(Warning, this post contains some graphic descriptions of female bodily functions. If you’re easily offended by such things, you might want to consider not reading any further.)
By age 8 I was struggling with my weight, and by my early teens it was evident there was something amis hormonally. I started menstruating around the same time as all my friends, but then I stopped for several years. Yes, years. For some reason this didn’t seem to raise any flags with my health care providers. I had horrible cystic acne starting right around age 13, on my face and also on my chest and back. Two courses of Accutane barely made a dent. I started growing hair in places girls aren’t ‘supposed’ to grow hair (like my chin). My weight was all over the place and by the time I graduated from high school I was clinically obese. My periods, once they started up again, were beyond irregular. I’d get them a few weeks apart for a while, and then not again for 6 or 8 months.
For some reason, I thought this was all normal.
My 20’s were much of the same, with the addition of chronic yeast infections, migraines, thinning hair and crippling bouts with anxiety and depression. My doctors would periodically put me on birth control to try to regulate my periods, and antidepressants to combat the depression. I continued to struggle with my weight and my cystic acne, sometimes seeing some mild success, but mostly just frustration. As I got closer to 30, my blood pressure started to read high here and there, although not consistently. When I asked my doctors about all this, they would say something about exercise and weight loss, but to me it felt like a brush off.
I got pregnant quite unexpectedly at 30, and for a few years my own health took a back seat. I suffered some pretty intense PPD after my first baby, but otherwise I actually have very little recollection of those first two years of motherhood. I don’t think I ever got a checkup, and acne and my weight were really low on my priority list at the time. I felt like crap all the time, I can tell you that.
When I got pregnant with my second baby, all hell broke loose. The beginning of the pregnancy was uneventful, but the second half was awful. I gained weight way too fast. I swelled up like a water balloon. I developed pre-eclampsia and had to go to the hospital for monitoring twice a week for the last several weeks of the pregnancy.
After my second daughter was born, I had problem after problem with my milk supply. My weight continued to go UP. My blood pressure remained high. I started losing hair in clumps, specifically on the front of my head, in the typical male-pattern baldness. I had an epic case of PPD, complete with daily panic attacks. My period returned about 6 weeks post partum, but it was crazy irregular, and heavier than it had ever been and I started passing chicken-egg sized clots. In 2006 I had a breast ultrasound to diagnose some recurrent pain I’d been experiencing. It turned out to be cysts. In 2007, another ultrasound to diagnose recurrent pelvic pain showed multiple ovarian cysts. I reached my highest weight of 231 pounds.
I’d started to put the pieces together and asked my doctor about the possibility that I might have PCOS. She was hesitant to give me a formal diagnosis because I didn’t appear to have infertility issues, and as she explained it, the only good a diagnosis would do would give her the option to prescribe fertility treatments, and since I didn’t want any more babies anyway, there wasn’t really a point of getting a formal diagnosis. She told me to exercise and lose weight. I felt brushed off again. I ate pretty healthy. I was active. I walked a lot, and chased my kids around I told her (and myself). I wanted an answer, a treatment, but she was just giving me the ‘exercise and lose weight’ brush off. I felt frustrated and hopeless.
So, like many women reading this, I started doing some research on my own. Every time I researched one of my symptoms, the trail I picked up led to the same place: metabolic syndrome and insulin resistance. Through my research, I identified other symptoms I had that I’d never thought could be connected to my hormonal issues, especially my panic attacks, which I’d determined were probably being triggered by wild blood sugar swings. I had virtually every symptom of metabolic syndrome and insulin resistance in the book, and in 25 years no one had put the pieces together.
