Here's A Book That Every Woman With PCOS Should Read
PCOS And Other Diseases of Civilization
PCOS, or Polycystic Ovarian Syndrome, is one of the "diseases of civilization" along with heart disease, Metabolic Syndrome, diabetes, obesity, and cancer. These diseases are very rare among peoples living far from -- for lack of a better word -- "civilization," who live mostly on game, milk, or some other traditional diet. These diseases start to appear in populations about twenty years after they are given the opportunity to adopt a "Western diet," which is high in sugar and refined carbohydrates.
PCOS, once thought to be primarily a problem with the female reproductive system, is increasingly being understood as a metabolic condition whose primary characteristic is insulin resistance (which then causes the other hormonal problems).
That's why Good Calories, Bad Calories, with its in-depth exploration of biochemistry, insulin, and obesity, is so very, very relevant to all women who have PCOS.
The Carbohydrate Hypothesis
In this exhaustively researched book, Gary Taubes presents what he refers to as The Carbohydrate Hypothesis, which is that is is refined carbohydrates, especially sugar, that cause susceptible individuals to develop - not only insulin resistance and diabetes (which we knew), but also heart disease, low HDL cholesterol, and even other, less obviously related ailments such as certain types of cancer.
The Carbohydrate Hypothesis, of course, flies in the face of what everyone in my generation has been taught since we were knee-high, which is that it is dietary fat and cholesterol that cause heart disease, and that the remedy for these is a diet low in fat and high in carbohydrates.
Taubes spends several chapters, in fact, tracing the development of the dietary fat hypothesis, and shows how it became popular and how it managed to survive even in the face of mounting contradictory evidence.
The Biochemistry of Obesity
Especially affirming for anyone who has ever struggled with seemingly un-budge-able weight are Taubes' chapters on obesity. He first surveys the history of obesity research, including how one or two very influential voices put forth the theory that the obese engineer their own condition by eating too much and not exercising enough, and that hence, it should be easy for them to lose the weight by reversing the process.
These obesity theorists did not actually work with the obese. There were obesity researchers who did, and they invariably found that neither restricted-calorie diets, nor low-fat diets, nor exercise, were at all effective for the majority of their patients. Exercise caused hunger; and even if a person was very overweight, when put on a restricted-calorie diet, their body invariably reacted just as a thin person's body does when the diet is restricted ... as if it were starving.
Taubes also surveys several well-documented cases of populations living in abject poverty where obesity among adults, especially among women, is nonetheless very common. One such group is the Pima Indians of Arizona. In groups like the Pima, some people actually seem able to become obese on diets that are deficient in basic nutrients.
Contrast this with groups such as Inuit, who live (or, at the time of studies, lived) exclusively on game, and indeed prefer the parts of animals that are highest in fat, such as the brains. These populations are not obese, and also have vanishingly low rates of heart disease, diabetes, etc.
Insulin in the key to all this. Over several chapters, Taubes gives detailed explanations of what happens in the body at a cellular and biochemical level. He explains the processing of glucose and other sugars, how these are converted into energy or stored in fat, and how the energy is retrieved. Insulin is a key player, but there are numerous other enzymes and hormones, including sex hormones, that both influence and are influenced by the process.
Taubes frequently warns that his descriptions of biochemical processes are "simplified." Obviously, my description of his descriptions is going to be simplified even further. So if you find the following explanation implausible, or simply want to learn more, I encourage you to read the book.
So, to simplify greatly, here is why some people can't lose weight:
Some people have an elevated level of insulin in their bloodstream, either because they are slightly insulin-resistant or for some other reason. While there are several hormones that instruct the body to retrieve energy from fat cells for use by other cells, insulin is the only one that instructs the body to store energy in fat cells. It also inhibits the working of the "take-it-out" hormones.
When there is glucose available in the bloodstream, your body uses this to fuel the cells that need it. When the glucose runs out, the body ordinarily switches over to the fat reserves. However, the presence of a lot of insulin can prevent the body from drawing on the fat reserves. It cannot "see" the energy that is there, or it cannot access the energy to get it into the bloodstream, and hence to other cells of the body. Insulin is acting like an overzealous bank guard that won't let you withdraw from your own account.
