Does Intuitive Eating Work for PCOS?
If you have PCOS, you may have been told to follow a diet to treat this condition. Unfortunately, dieting only tends to make PCOS (and other health conditions) worse. So if dieting isn’t the solution to PCOS, what is? Can you do intuitive eating with PCOS?
In this blog we will cover:
What is PCOS?
How is PCOS treated?
Why diets don’t work for PCOS
Do you need to cut out gluten and dairy for PCOS?
Should people with PCOS follow a low carb diet?
Will weight loss improve PCOS?
What is intuitive eating?
How to manage PCOS with intuitive eating
Managing blood sugars
Decreasing inflammation
Incorporating joyful movement
Managing sleep and stress
What is PCOS?
Polycystic ovarian syndrome, commonly referred to as PCOS, is one of the most common hormonal disorders that affects menstruating folks. The exact cause of PCOS is unknown, although multiple factors appear to play a role, including genetics, hormones, lifestyle, and environment.
PCOS is a condition that results in increased androgens (including hormones such as testosterone) and irregular menstrual cycles. People who menstruate do naturally produce some androgens, but much less than people who do not. In people who menstruate, androgens play a key role in the hormonal cascade that kick-starts puberty, stimulating hair growth in the pubic and underarm areas.
PCOS is also characterized by the presence of small cysts (follicles) in the ovaries. High circulating androgens may result in excessive facial and body hair growth (hirsutism), hair loss (alopecia), and acne.
People diagnosed with PCOS are at higher risk for developing impaired glucose tolerance, type 2 diabetes mellitus, and metabolic syndrome and they may be at higher risk for developing coronary artery disease. In other words, PCOS affects more than just the reproductive system.
50% to 70% of people with PCOS have insulin resistance with compensatory hyperinsulinemia. High amounts of insulin may promote abdominal weight gain, difficulty in losing weight, food cravings, and hypoglycemic events.
Other observed associations with PCOS include:
Hypothyroidism
Obstructive sleep apnea
Nonalcoholic fatty liver disease
Depression and other mood disorders
Fatigue
Period problems
Infertility
How is PCOS treated?
At this time, there is no cure for PCOS. Run far away from anyone selling a cure! Treatment of PCOS is all about symptom management.
Nutrition interventions can be implemented to support a medical care plan. The goal of PCOS treatment is to achieve the following:
Regular menstrual function
Reduced androgen and insulin levels
Improved dermatological symptoms
Prevention of long-term complications
Why diets don’t work for PCOS
People with PCOS are often recommended to diet and “just lose weight” upon diagnosis of their condition. This treatment approach has many disadvantages.
You might assume that because weight loss advice is so frequently dished out that it would mean that dieting is an effective approach. Yet upwards of 97% of people who lose weight through dieting regain the weight they lost within two to five years. Not only that, but one- to two-thirds of people who diet regain more weight than they originally lost, ending up at a higher weight than where they started.
Simply put, diets don’t work, including for people diagnosed with PCOS. If you have tried treating your PCOS by going on a diet and it did not work for you, do not blame yourself. You are not the problem. Weight loss programs have an astronomically high failure rate, yet we continue to blame the struggle to “stick with it” on lack of motivation or willpower.
Do you need to cut out gluten and dairy for PCOS?
Nope, you do not need to remove gluten or dairy to treat your PCOS. There are literally ZERO research studies demonstrating this method is actually effective at remedying your PCOS symptoms. All foods can fit.
Should people with PCOS follow a low carb diet?
Low carb diets are also often recommended for people with PCOS for treatment of insulin resistance. But carbs can absolutely be included in a PCOS-friendly diet. We will go over how to incorporate all of your favorite foods later in this blog post.
Will weight loss improve PCOS?
Telling someone with PCOS to “just lose weight” is, frankly, terrible advice. Unfortunately, this is what many people with PCOS (especially those in larger bodies) are told to do when they are diagnosed with PCOS. There is some research to suggest that 5-10% total body weight has been shown to improve both metabolic and reproductive aspects of PCOS in the short term. But as with most weight loss research, this is correlational evidence and it is also does not demonstrate the outcomes in the long term. In the long run, intentional weight loss will likely do more harm than good.
As previously mentioned, dieting attempts (ahem, weight loss attempts) fail up to 97% of the time, whether you have PCOS or not. Having PCOS makes pursing weight loss even more difficult by slowing down the metabolism, increasing insulin levels, exacerbating carb and sugar cravings, and altering hunger and fullness hormones. Of course it feels like dieting and losing weight are impossible! Just know that there are biological reasons for this that have nothing to do with willpower.