So, since all trails were leading back to insulin resistance, I decided to look a little deeper into it. I wanted to know WHY I was having these symptoms, not just how to ameliorate them. WHY was my hormonal system all whacked out (insulin is a hormone)? As a critical thinker and skeptic, I was pretty good at spotting dubious sources. A lot of the ‘information’ I ran across in my internet research was actually thinly veiled advertising for supplements and diet books. In fact, I was sort of appalled by how much of that I ran across. I started to identify credible sources, and I followed the science. What I realized was that all of the established, reputable medical and scientific organizations were in a fair bit of agreement on the cause of insulin resistance. The common theme I kept running across was energy imbalance (and its role in obesity), inactivity, and genetics. According to Johns Hopkins, Metabolic Syndrome and IR are caused by “…obesity, coupled with a sedentary lifestyle…[as well as] genetic variations in a person’s ability to break down lipids (fats) in the blood.” The Mayo Clinic says “Some people may be genetically prone to insulin resistance, inheriting the tendency from their parents. But being overweight and inactive are major contributors.” The NIH and NDIC are very clear that “scientists have identified specific genes that make people more likely to develop insulin resistance and diabetes. Excess weight and lack of physical activity also contribute to insulin resistance.” Notice none of the resources I link to are bloggers or alternative practitioners selling remedies and ebooks. I like science. I looked for science, and favored science from reputable sources. I found study after study after study after study after study after study after study after study after study after study after study after study (I have more) showing that physical activity levels are inversely correlated with the incidence of insulin resistance, and that insulin sensitivity is improved with physical activity. The science was pretty clear: genetics, energy imbalance and obesity, and inactivity are the drivers of insulin resistance. And all that advice to lose weight and exercise my doctor had given me wasn’t a brush off. She was right. She was giving me the evidence-based solution to my problems, and I was brushing HER off.
I don’t have a huge genetic factor. A few of my grandparents and aunts and uncles developed diabetes when they were older, but my parents and siblings are so far relatively metabolically healthy. I was obese though, and I was obese for one reason: I ate more food than my body needed. And when I was honest with myself, I wasn’t really that active. Yeah, I walked a little, but it wasn’t really as much as I kept telling myself (and my doctor). And I certainly didn’t walk vigorously enough to raise my heart rate or break a sweat. In fact, when I was really, truly honest with myself, I had to admit that I spent most of every day sitting down. So, at 35, I decided to actually do what my doctor had told me to do all along: lose weight and exercise.
I ate more vegetables and protein, but I never restricted carbs. Mostly because I’d tried it before and hated it. And besides, the EVIDENCE pointed to inactivity, not carbs, as the driver of IR. The main change I made was to track my calories, keeping them at a level that would support my activity but allow for gradual weight loss. I’ve talked elsewhere about how I determined the proper energy balance that would allow me to lose weight gradually and keep my metabolism from tanking. It took me about 6 months to get that figured out. I explain what I mean by ‘energy balance’ in this video:
It also took me about 6 months to get into an exercise routine. Those first six months were frustrating and frequently discouraging. I lost about 15 pounds, which was really disappointing to me considering how much effort I was putting in. I had some small improvements in some of my symptoms, but I still felt like crap most of the time. I nearly quit so many times. But I kept telling myself that I needed to be a good role model for my daughters, who I knew would follow in my footsteps, and I wanted them to be footsteps in the direction of health and self-care. So I kept going.
That six month mark was really a turning point, for a couple reasons. A BIG one was that I started weight lifting. I have since done more research and decided that weight lifting/strength training is VITAL to improving insulin sensitivity because muscles, very simply, behave very differently, metabolically, than fat. Muscles suck all that sugar out of the blood and USE it. I also had improved my endurance and conditioning to a point that I was able to perform the amount and intensity of physical activity that I think was necessary to really improve my metabolic function. When I was just doing cardio, the magic number seemed to be 60 minutes a day of an activity that kept my heart rate elevated (once I added a significant amount of muscle mass from strength training, I could get away with much less, these days I typically average half that). I also got my diet ‘dialed in’, in that I settled into an calorie and nutrient intake that gave me the nutrition and energy I needed but wasn’t more than my body could use in a day. Over the next six months I dropped about 50 pounds. I also saw my periods normalize into a steady 28 day cycle for the first time in my LIFE. I never got another panic attack or migraine after that. To this day. About a year in I realized my hair had started to grow back, fuller than it had been in my adult life, and over the next year my acne had all but disappeared save for a little breakout before my period. My blood pressure has been optimal at every checkup since then. My HDL, which has been hovering in the high 30’s before I started all this, is now in the high 60’s. My triglycerides are routinely in the 30s and 40s. My glucose is ALWAYS in the low 80’s no matter what I’ve eaten or not eaten beforehand. In short, I am, for the first time since I was 8 years old, metabolically healthy.
And I did it by following my doctor’s advice: lose weight and exercise.
(***I am not a doctor. AS ALWAYS, if you suspect you have a metabolic problem, please find a qualified, reputable medical professional to work with, and never, ever, EVER rely on bloggers for your medical information and health care.***)