PCOS and Weight Loss (or Weight Gain)
Many women struggle with hormone imbalance at some point in their lives. If you are diagnosed with PCOS or diabetes, you may be told to “just lose weight” or pop a birth control pill until you’re ready to have babies. This is extremely unhelpful, biased, and problematic advice. If you want to use a non-diet, intuitive eating approach with PCOS, or you feel like the advice you’ve been given isn’t quite sitting right with you, I hope this post sheds some light on some nutritional and weight-neutral ways to care for your wonderful body and misbehaving ovaries.
What Is Polycystic Ovary Syndrome? (PCOS)
Polycystic ovary syndrome (PCOS) is a hormonal disorder affecting millions of women and people with ovaries. PCOS can cause irregular menstrual cycles, high levels of androgens (a group of hormones), and cysts in the ovaries. PCOS affects the body in many ways, including messing with fertility, metabolism and weight, cardiovascular health, sleep quality, and mental health.
While there is no one-size-fits-all PCOS plan or PCOS diet, using an intuitive eating approach can have huge benefits for both symptom relief and overall health. This is a smart approach for anyone but can be especially helpful if you have disordered eating or have been subject to yo-yo dieting (losing weight and gaining it back) many times in your life.
In this article, I’ll be exploring why intuitive eating is good for PCOS, why googling pcos diet or PCOS eating plan will not lead you anywhere good, and how intuitive eating can help improve your relationship with food, your body, and your life – all while promoting physical and emotional wellness.
The Connection Between PCOS and Insulin Resistance
About 70% of people with PCOS have insulin resistance. High levels of insulin can lead to increased hunger and cravings for sugary foods because your cells are not getting the energy they need, so they tell your body they need more. This makes it harder for individuals with PCOS who are struggling with “weight management” (a term I have grown to despise). Being insulin resistant can lead to weight gain and make losing weight impossible.
Insulin controls the amount of glucose, or blood sugar, floating around in your blood by telling your cells to suck in from the blood to the cell. Insulin also helps your body store unused glucose for later.
This is a main metabolic change that can happen with PCOS and diabetes, where the cells aren’t as great at using the insulin as they used to be, so glucose doesn’t get into the cells. Your body then makes more insulin, which can eventually wear out, and then the blood sugar stays high.
The best thing to do to manage insulin resistance with PCOS is to eat balanced, consistent meals that include carbohydrates, protein, fats, and fiber. You don’t want to go too long between meals, skips meals, or do intermittent fasting, so you don’t get overly hungry and become at risk of overeating, or binge eating. More on that below.
The Role of Stress and Adrenals with PCOS Symptoms
Cortisol is your stress hormone. It is released from your adrenal gland in response to the fear response in the body. This happens when something super scary happens, like a car jutting out in front of you in traffic, but also happens in response to regular life stuff, like a busy work life, family drama, and to systemic issues like racism, fatphobia, and gender-based discrimination.
With the sleep disturbances that are common with PCOS, cortisol can also be high in the morning, making breakfast difficult and afternoon snacking even more tempting.
Weight Loss & PCOS
If you have PCOS and are not thin, it is very likely someone has told you to lose weight. You may have been tempted to try someone’s “hormone diet”, “diabetes diet”, “PCOS diet” or something along those lines. You probably have read that you should avoid carbs, or that you should not eat dairy, beans, meat, or any number of other solutions.
I see you.
The PCOS experience can be frustrating and scary – a diagnosis for a condition that is vague and less than well-understood. Plus with all the anti-fat bias in healthcare, being told to lose weight is all but inevitable. If this is your situation, I want you to know that you do not need to lose weight to improve your health.
Why Weight Loss Doesn’t Work With PCOS
PCOS Causes Carb Cravings
Insulin resistance makes weight loss extremely difficult and often leads to weight gain. With insulin resistance, the cells of the body do not get the energy they need, leading to more hunger and carb cravings. These cravings can be really intense. The hunger is real! It could actually be said that PCOS makes you hungry. Learning how to eat enough carbohydrates throughout the day and to eat balanced meals to keep carb cravings at bay is an important part of managing the condition.
