PCOS and Insulin Resistance: Some Questions.

My sister was diagnosed with PCOS about two years ago, similar circumstances, steady weight gain, lots of exercise, fairy good diet. Through changes in diet and exercise over the past year and a half she's improved all her test scores and symptoms, her physician is very impressed. Here are a few things I learned helping her out. Doctors It is rarely a bad idea to see another doctor who is qualified to treat your daughters condition, new tests, alternative treatments and most importantly a fresh perspective to treatment and cause. Reproductive endocrinologists tend to see a lot of PCOS cases as it is a common "cause" of infertility Metformin A derivitive of French lilac, one of the oldest diabetes treatments. It's effective, but I'm surprised it was immediately prescribed. Did your daughter have a particularly poor score on the fasting glucose tolerence test ? Magnesium Almost everyone with insulin resistance and/or type II diabetes is magnesium deficient. Magnesium intake is also a strong predictor for type II diabetes risk. Studies that use a high quality magnesium supplement (chelated, like magnesium citrate or magnesium gluconate) significantly improve the insulin sensitivity of the magnesium group. Magnesium oxide has poor bioavailability and is absorbed at up to 1/5 the rate of chelated magnesium in deficient individuals. Diet Although you say your daughter eats clean, it's likely her body isn't particularly fond of what she's eating as she continues to gain weight. Try the usual suspects - cut total carbohydrate intake by 50% - never eat carbs without protein/fat - don't eat anything that comes in a box (processed) - then look at glutin, milk protein and other less common food intolerences, try elimination diets. http://www.eklhad.net/adhd/ is a good place to start on different techniques and culprits. Also, have her keep a food log for a few weeks. I do from time to time and i'm shocked at what I eat sometimes, it's too easy to lie to yourself. Fish oil My sister loves to eat pasta, lots of it. I suggested she take fish oil when eating pasta as studies show it blunts the insulin response to a large carbohydrate meal. Turns out it also seems somewhat effective in treating pcos, http://scholar.google.com/scholar?q=fish%20oil%20pcos&oe=utf-8&rls=org.debian:en-US:unofficial&client=iceweasel-a&um=1&ie=UTF-8&sa=N&hl=en&tab=ws There is also plenty of research showing high intake of omega-3 fatty acids (fish oil being one of the best sources) having lower cholesterol, higher HDL, lower triglycerides, lower mortality, less cancer, better cancer survival rates, lower rate of mental disorders like bipolar and schziophrenia and so on. Exercise 12 hours a week is a lot, most elite athletes and bodybuilders limit their workout sessions to 45 minutes as cortisol begins to dramatically rise at that point, lengthening the healing process and blunting fat loss. http://www.cardiologytoday.com/view.aspx?rid=30079 Why do you think http://http://www.iaaf.org/mm/photo/competitions/other/34510_w400xh600.jpg have less bodyfat than marathoners? If you perform an exercise aerobic in nature, the primary fuel are fatty acids, and the body supercompensates by storing more fatty acids. http://en.wikipedia.org/wiki/Glycogen is the primary fuel for glycolysis in interval training, which forces the body to become more efficient at using glucose/glycogen, improving insulin sensitivity (reducing resistance). These sample workouts are very time efficient (30 minutes and 8 minutes excluding cooldown and post workout stretching), and incredibly challenging as well, but produce great results. The day2 workouts are based loosely on a workout the 1996 japanese speed skating team that set 4-5 world records, they are devasting to say the least. (first 18 days) day1 - pick two pushing (pushups, bench, overhead press) and two pulling (pullup, rows, lat pulldown) exercises. Perform each for 1 minute, move to the next without rest, rest 1 minute when you complete all 4 and repeat 6 times. day2 - as many squats or lunges as you can for 20 seconds, rest 10 seconds, repeat 8 times day 3 - off (second 18 days) day1 - two new pushing and pulling exercises (slight change ok, barbell to dumbell, machine to dumbell), but do each exercise for 2 minutes, rest 1 minute after all 4 exercises finished, repeat 8 times. day2 - run, or use any machine (elliptical, bike) as fast as you can for 30 seconds, rest 10 seconds, repeat 8 times. day3 - off