Hence, even though you may have plenty of energy stored in fat cells, when your blood sugar goes down, your body has no more energy to give your cells, and it registers this as hunger. And at the cellular level, you are hungry! Your cells are starving! The energy locked in your fat cells is no good to them, all they know is that they are not getting fed. Taubes calls this "internal starvation."
Feeling hunger, you eat. You may eat refined carbs, either because you are craving them, or because you have been told to avoid meat and fat and cholesterol, and the alternative is carbs. Once the refined carbs hit your system, this triggers the release of more insulin, and the whole thing begins again.
So yes, my friends, overweight people really do feel hungry. Maybe even hungrier than the thin folks feel. At least hungrier than the thin folks imagine we could feel. Overweight people get all the same symptoms of hunger that the thin do ... and when put on a semi-starvation diet, they experience all the same symptoms of starvation.
Symptoms of Obesity and the Reasons Why: Two Theories Give Their Answers
"Positive Caloric Balance" Explanation
Carbohydrate Hypothesis Explanation
the person eats too much
the body is storing food energy as fat rather than using it
hungry all the time
person is a glutton, has no self-control
the body cannot access fat to use for energy, therefore experiencing "internal starvation" and sending hunger signals
obsessed with food
the person is a glutton
the person is "internally starving," and has spent years trying to control and tweak their diet
the person is lazy
fatigue caused by "internal starvation," exactly like fatigue caused by ordinary starvation
exercises but doesn't lose fat
hard to explain, but must still be the person's fault somehow
exercise causes hunger because body is maintaining homeostasis, and still not drawing on energy locked in fat stores
craves carbs and sweets
is a glutton
chemical addiction caused by hormones, insulin resistance; needs to be broken
Other Sources Confirming the Carbohydrate Hypothesis
Good Calories, Bad Calories was well-written, an enjoyable read, and a revelation to me. But not everything in it was entirely new. I had been prepared to receive this new paradigm by various things from my previous reading and personal experience.
One of these was the book In Defense of Food by Michael Pollan, which I read in 2009. This is a great book for other reasons, but the main insight from it that prepared me for Good Calories, Bad Calories was all the documented research showing that a traditional diet - almost any traditional diet, no matter what it consisted of - was better for you than the modern diet. Pollan did not have a full explanation for this, because he had not stumbled onto the Carbohydrate Hypothesis, but the evidence was undeniable. He also pointed out that traditional diets, having been developed in a particular environment over millenia, tend to contain food pairings that complement one another nutritionally, such as beans and corn.
Having read Pollan's In Defense of Food, I was well prepared to follow Taubes when he took the next step of pointing out that what all these traditional diets have in common is something they don't contain ... namely lots of highly refined carbohydrates.
Other, slightly less direct, confirmation came from the book Brave Girl Eating by Harriet Brown. This is a mother's memoir about her teenage daughter's struggle with anorexia. Though most of the experts insisted on treating the anorexia as a behavioral disorder caused by unhealthy family dynamics, Brown noticed that her daughter developed it very suddenly, almost overnight, and that it seemed to have physical causes. As she nursed her daughter back to health, she noticed that whenever her daughter was well-nourished, her attitude seemed to improve, whereas whenever she got even a little bit too hungry, the "demon" of anorexia would suddenly surface and take over her personality again. Though there are no proven answers, Brown shares scientific speculation that anorexic symptoms may be the way some people's bodies respond to starvation. This sounds very plausible.
And of course, if one "eating disorder" that was thought to be a psychological problem can turn out to have physical causes, so could another.
Finally, there were my own real-life observations. As I read Taubes' book, I started to remember these. There was the friend who at one point was eating 800 calories a day and still not losing weight (her doctor didn't believe her). There was the other friend who was believed by no one (OK, by neither doctor nor boyfriend) until she showed them her food diary to prove how little she had been eating. There was the long-ago Reader's Digest story of the woman who ran marathons while remaining plump. There were the many Internet testimonies of women who suddenly gained 20 or 30 pounds when they hit a certain age.
And then there was me.
