom” (she did, however, say that she could help me if I decided I wanted to get pregnant). She recommended trying a ketogenic diet as there are studies demonstrating that women with PCOS respond particularly well to this kind of diet and going back to my GP for a prescription diet drug such as Belviq.
So, what do I do now?
I think its worth trying a ketogenic diet. Right now because of knee surgery my training volume is very low, so a low carbohydrate approach is not a bad idea. In addition, there are some pretty good resources out there on how to make training and a ketogenic diet work together. If it doesn’t work, I won’t be any worse off than I am now. I’m not sure how I feel the diet drugs recommendation. I figure it is probably worth making an appointment to discuss it, but I don’t know that my doctor will actually prescribe it and I don’t know if the side effects will make taking it worthwhile. The only truly concrete thing I can do is keep training, try my hardest and race smart. I just wish that the way my body looks actually reflected how much time and effort I spend on my training and nutrition. Overcoming that particular reservation may be the hardest thing of all.