I was diagnosed with PCOS when I was the same age as your daughter (I am now 30). From puberty (age 11) until then, I only got my period once or twice a year, but had never been tested for PCOS. Most doctors ignored the symptoms because I was very overweight and focused on that issue (understadably) instead of on the abnormality of not menstruating (not as understandable). As my weight became out of control and I started college, I became extremely restrictive with food to the point of passing out all of the time, though I still never seemed to lose much weight. After college, I was less restrictive (but I was a vegetarian and I would swear that I ate less than most people) and I gained steadily until my highest weight of about 310. At 26, my new gynecologist finally decided to test me for PCOS and lo and behold, that had been my issue this whole time. I know that you find the idea of restricting carbs to be an awful thought, but the day that I left that doctor's office and did research on PCOS and read that a low carb diet worked for this disorder I started doing my own version of a low cab diet (I started eating meat again, but only fish and poultry, and I ate as many vegetables as I wanted, but no sugar, bread, pasta, rice, etc). Four days after I went low carb, I got my period, and until a few months ago (I've become more lax with carbs in the past few months, which enforces to me how strongly they're tied together), I got my period every single month! It still blows my mind that all it took to go from 1-2 periods a year to a regular cycle was to cut out carbs, but there you go. I went on birth control for a while, but not really for the PCOS and I chose to not use any other medication, though it was my choice as the insulin resistance aspect of my PCOS wasn't as bad as the other symptoms, and therefore wasn't necessary. In the four years since my diagnosis, I have lost ~150 pounds. Every woman with PCOS has different needs, and maybe the Metformin alone would help her lose weight, but cutting out sugar and white breads/pastas/rices and replacing them with whole grain or low carb/high fiber options (there are many breads and pastas made to be low carb) would help. My diagnosis of PCOS is perhaps, the best thing that ever happened to me. I would obviously be happier if I didn't have it, but living with it for so long without knowing I was doing so was seriously awful. At least now I have some idea of how to go about fixing the symptoms that accompany it.

My wife had the same thing. She went on a low-carb diet (even avoiding carrots!) and lost about 25 pounds, and the condition abated. Exercise was helpful, but the endocrinologist stressed that diet, more than anything else, would help her fight PCOS, and it worked.

should we go to another doctor? What kind of doctor treats this? While her OB/GYN is a good start, she would probably also benefit from seeing an endocrinologist.

Very surprised nobody has mentioned http://www.soulcysters.com/, the online community for women with PCOS. The women http://www.soulcysters.net/ are crazy-experienced with this, and there are areas specifically for the new newly-disagnosed to ask questions.

I have both PCOS and insulin resistance. I take Yasmin (birth control pill) and metformin. The insulin resistance is driving the weight gain. She needs to start taking it otherwise she is not going to see any weight loss. First, I would recommend that she sees an endocrinologist. I know that every OBGYN I've been to in the last twenty years have been less than helpful with my PCOS. Has she been prescribed the extended release version of metformin? That's preferable to the older version, it's easier to take. She will probably have some stomach upset for the first few days on it, but at this point I've been on it for years and I take it without food and I'm fine. Personally, I have only had success with weight loss in connection to a lower carb diet, but it is difficult to eat well for me. There have been a ton of developments in treating PCOS in the last few years, mainly in dealing with the metabolic and hormonal components. I have a ton of books and websites to recommend. If you're interested, please feel free to memail me.

*favoriting* I'm in some ways similar to http://ask.metafilter.com/117697/PCOS-and-Insulin-Resistance-Some-Questions#1686377, I was diagnosed at 16 and am now almost 30. For some time I was on aldactone and the Pill. Found that combo - but with only non-generic aldactone - worked well. However I lived overseas for some years and didn't have health insurance here for others and only started back with treatment last summer. NEw endocrinologist did tests for glucose tolerance, etc. all came back clear and she put me on metformin. I haven't had the severe side effects that some of you mention, but then again I haven't found a strong benefit to Metformin since my period is still crazy and the PCOS symptoms haven't abated. I'm seeing a new endo next month due to insurance and I'm going to speak with him about switching to either non generic and/or going back to the old regimen, which worked. Also http://www.google.com/hostednews/ukpress/article/ALeqM5iLpJlUEx4jxhKNTdd7UrN0ChIvIw on the connections between PCOS and obesity Happy to discuss further if you'd like to MeFi mail me.

My husband's on Metformin for type II diabetes, and the GI symptoms vary by the person, but mostly seem to involve fascinating bowel movements and epic flatus. Your daughter should be prepared for same-- they do go away, although when Mr. F's mail-order pharmacy changes the brand of generic Met they get, he occasionally experiences a resurgence of GI symptoms. If they're completely intolerable-- don't go away in a few weeks, cause problems with her job, etc.-- she definitely should talk to her doc again. Mr. F's old job kept weird hours and changing demands and so on, and he's found that having a snack with his before-bedtime Met dose, has worked out OK for him. That being said, his doctors suspect that the weird schedules he used to keep-- 15-hour shifts, working nights, etc-- made the endocrine disruptions worse, so keeping to a schedule may improve your daughter's situation. She'll almost certainly need a good reproductive endocrine specialist to figure that one out, though-- don't take my word for it, my representative sample is one 36-year-old guy with no ovaries. ;) As for the no-drinking, our GPs have mostly been of the opinion that one drink occasionally is a lot better than strict denial and then a five-drink bender, and that's worked out well, although subbes's warning is one to keep in mind. (Mr. F's found that a nice dry gin and tonic is a safer drink, if he's going to drink, than just about anything else.)

More later, but: the no-drinking on Metformin rule is because of the risk of diabetic ketoacidosis, which is serious but rare. I take Metformin for my PCOS and continue to imbibe occasionally, though my husband has been warned of the symptoms just in case.