PCOS trouble 2 years post-op?

Hey everybody. It's been a while since I've been anything but a lurker, but I could really use some help/advice.

I'm 25 months post-op and I've been in active maintenance for about the last 7 months. I'm in recovery from binge eating disorder and I'm still not super confident in my abilities to "experiment" with macros and different ways of eating to see what works best for me in maintenance. All that said, I average 1200-1600 calories a day and I work out a lot. I lift, I do kickboxing classes, I run, I bike, I do yoga. 

Anyway, one of the reasons I pursued VSG in the first place was because I was diagnosed with severe PCOS and was unable to get or stay pregnant. I've lost almost 200lbs since then, and my hormones never got right. I still don't ovulate, I still don't cycle correctly, I still can't get pregnant without IVF-level medical interventions. 

I can feel my PCOS symptoms creeping. I get compounding PMS symptoms. One of the things that made PCOS so hard for me was that I could work my ASS off and still not lose weight. Sometimes even gain it. I've worked so hard over the last two years to be who I am now...but I hear that big unhappy girl I used to be knocking. 

I've steady put on weight over the last three months even though my activity levels and intake haven't changed and have even improved. Yes, I still weight and measure everything. Yes, I still track everything on MFP. Yes, I have some terrible days where I go off the rails, but they don't turn into terrible weeks. I have tried IIFYM diets, I have tried sticking to what I know (high protein low carb) and it doesn't seem to make much of a difference. The weight is creeping back on. 

Anyone else with hormonal issues experience this? Any advice from vets on where I should go or what I should do next?

I never had PCOS but started having trouble with regain at 30 months.  The surgeon said that is normal and the only cure is to eat fewer calories and exercise more.  Rebound is the way your body recovers from being starved and it takes fewer calories every year for me to maintain.  I maintain 136 pounds at 1400 calories a day and lose one or sometimes two pounds a week when I stay under 900 calories a day.

If I could maintain on my activity level at 1400 calories a day I'd be over the moon. 

So ultimately calories are the key to weight loss.  If you have to consume more calories to maintain your level of activity, you might consider lowering your level of activity so you can consume the calories you should be aiming for.  Seems contradictory, but, as the saying goes, you can't outrun a bad diet.  

I maintain a very high level of activity on 800-1000 calories (running, yoga, pilates, tai chi, weight lifting, etc.).  You might want to consider changing the timing of your meals, so that you're eating at the right times to maintain your activity level.  For example, if you get hungry after working out, plan to eat your meals after working out so that you don't need to add an EXTRA meal after you work out.  

I appreciate your insight. I'm not adding extra meals to compensate for my workouts by any means. I upped my calories modestly and changed up my macros to fuel my goals now - maintenance of weight and adding muscle/strength. In the spring I'll change my goals again as I start training for a half marathon. 

It seems counterintuitive to everything I've read on nutrition that I can maintain my weight and build muscle on 800-1000 calories a day. I know I don't perform as well. Moving into maintenance, I expected to up my calories some. But a modest uptick in my calories and a significant uptick in my activity have led to slow, steady weight gain over the past few months.

I know my hormones are out of whack because the secondary symptoms of that have been piling back on as well. Sebhorric dermatitis on my scalp, acne, depression, fatigue..all of the things I lived with at 350+lbs that I thought were just because I was fat. Turns out that's not the case. My body is spinning its wheels, so to speak...just looking for anyone who may have had a similar experience and figured out how to solve it.

Building muscle and losing weight are pretty mutually exclusive - one requires a caloric deficit, the other a caloric excess.  You might find that gaining weight during your weight lifting seasons is just something that you need to deal with, with the knowledge that you'll lose it again when you cut the hypertrophy.  But, regardless, you upped your calories and you started gaining weight - the connection here seems fairly intuitive to me.  Once you're at your goal, it's best to increase your calories gradually to see where your maintenance level is - i.e., by 100 calories a day for a week, then 100 calories a day for the next week, etc.  This should be done indecently of any exercise you're getting.  While exercise is wonderful for your health, it does not have a large impact on your weight.  

I'm currently training for a half marathon.  (YAY!)  I run fasted in the morning and have a protein shake for breakfast once I finish.  I don't like eating solid food in the morning, never have, so a shake gives me protein my muscles need for recovery and makes my stomach happy.  Then I eat a protein forward lunch and dinner, both in the 200-300 calorie range.  I don't snack.  For long runs I do use Clif Blocks, I'll eat one every 2 miles or so, but that's only for runs that are longer than 6 miles, otherwise I just hydrate as needed.  

On lifting days, I do something similar - I lift fasted in the morning and follow with my breakfast protein shake.  Yes, I was dragging a little with energy initially when I added exercise to my life, but my body adapted once it learned that I was NOT going to increase my calories, even "modestly" as you have.  