Low Calorie Diets Stress Your Adrenals
Cortisol, the stress hormone, increases in response to a low-calorie diet.(5) Yep – dieting is stressful. When we feel stress, our body releases blood sugar in order to give us enough energy to run from that stress. So for some folks, their stress response is running a lot, and their blood sugar follows. Not getting enough sleep regularly also causes an increase in cortisol release, which is why sleep is so important for healthy metabolism.
Restriction Backlash (or Rebellious Eating)
This phenomenon shows up in many ways, but somehow it always does. Restrictive diets are not sustainable, so at some point, you will no longer be able to stick to them. This usually doesn’t happen in a super chill way but feels really stressful.
You may experience binge eating at this point, or feeling like you’re unable to stop eating. You eat pizza one day, then more and more pizza. These foods are wonderful, by the way, and I don’t mean to demonize them. But these foods aren’t allowed on ANY diet I’ve ever seen, so they are often the ones we reach for once the diet stops working.
Another thing that ends up happening so often on a restrictive diet is you eat so little all day, just salad for lunch, very little dressing and definitely no croutons or cheese, you drink water and caffeine to make hunger go away, then you get home from work and are famished. You start there and eat all night.
This is disordered eating. This does not mean you have no willpower, just that you’re extremely hungry and your body has figured out how to get what it needs, despite your best efforts. Not only does this make you feel guilt and shame, but this inconsistent eating – restricting and binging – is also pretty bad for your hormones.
Metabolism Can Slow Down
If you are counting calories, “clean eating”, or cutting carbs, it’s possible you are eating less than your body needs to perform its many functions. Under-eating can have many negative effects including putting your body into starvation mode. This can cause you to hold onto weight that you may not if you gave your body enough food.
So if you have been eating 1200 calories a day and are confused about why you’re not losing weight – this is probably why. Your body is smarter than your diet. (and as I mentioned, weight loss doesn’t work for the majority of people long term, and is even more difficult for people with PCOS)
Eating disorders and PCOS often co-exist. People with PCOS are about 4x more likely to have an easting disorder than those without PCOS.
What Is Intuitive Eating?
Intuitive eating is a way of eating that taps into your inner body cues to tell you what, when, and how much to eat. It is a self-care framework that takes the emphasis off of body weight as the central indicator of health and places it on your inner wisdom. It is now supported by over 200 studies! The data is in, eating intuitively works.
The founders, Evelyn Tribole and Elyse Resch had this wonderful article written in the NY Times about their life’s work. Intuitive eating can be used for anyone, including those with type 2 diabetes, pre-diabetes, and PCOS. And despite what some people (uninformed people) may think, it is not true that intuitive eating means eating whatever you want, whenever you want, with no care for nutrition or health.
Intuitive eating is a non-diet approach to eating that emphasizes listening to your body and honoring its needs. It involves cultivating a positive relationship with food, rejecting diet culture, and trusting your body’s innate wisdom to guide your food choices. Rather than following strict rules or restrictions, intuitive eaters focus on tuning into hunger and fullness cues, exploring their cravings without guilt or shame, and discovering what foods make them feel best both physically and emotionally. I talk about the 10 principles of intuitive eating in detail here.
How To Use Intuitive Eating With PCOS
1. Eat enough throughout the day
It’s best to eat three meals a day and probably at least one snack, maybe 2-3. These meals need to include carbs, protein, fat, and ideally, fiber. Pay attention to your hunger signals and eat enough on a regular basis. You don’t want to let yourself get too hungry, where you’re cranky and irritable, and can’t think straight enough to eat mindfully.
By mindful, I just mean being able to stop working for a few minutes and think clearly about what you want, and what your body wants and needs. Don’t let yourself get too hungry. Your blood sugar will drop and this can cause the urge to eat quickly, and possibly binge eat.
