Skinny with PCOS

by S

My daughter has always been skinny, and yet she does suffers with PCOS, since the age of 18.

Everywhere I look, the problem refers to overweight women.

The question is; what should slim and underweight women do to follow your suggestions while managing to maintain their weight, and in my daughter's case, even gain some weight.

She is 35 years old, 5foot 3 inches, and is 100 lbs.

Her cortisol level is 1.5. She is following a Low Glycemic, organic diet, takes supplements, vitex, saw palmetto and everything else you suggest.

Where can we find physicians that treat PCOS naturally, in Northern New Jersey 07043?

I look forward to hearing from you.


Editor's comments: In the PCOS population, lean women are a significant and under-recognized minority.

It is especially difficult for a health professional to determine the best course of action.

You might try consulting with an endocrinologist in your area. Lab testing will at least reveal some possible hormone imbalances that can be treated in some way.

I have no magic solutions for lean women, such as "lose weight". I can only offer some thoughts. It sounds like she is already doing most of the right things.

1) Regardless of overweight or lean, always have your vitamin D levels assessed with a lab test. Vitamin D must be normalized. Ideally, the vitamin D level would be in the middle of the range of "normal". Not at the bottom of the normal range. The middle.

2) In spite of not being overweight, lean PCOS women may have excess belly fat. This is a tipoff for possible insulin resistance, chronic inflammation, and/or chronic stress. All of these possibilities should be investigated.

Insulin function can be tested.

Chronic stress is trickier. It is hidden and very subtle. It should NOT be underestimated! It's important that she reduce all sources of stress. That includes self-esteem issues, which are a source of stress. The Natural Diet Solution for PCOS and Infertility has a fairly extensive chapter on stress.

The (stress hormone) cortisol reading of 1.5 doesn't mean much to me. What time of day was it taken? Cortisol goes up and down over a 24 hour period. It's more valid to take a series of four cortisol readings over the 24 hour span. Was the sample based blood, urine or saliva?

3) Chronic inflammation can be present in lean as well as overweight women with polycystic ovary syndrome. Chronic inflammation causes the ovaries to increase production of male hormones (example testosterone). The high levels of male hormones cause many of the symptoms that comprise polycystic ovary syndrome. Her diet -- what she eats and drinks -- has a profound effect on inflammation.

4) If she is lean -- but is found to have insulin resistance -- she needs to start an intensive exercise program. Exercise, the more intense, the better (within health limitations), is critical for reducing insulin resistance. Reduction of insulin resistance relieves all symptoms.

Don't worry that a healthy diet and lots of exercise will make her lose weight. Weight is not the primary issue. Her hormone balance and health is the primary issue. If she combines diet and exercise, she may lose some weight -- or maybe none. Remember, as she loses fat and gains muscle mass, her weight should stabilize, because muscle is much heavier than fat.

Please keep in mind that "lean" women may have too much fat. In other words, relatively sedentary women frequently have fat that has infiltrated into the muscle tissue. As muscle cells atrophy, fat fills those spaces. So a lean person can have a body fat percentage that is way too high. Just because someone "looks" lean does not mean that it is a "healthy lean". A woman can be lean and have too much fat.

The way to determine this is to get a body fat percentage test.

5) Just like overweight women, lean PCOS women can also have problems metabolizing a B-vitamin called "inositol". Supplementing with inositol or d-pinitol (a cousin of inositol) has been shown to improve symptoms and help restore a normal cycle.

6) She could have an environmental chemical overload. For example, lean women with PCOS have 1.6 times the amount of BPA than other lean women do. BPA (bisphenol A) is a known estrogenic hormone disrupter. There are lab tests for identifying possible environmental chemical overload, but not every doctor knows about them or how to use them. Even if they are identified, it is very difficult to remove them. A detox specialist would need to be consulted.

Please note that BPA passes from the mother to the fetus. Environmental chemicals are a serious threat to your health and a hidden cause of PCOS symptoms that nobody is talking about. Almost nothing is being done to actually reduce the total chemical pollution burden that we are all carrying.

7) If insulin resistance is identified in lean women, the doctor is likely to prescribe metformin. However, according to research evidence, metformin is less effective in lean women. And -- metformin has side effects, like a vitamin B12 deficiency.

8) If she is following the recommended diet in our PCOS diet e-book, she can add legumes and beans to the diet, which would increase her carbohydrate intake. The increased carb intake should help her to maintain weight. Quinoa and brown rice are other possibilities. However, the higher the carb-to-protein ratio, the more difficult it may be to reduce insulin resistance, which is a root cause for the majority of cases of PCOS.