People with PCOS also have a higher likelihood of developing an eating disorder, especially binge eating disorder. High levels of insulin can sauce low blood sugars, as can following a low-carb diet that is often recommended for PCOS. Paired with the stress of living with PCOS as well as other mood disorders that can result, it makes sense that binge eating can be the result.
The bottom line is that PCOS is not caused by gaining weight or being at a higher weight, so weight loss isn’t the solution. There are plenty of thin people who have PCOS and the same PCOS treatment is warranted no matter what size your body is.
Some individuals may lose weight when treating their PCOS and making nutrition and exercise changes. This does not mean that weight loss is what improved their symptoms - the behavior changes did! This also does not mean that they did anything wrong by losing weight. They were likely just above their set point weight when they started making behavior changes. That said, weight loss as a sole treatment for PCOS is often ineffective and not every person with PCOS will lose weight as they treat their symptoms.
What is intuitive eating?
Intuitive eating is a non-diet approach to eating that was developed by two registered dietitians, Evelyn Tribole and Elyse Resch. There are 10 principles of intuitive eating with a goal of helping you improve your relationship with food and your body.
Reject the diet mentality
Honor your hunger
Make peace with food
Challenge the food police
Discover the satisfaction factor
Feel your fullness
Cope with your emotions with kindness
Respect your body
Movement - feel the difference
Honor your health - gentle nutrition
New to intuitive eating and want to learn more? Check out this blog post for a full beginner’s guide. I also made a compilation of all of my favorite intuitive eating and anti-diet books here to help you get started.
How to manage PCOS with intuitive eating
Intuitive eating is the way to manage your PCOS without dieting and cutting out your favorite foods. Intuitive eating involves learning to listen to your body rather than relying on food rules to dictate your food choice. There are ten total principles of intuitive eating and I recommend reading this post to learn more about how intuitive eating can be used to treat chronic conditions. The principle I want to focus on for PCOS treatment is the principle of gentle nutrition. Gentle nutrition is essentially the intersection between fueling your body with the nutrients it needs while also eating foods that you want and enjoy.
Here are a few ways to incorporate gentle nutrition to manage PCOS symptoms:
Keep blood sugar levels steady
Balance your blood sugars by eating meals with protein, carbohydrates, and fats (try to aim for at least 2 of the 3 macronutrients each time you eat). Eating consistently (every 3-5 hours or so) will also be key for balanced blood sugars and to help manage insulin resistance.
Protein sources:
Meat, poultry, and seafood
Eggs
Cheese, yogurt, and milk
Nuts and seeds
Beans
Carbohydrate sources
Starches (bread, rice, pasta, and crackers)
Starchy vegetables (corn, potatoes, and peas)
Fruit
Sweets
Milk and yogurt
Fat sources
Oils (olive oil, canola oil, avocado oil, etc.)
Fatty fish such as salmon and mackerel
Avocado
Nuts and seeds
Choosing high-fiber carbohydrates (such as whole grains and high-fiber fruits and vegetables) will also help manage blood glucose levels. Fiber slows down digestion and subsequently leads to slower increases in blood sugar. This does not mean that simple carbs are not allowed! Remember, this is gentle nutrition. Take these suggestions as guidelines, not rules that must be followed.
Balancing blood sugars with a non-diet approach is something that I teach inside my intuitive eating membership. This is such an important concept, even for those without PCOS. Become a member to learn more!
Decrease underlying inflammation
PCOS is considered an inflammatory condition. Eating plenty of fruits and vegetables along with omega-3 fatty acids can provide your body with nutrients that have anti-inflammatory properties.
Sources of omega-3 fatty acids
Fatty fish
Flax seed
Chia seed
Nuts
Soybeans
Dieting will not help with inflammation! In fact, the stress of dieting and cutting carbs, dairy, and gluten can make inflammation worse.
Increase joyful movement
Both cardiovascular movement along with resistance training can alleviate PCOS symptoms and reduce the risk of the development of other conditions such as type 2 diabetes and heart disease.
It’s likely no surprise to hear that exercise is good for you. However, over-exercising can increase the stress response and worsen inflammation. Joyful movement is the key here. There is no place for using exercise as punishment or as a way to “make up” for what you ate the day before.
Get enough sleep and manage stress
Poor sleep and stress can cause inflammation and increases in stress hormones. This can also impact your hunger and fullness hormones.
Bottom line - can you do intuitive eating with PCOS?
Yes, people with PCOS can do intuitive eating. Intuitive eating might look different for those with PCOS - this does not mean that it is not possible.
PCOS is a common endocrine disorder caused by both genetic and environmental factors. While there is no cure, you can manage your symptoms and there is a way to do so without dieting and restriction.
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