Intense carb cravings are a common manifestation of PCOS. This is hard enough to manage as is, but if you’re trying to eat low carb, or restricting in general, you’re going to crave what you’re not getting. So having intense carb cravings in the afternoon can be improved by eating enough carbs, along with fat and protein, at all of your meals.
2. Use gentle nutrition to add the good stuff
Your diet does matter. That is one thing that often gets confused with intuitive eating, or a non-diet approach. Intuitive eating is not food anarchy. It is gentle, mindful nutrition.
Increase the good fats in your diet like nuts, fish, avocados, and flax seed oil. Get plenty of fiber in your diet. Eat fruit, vegetables, and my favorite – beans. Eat a savory breakfast half of the week or so, with eggs and/or avocado.
If you are at the beginning of your intuitive eating journey, these suggestions may be triggering. That’s ok – you can get there eventually. It’s possible it’s too soon to do this step. Just be patient and work through giving yourself unconditional permission and banishing the food police. Reach out for help or with questions if you aren’t sure if you’re ready.
3. Be kind and gentle with yourself
Just as stress can cause your hormones to be out of whack, self-compassion can settle your nervous system and return you to a state of calm. According to Dr. Kristen Neff, the leading self-compassion researcher, talking kindly to yourself can directly lower your cortisol response. How cool.
There is a major misconception in our culture that shaming or criticizing yourself will cause you to make a change, loss weight, and do better. Real change happens when we are kind to ourselves. Here are a couple of ideas for bringing more self-compassion into your daily life:
- notice when negative self-talk arises in your thoughts
- use soothing self-touch, like putting your hand on your heart or a relaxing scalp massage
- Use a loving mantra to remind yourself you are doing the best you can – something like “my body is doing the best it can for me every day”, or “I trust myself”.
4. Prioritize good sleep
Most people need between 7-9 hours of sleep each night. Our busy lives can make this hard, but it really is so important to prioritize your sleep routine. Incorporating some solid sleep hygiene into your life can make a huge difference.
Limit alcohol, especially in the hours right before bed, turn off electronic devices, and try meditation or calming music. My personal favorite is this relaxing body scan for sleep on Insight Timer. I suggest using a mindfulness app all the time.
And if you’ve tried everything and still have trouble getting to sleep or staying asleep, talk to your doctor – and ask for the same solution they would give a thin person coming in for the same problem. Weight-stigma is common for sleep issues, so you’ll need to advocate for equal care. If you need more suggestions with this, check this out.
What About Inflammation and PCOS?
And a word about inflammation – restricting and dieting are PRO-INFLAMMATORY, especially for people with PCOS and hormonal difficulties. Weight cycling causes your body’s natural anti-inflammatory processes to work less effectively. This is such a common question I get these days, so I wanted to just add this little tidbit here.
To Sum Up, Using Intuitive Eating With PCOS Is Smart
I hope this has been helpful to remind you that you should not try a restrictive diet to heal your hormones, especially if you have a history of disordered eating, chronic dieting and weight cycling. There are non-restrictive ways to improve your hormones, your health, and your relationship with food.
If you have PCOS, or another reproductive health disorder and want non-diet, holistic nutrition guidance, reach out for help. I offer one-on-one nutrition counseling for disordered eating, chronic health conditions, and body image.
I also have a transformative group program – The Love Food Again Program. Enrollment is open now for spring 2024. We start February 19, 2024. You’ll learn to liberate yourself from diet culture while keeping your self-care and health front and center. I’d love to be your guide.
If you aren’t sure which program would be best for you, book a discovery call today and we’ll figure it out.
Emily Van Eck, MS, RDN specializes in intuitive eating, mindfulness-based eating practices, embodiment with food and movement, and healing from years of weight-bias and disordered eating. She helps womxn find balance, consistency, and peace with their eating habits so they can feel confident to get outta their heads and into their bodies. Emily is a registered dietitian and certified intuitive eating counselor with a master’s degree in nutrition science. Read more about her here.