Considerable experimentation is required in order to find the best dietary balance for her.

These are just some thoughts that occurred to me, based on what little you've said.

Comments for Skinny with PCOS

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vitamin D + Omega 3 (EPA/DHA)
by: PCOS Editor

Thanks for sharing your story!

There's no doubt in my mind that this combination substantially increases the probability of conception and a successful pregnancy.

But sadly, it's my impression that many women do not employ this treatment. Vitamin D insufficiency is rampant among women with PCOS.

Vitamin D omega3
by: Anonymous

After 6 months with no period I started taking vitamin D and omega 3. Within 7 months I had 3 periods and became pregnant. I just wanted to share this as it worked for me and I hope it works for someone else too.

metformin appears to work for all PCOS
by: PCOS Editor

Thanks for your comment. Unfortunately, I've lost track of the study I may have mentioned earlier.

Nonetheless, I've shifted my thinking more in favor of metformin, for either overweight or lean PCOS.

Although metformin is intended to improve insulin function and thus reduce insulin resistance, there is some evidence to indicate that it is effective in both overweight and lean women, whether or not they have insulin resistance.

So I would agree with you in your assessment.

Metformin helps lean pcos
by: Anonymous

According to the research I've found and various studies, metformin can help lean pcos women. One study said that at as many as 70% of lean women started ovulating. What study did you find that was contradictory to this?

PCOS causes
by: PCOS Editor

The cause of PCOS is multifactorial. That is, many factors are involved. Only one of those factors is "genetics".

An overlooked factor is "fetal programming", which means the disease you have as an adult started way back when you were in your mother's womb. To understand more about this, read our fetal programming article.

You probably don't really know whether or not you have an insulin dysfunction or chronic inflammation, both of which are causal factors for PCOS symptoms. That's because doctors usually don't do testing that is thorough enough. So no one actually knows.

For example, a doctor may order a fasting glucose, fasting insulin or glycohemoglobin A1C blood test to assess insulin resistance and hyperinsulinism. That's a step in the right direction but does not identify "early" insulin resistance. A more definitive test would be a 4-hour Glucose Tolerance/Insulin Resistance test, which can catch an earlier stage of an insulin disorder.

Women with excessively high testosterone should be extremely careful with diet. There's some evidence to suggest that high testosterone can make you more sensitive to high glycemic foods, which can increase chronic inflammation. Please note that chronic inflammation is not something that is visible and obvious.

Thanks for the info
by: Anonymous

Thanks so much for all this information. I was diagnosed with pcos at age 16. I have facial hair and body hair and acne, as well as high testosterone and ovarian cysts, but none of the other symptoms of pcos. I'm 5'4", weigh 125 lbs and have 25% body fat, as well as a very flat stomach. No insulin problems, vitamin D problems, or inflammation (which I reduced after removing dairy from my diet). Still don't know what's the cause of this pcos, but on both my parents' sides almost all of the women suffer from it. Could be that.

5 things to think about
by: PCOS Editor

Hi Atypical,

A few comments:

1) The fact is, "PCOS" is one not monolithic disease. Rather, it is a cluster of closely related diseases and disorders. The entire body is involved, not just the ovaries. Furthermore there are at least three different "official" definitions of what PCOS is. Doctors cannot agree on exactly what this disorder is or is not.

So it is no surprise you do not fit the expected "normal" pattern.

2) Bio-identical ("natural") progesterone applied trasnsdermally would be a better choice than a synthetic progestin, which has side effects. Bio-identical progesterone does not have side effects.

3) Spearmint, green, and marjoram tea are all recommended for helping to control hirsutism as well as other symptoms of PCOS. Green tea is strongly recommended.

4) It's imperative to remove sugars and refined carbohydrates from the diet if you're going to control testosterone levels and insulin dysfunction. But it's not just "cutting carbs". It's all about CHANGING your carbs. Best carbs are whole vegetables. Worst carbs are sweeteners and refined grain food products. It's necessary to reduce your glycemic load.

5) It's essential that you optimize your vitamin D level. A test value of 50 is something to shoot for. If below that, think about vitamin D supplementation. I can't emphasize enough how important it is to not have a vitamin D deficiency. Remember, vitamin D is a hormone, not just a vitamin.

Atypical PCOS
by: Anonymous

I have had PCOS symptoms since 18 and was diagnosed at 33.