I've always had a sweet tooth. I was always built square, but never fat. In middle school, I started sprouting hairs on my upper lip and chin. I plucked them out. The hairs continued through high school, and by the summer after senior year, I was definitely fat. It did not occur to me that this could be anything other than my own fault. I've always loved my sweets, and have never been athletic. I would take walks, hikes or bike rides, but no hard workouts.
In college, I diligently swam in the pool and ate my cottage cheese, but remained plump. Worse, the body hair seemed to be spreading. Finally, partway through college, I got alarmed enough about the hair that I went to a doctor. He immediately diagnosed me with PCOS, and prescribed three drugs, one of which (Glucophage, a.k.a. Metformin) treats high blood sugar.
I still remember the doctor's family picture in the hallway of his office - the gorgeous, thin wife and daughters. And I remember the advice he gave me: "Body fat encourages the production of testosterone, so if you want to control your hair growth further, you should try to lose some weight. And that should be easy for you, 'cause I never met a woman who didn't want to lose weight."
What a perfect example of the Positive Caloric Balance hypothesis. Weight loss is easy. All it takes is the "want-to."
Well, it did turn out to be easy to lose the weight, because after several months on Metformin, I started slowly losing fat. I didn't become Iman, but I got closer to the normal, not-overweight version of myself. So much so that when I returned to my summer job the next year, my boss asked me, "So, Jennifer, just how much weight did you lose?" I answered confusedly, "None." I still weighed the same number of pounds, nor had I tried to diet. But my cravings had changed. Instead of craving sugar, I went for sour things, like peppers and pickles.
When personal experience, previous reading, and one well-researched book coalesce like that, it's pretty powerful. So I am convinced of Good Calories, Bad Calories' Carbohydrate Hypothesis.
Restrict Carbs, Not Calories or Fat
So if Good Calories, Bad Calories is correct, then how CAN we lose weight and fight PCOS? Abundant research - and personal experience - show that it does not work to restrict calories, nor to eat a low-fat diet, nor even to exercise. What else is left?
At the risk of being dismissed with a phht, the answer is basically ... (drumroll) ...
... the Atkins diet.
It's true that the Atkins diet is exactly the opposite of all the conventional nutritional wisdom of our lifetimes (which wisdom we now know to be completely wrong because it basically ignored the role of insulin). That said, Dr. Atkins' diet was not actually a new, never-before-tried fad. It had been known, even as early as 100 years before, that cutting out carbs could help people lose weight. Taubes traces the various studies that discovered this, what they found, and why they either got buried or failed to come to the surface of nutritional research in the U.S.A.
Eating lots of protein and ... yes ... even fat can help people lose weight, particularly if they have any insulin difficulties. Eating meat, eggs, and cheese helps keep your blood sugar stable, avoiding the spike-and-crash that leads to hunger later. Fat is is satiating, and protein gives you energy for a long time.
Can you believe how many times we've been told to do exactly the wrong thing? All the low-fat products they sold us?
So yes, my friends, you can eat eggs, hamburger, chicken, avocado, bacon. Wow. What a brave new world.
This is idea is starting to be re-discovered by the way, perhaps in part due to books like this one. I see "protein packets" available in the grocery store, and I've even seen the advice "eat fat to lose fat" in a magazine. When I was a teenager, this would have been unheard of.
If you have PCOS, what has helped you the most?
By the way, lest you misunderstand me, I am NOT recommending that women with PCOS - or the obese - or anyone else - stay away from exercise.
Taubes presents convincing evidence that exercise does not help people lose large amounts of weight. It is possible to be fit and fat. But this doesn't mean that exercise is worthless. Of course it brings many benefits, such as strength, flexibility, better wind, and better sleep. Let's exercise for all these reasons, and when we don't lose fat, let us not conclude that the exercise is doing nothing for us.
To lose fat, we need to address our insulin/blood sugar issues. And when we do that, we'll find that we have even more energy for the exercise we love.
- PCOS is a metabolic/insulin disorder.
- Good Calories, Bad Calories explains the role of insulin in weight gain.
- Refined carbohydrates, especially sugar, are very bad for people with insulin problems.
- Meat, eggs, and cheese are not bad for people. In fact, they help you feel full and not crave sugar.
- Let's go eat some bacon!
If you have PCOS, diabetes, struggle with obesity, or have lost a lot of weight, please leave a comment below and tell us your story.