I assume you're seeing an endocrinologist?  

Sadly, the truth is that you are either eating: too many calories, too many carbs, or a combination of both.  Hormone and thyroid disorders may impede weight loss but they can still allow it.  

Also, for some of us with the sleeve we always need to restrict our calories lower than we are told.  I recently cut down to 600/day to start losing.  Over 800 calories and I gain like crazy.  I, too, have hormonal issues.  While I do not have PCOS, I do have corpu****eum cysts that require me to be on birth control permanently.  

Binge eating disorder complicates things, too.  I also have bad days.  The problem if we eat low carb and have a terrible day is it kicks us out of ketosis which benefits both the PCOS and the weight loss.  Nutritionists won't tell you this, but when binge eating and food addiction are involved, it's best to avoid certain foods permanently.  Much like an alcoholic can never drink some wine here and there "for the health benefits," it is dangerous for us to do this, too. 

Often we are not "bingeing" any more but we rely on food addiction when it goes into remission.  We are just now starting to study food addiction.  I believe I have both, actually.  I relapse and it crushes my weight loss for a month - literally.  It's awful.  I combat it by being in therapy and going to support meetings.

I have drastically improved my binge eating disorder, but it is still a daily battle.  It is why I feel support is invaluable.  I try not to have bad days - one bad bite and then the rest goes away.  If I have a bad day I do something else instead of eating.  It is extremely hard to do, and I have only recently become more successful.  

I don't use MFP - I use a notebook.  When I physically write things down I notice I eat FAR more than when I track with MFP.  I write things down before I even eat it.  Doing this I realized I was eating 2x as much stuff than I was logging in MFP.  It was crazy!

Hang in there and good luck.

Thank you for replying. 

Binge eating and food addiction are daily battles for me too. I weigh and measure everything I put in my mouth 95% of the time. The other 5% it just isn't practical. I cook at home where I can control what goes into my food. I don't keep junk in the house at all (my husband is a sleever too, so it's easier). Working out has become my new favorite coping mechanism for stress and my best success when I'm having those obsessive thoughts about bingeing. The food addiction is still SO real and it's still hard, but I'm making progress. 

Am I wrong in adding carbs back in (I stay under 100 most days) in maintenance?

If I have to work this hard and eat under 1000 calories a day forever just to stay where I'm at, I think that's a sign that something is broken. If I want to lose, yes I'll go back to basics and stick under 1000 calories and under 30 carbs a day. But if I have to live that way to maintain, especially with the level of activity I'm doing...something's wrong.

The more obese we are, the more we eventually need to reduce our carbohydrate to lose and maintain.  Also, many of us may never be able to eat more than 30g/day of carbohydrate.  Low carb keeps our insulin low, and this keeps us from storing fat.  Is it fair?  Probably not.  It is what it is.  It is the price for having been morbidly obese, sadly, that many of us pay even after weight loss.  With binge eating disorder we have many triggers and it's best to avoid them long term in lieu of outcomes, especially if you have food addiction and BED like I do.  The outcomes are simply better, especially with just the sleeve.

And, the sleeve is restriction-only, which means you have to count calories, and most likely stay 1000/day or under, especially if you aren't going to eat low-carb. 

I work 80 hours a week between two jobs and commute over ten hours, and I still cook all my meals and make good choices.  It's absolutely hard to do, however it is also possible. I, too, make mistakes of course.  :)  We are different with BED, though.  The problem for us is that it's far less practical to not do it the other 5% of the time if our metabolism is damaged.  The reality is that the 5% of the time we view it as impractical is actually the 5% of the time it is absolutely vital to stay on plan.  It is no different than any addiction.

As for adding carbs back in, you may regain.  You may not.  I will most likely never eat over 50g of carbs a day for the rest of my life.  I have too many hormone issues, a thyroid issue, and an eating disorder.  It's a bad idea for me.  Having said that, you know yourself better than me, a random person on the internet.  PCOS definitely benefits from staying low carb, though, by a wide margin.  Look at this study for example.  The improvements for PCOS are huge.  So, it depends how much you are willing to live with the PCOS side effects, weighed against how effective other treatments are, weighed against higher carb intake.  Insulin is a hormone, though, and it affects other hormones, as well - insulin resistance is known for causing/contributing to PCOS. 

Some of us also just wind up needing malabsorption which the sleeve does not have.  I have lost 460ish pounds (most on a low carb diet), but I will be getting the duodenal switch when I am able.  If you are struggling with weight loss it might be worth considering a malabsorptive procedure - they allow us to eat more, particularly the DS.

Thanks for your insight. I have no interest in an additional surgery if I can maintain and thrive here. If I can solve my metabolism problems or at least get some answers, I'll be on the road to where I want to be.