I went to the doctor because I have always had long running periods and for the past several I have been on my period every day. I mainly went because of moods wings which I attributed to PMDD. The doctor confirmed that I did not have PMDD, but did a blood test to see if I had a thyroid problem, which I did not. I was low on vitamin D, vitamin B12 and iron. I saw another doctor who tested my blood for all hormone levels and any vitamin deficiencies. It was then that I was told I had PCOS.

The strange thing is that I don't have a lot of the symptoms that the majority of women who have this disorder have. Unlike them, I am not diabetic, have a period every day, do not have ovarian cyst. What I do have is high testosterone, male hair growth and hair loss, as well as acne. This has become worse with age.

I was prescribed birth-control with estrogen and progestin, but could not handle it because of the mood swings and carb cravings. Everything made me cry.

So I switched to the pill with only progestin. I take it every day and it helps with my mood and stops my period for at least four days before it starts up again or about seven.

I have spent over $500 on electrolysis for my beard and mustache hairs (about 20 sessions). It seems to have been a waste, as I do not see any improvement. Both electrolysists I have seen have suggested laser treatments, which is much more expensive.

I read that spearmint produces testosterone levels by 50%, so I've been taking those that in pill form almost daily. I do feel like it helps. The only way I can tell is by the change in my libido.

I have not tried lowering my carb or sugar intake, but I guess I will just have to.

Vit D
by: PCOS Editor

I forgot to mention, that at your age, vitamin D adequacy is an issue. As we age, our ability to manufacture vitamin D from the sun diminishes. Also, I would imagine you don't do a lot of nude sunbathing or live on the equator.

Therefore, I strongly recommend you get a vitamin D blood test. I'll bet you a dime that your level will indicate a vitamin D insufficiency, i.e., sub-optimal. I would say if the value is below 50, you have an issue and might consider supplemental vitamin D.

More info on vitamin D here.

Wisdom comes with age
by: PCOS Editor

They say that wisdom comes with age. That's certainly true in your case.

PCOS is actually a systemic metabolic/hormonal/inflammatory disease that simply changes its manifestations over time. Our job is to diminish its impact through better diet, physical activity, lifestyle, selected nutritional supplements, etc.

Most doctors have little comprehension regarding the true nature of PCOS, let alone what to do about it. Equally important, their knowledge of nutrition and nutritional therapies is generally abysmal.

And since when is it unhealthy to be thin? Where's the proof? Where are the medical studies to substantiate that?

I myself have made a transition to a very healthy mostly ketogenic diet and greatly increased my exercise. I was pretty thin to begin with. But guess what? I got even thinner (around the middle only) but I feel great and have more energy. I'm in better shape than I was twenty years ago. I personally don't care how thin I am so long as I am healthy and fully functional. My weight has stabilized at a lower level and I'm not worried about it at all.

However, in the case of UNEXPLAINED weight loss, a person should definitely get a complete metabolic profile blood test, just to see if there is anything going awry. Did your doctor order a complete metabolic profile? I'm betting he/she did not. So, in essence, your doctor is making nothing more than an unsubstantiated generalization. When a doctor makes a bold assertion, we should always ask, "Why?" Or, "What is your reasoning for saying that?" Or, "How do you know that is true?"

When a doctor shoots from the hip and does not substantiate their statements and does not do any testing to discover possible hidden problems, that is not good medicine in my view. It's time to change doctors or go back to the same doctor and demand some explanations and detailed guidance.

In terms of belly fat, don't fret about it. Just focus on being healthy and active. The belly fat may be due to some combination of insulin resistance, leptin resistance and cortisol dysrhythmia. A fundamental way to optimize these hormones is to eat a healthy diet, get plenty of exercise, manage stress, and be sure to get plenty of high-quality sleep.

Struggling w/Insulin Resistance
by: Aging with PCOS

Hi, I am 65 years old and was diagnosed with PCOS in my 30's, when I went for 9-10 months without having a period.

I have always been on the thin side, with a max weight of 120, height 5'2.

Last year, I had an A1c test and learned I was prediabetic.

I was shocked, since I only weighed 108 at the time and was extremely active: cycling 100-150 miles a week and working out at the gym regularly. I put myself on a low carb diet and began testing my blood sugar.

After a year on the diet, my weight dropped to 101 and my A1c fell into the normal range, at 5.5.

When I saw my Dr, I thought she would be impressed at my progress. Instead, she was upset at my weight loss and told me to stop testing my blood sugar, eat "normally" to gain weight, and quit worrying about getting diabetes!

I am comforted by this web page and the discussion of insulin resistance. I assumed when I got beyond menopause that having PCOS wouldn't impact me anymore. Now I am understanding that insulin resistance is likely to be a lifelong issue for me, and I need a Dr. who is sensitive to that.

Also, I have been frustrated by the fact that even at 101 lbs, I have too much belly fat - now I get it that this is a sign of my insulin resistance/PCOS. It's easier to accept something when you are more knowledgeable about it :-).

by: PCOS Editor

Nice selection of ingredients, but potency quite low. DIM appears to have an anti-androgenic effect, but at the dosage in this product, I would doubt it would have any significant effect. Green tea extract is highly recommended for PCOS. Spearmint tea is also recommended.

This product does not appear to be designed specifically for polycystic ovary syndrome.

Where to start...lean women with PCOS may have insulin resistance and/or a disturbed cortisol biorhythm. There are lab tests that can help you to assess these possibilities.

Meanwhile, you can modify you diet to reduce insulin levels, make sure you're exercising or physically active every day, and consider getting a vitamin D test.

by: Anonymous

Is the supplement ESTROSMART doing anything good for PCOS?

Lean and PCOS is so strange. Bellyfat att skinny is so weird. Where to start ?

a few thoughts...
by: PCOS Editor

Depression, anxiety and mood swings are a central aspect of PCOS. As your metabolic and hormonal balance is regained, these symptoms should diminish.

The prescribed medications should reduce the insulin resistance and testosterone levels.

So what else can you do? You can shift your hormones and metabolism by eating a healthier diet. More veggies. Avoid all processed convenience foods. Reduce grain consumption. Drink green tea or spearmint tea instead of soft drinks. And moreā€¦visit the Diet section of this site for more info.

Also, exercise will help ease insulin resistance in muscle tissue.

Also a good idea to get a vitamin D blood test. If below 40-50, a vitamin D supplement would help to relieve the situation.

You can also visit our Hirsutism section for some additional thoughts.

Above all, know that you can control this disorder. It just takes knowledge and perseverance.

A bit confused...
by: Anonymous

I am 22 years old, 5'1 and 98 pounds.

I began losing weight after high school and have always been active.

I have always had more hair than any girl I have met and thought this to be normal from a young age. Just as well I have had acne issues and oily skin since fourth grade.

Over the last year my anxiety and depression has increased significantly on top of crazy mood swings.

I began seeing a therapist when I felt like I had lost control of my own personality but even that does not make me feel normal.

After a recent visit to the endocrinologist, I was tested and told I have PCOS. My results showed that my body is creating more testosterone and DHEA than estradiol. As well, my body shows symptoms of being insulin resistant.

I was prescribed Aldactone and Metformin as well as a low dose of birth control (lo loestrin).

I'm wondering if this will help my stress and anxiety or if there are other things I can be doing to feel more like, me. I have lost the passion for things I once loved doing and find it very hard to concentrate these days.

Skinny w/pcos and endometriosis and 4 babies
by: Jill

I'm skinny and I always have been. I have PCOS and endometriosis. I have had 4 babies all naturally. I eat mainly protein. My oldest child is 10 and my youngest just turned 1 year old. I am at my heaviest weight not being pregnate at 125lbs and I'm 5'7. My typical weight is 117lbs and I'll probably get back down to that. I have no hair loss and no skin problems. I am however tired all of the time but that may be due to the 4 kids. Hope this helps someone out there.

Young, thin with pcos
by: Anonymous

I was always very lean and had been on birth control for my painful irregular periods for a number of years. Could always eat anything and not gain a pound. Didn't think anything about it until I got married and was trying to get pregnant. It took over 2 years for me to finally be diagnosed with pcos. Metformin did the trick and I was able to get pregnant. (and have gotten pregnant twice since with no issues). I found taking estrosmart helped alot to rid my body of a bunch of the extra estrogen and I felt alot better (less moody, migraines gone, periods more regular).

My story
by: Anonymous

Hi, My name is Sherry and I am 41 yo. I was 5 ft and weighed 95 pounds until I had my first baby at the age of 20 yo. My periods were weird as a teen, but because I was not sexually active, I did not see a dr. until my periods were every 5 days. The Dr. put me on birth control w/o a diagnosis. After I had my first child, I gained 50 pounds within three months and went three years w/o period. I was given provera to jump start period, but it didn't work. I was finally diagnosed with PCOS and went through many birth control pills to find out I cannot take them. At the age of 26, I had 1 period and became pregnant. I am thankful for this website and Dr. Nancy Dunn.

God bless you,

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