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PCOS & Binge Eating – What’s the Connection? 

by | Feb 28, 2024

If you’ve stumbled across this post, my guess is that you’ve either been diagnosed with polycystic ovary syndrome or you suspect you have it. For many women, this space is riddled with confusion and frustration. Getting a diagnosis isn’t easy, and figuring out what treatment options are best for you is also confusing. If you’re also in recovery from an eating disorder, or are currently struggling with binge eating, this adds a layer on top of any treatment plan. In this article, I’ll be explaining why eating disorders, and binge eating specifically, are so common with PCOS, and what you need to know to take care of your body, and your overall well-being.

PCOS Basics

Polycystic ovary syndrome (PCOS) is a hormonal disorder affecting millions of women and people with ovaries, 10-15%. PCOS is still a bit mysterious and we don’t know exactly what causes it. What we do know is that it’s likely a combination of genetic susceptibility and environmental triggers.

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.

I’m not going to go in depth into the condition in this post to save time. You can check out a more thorough explanation of PCOS and why I use intuitive eating with my PCOS clients here.

The Critical Link Between PCOS And Mental Health

Folks with PCOS often have one or several co-occurring conditions, including diabetes, cardiovascular disease, anxiety, depression, and eating disorders. Women of reproductive age are twice as likely to suffer with major depression disorder as men, and women over 45 have the highest prevalence of anxiety in the U.S. Anxiety and depression are major warning signs of eating disorders and reports show that women with PCOS are rarely fully screened for mental health status.

All of this, combined with some of the physical and emotional factors with PCOS can make someone vulnerable to binge eating. Understanding the link between PCOS, body image, weight loss recommendations, and mental health can help you understand why these folks are susceptible to disordered eating including binge eating.

What Is Binge Eating?

As a dietitian who specializes in helping women with PCOS heal disordered eating, I know a lot about this topic and I hope you find this helpful.

Binge eating disorder is characterized by eating an amount of food that is larger than what most folks would consider “normal” in a short period of time. The binge eating episode has a feeling of being “out of control” or has a sense of loss of control. This could feel urgent or that you cannot stop eating no matter what or how much you’ve eaten.

Other types of eating disorders, like anorexia, bulimia, other specified feeding or eating disorder (OSFED) and unspecified feeding eating disorder, and even orthorexia often also have binge eating behaviors. One main difference with binge eating disorder (BED), is that there are not compensatory behaviors, such as purging or excessive exercise, although restriction is often present.

The connection between Polycystic Ovary Syndrome (PCOS) and binge eating is due to physical, cultural, and emotional factors.

The Cycle of Restrictive Dieting and Binge Eating

The cycle often begins with a restrictive diet that is difficult to maintain due to the physiological changes caused by PCOS, plus just regular life. Diets are impossible to maintain long-term for most people. Once the diet is broken, guilt and shame are common (an outcome of diet culture’s insistence that we should all have enough willpower to lose weight), leading to binge eating as a form of self-punishment or to cope with these negative emotions. After binge eating, you may attempt even more restrictive dieting to compensate, perpetuating the painful cycle.

Why Binge Eating is Common In PCOS

As I talk about more in my introduction to PCOS and Intuitive Eating post, the conventional approach to “treating” PCOS usually involves birth control and often recommendations for weight loss and low carb diets. To be fair, this is definitely starting to shift due to the 2023 International Evidence-based Guideline for PCOS recently released by the PCOS Network, but diet culture’s grip can be pretty tight.

insulin & blood sugar swing cause Carb Cravings

The hormonal imbalances, like high insulin and testosterone, can disrupt normal hunger cues, cause under-eating in the morning and then intense cravings later in the day. These cravings can trigger binge eating if not understood and managed appropriately.

A key feature of PCOS is insulin resistance, where the body’s cells don’t take in the enough glucose in response to insulin release. This can lead to higher insulin levels in the blood and fluctuations in blood sugar levels, which may increase hunger and cravings, particularly for carbohydrates and sugary foods.

If the blood sugar gets really low, the body can react by feeling the need to quickly replenish energy, which can trigger binge eating. When individuals with PCOS attempt to lose weight through restrictive dieting, these cravings can become overwhelming, leading to binge eating episodes.

Emotional Binge Eating

Managing PCOS symptoms can be stressful and emotionally taxing.

The emotional stress associated with managing PCOS symptoms—such as weight gain, fertility issues, and body image concerns—can be a lot. This can understandably be an emotional experience. And emotional eating can feel like a soothing coping mechanism to cope with with negative emotions, such as frustration, sadness, or anxiety about their condition.

Weight loss attempts can exacerbate these feelings, particularly if they involve restrictive dieting, which can feel like deprivation and lead to emotional binge eating. This creates a challenging cycle where binge eating can worsen PCOS symptoms, particularly through irregular eating patterns, and further insulin resistance. Hence, it’s important to address both the PCOS and the disordered eating for effective, compassionate, and holistic management.

Dieting-Induced Binge Eating

Because folks with PCOS often gain weight as a result of the syndrome, doctors may suggest weight loss as a “solution”. But typically this does more harm than good, as weight loss is incredibly difficult for people with PCOS and can even backfire. These weight loss attempts often result in worsened body image, eating disorders, raised blood sugar, and more out of whack hormones.

As I talk about repeatedly here on the blog, dieting is a trigger for eating disorders, including binge eating disorder. Your body is wired for survival and depriving it of essential nutrients can cause it to react by making you seek out large quantities of food.

Restrictive dieting often leads to nutritional deficiencies, increased cravings, and a preoccupation with food, setting the stage for binge eating when you inevitably can’t continue to the restriction.

This is not your fault and certainly doesn’t mean you lack self-control or willpower. As I talk about quite a lot on this blog, and in my newsletter, binge eating is a direct result of restriction.

Read all about how toxic diet culture is and how to help protect yourself against it here.

Hormonal Imbalances

PCOS is characterized by many hormonal imbalances, including androgens, leptin, and ghrelin. These last two are your hunger and fullness hormones. These imbalances can distort hunger cues and appetite regulation, making it difficult to maintain a consistent eating pattern and increasing the risk of overeating

Body Image Distress

PCOS often causes weight gain and difficulty losing weight, as well as other physical symptoms like hirsutism and acne, which can negatively impact body image and self-esteem. As I’ve expressed, sustained weight loss is nearly impossible for anyone, but is even more impossible for those with PCOS. Despite this, the pressure to lose weight can be intense and come from healthcare providers. This can intensify these issues, leading to cycles of dieting, failure, and binge eating as a response to feelings of low self-worth or failure.

Reach out if you have PCOS and have been told to lose weight but are struggling with binge eating.

How to Stop Binge Eating if You Have PCOS

In order to truly take care of your hormone health, you need to heal your relationship with food first. Compassionate, holistic care is important for effective PCOS treatment. This includes focusing on sustainable lifestyle changes, emotional support, and strategies to manage insulin resistance and hormonal imbalances without using restrictive diets that will just exacerbate binge eating and other disordered eating.

If you are dealing with disordered eating and PCOS, here’s what I want you to know:

Avoid Restrictive Diets

The temptation to follow a low carb of low calorie diet is tempting, but they are not advised, especially if you’ve struggled with chronic dieting or disordered eating. Instead of following strict diets that can trigger binge eating, adopt a balanced approach to eating that includes a variety of nutrients and that doesn’t demonize any foods. Focus on incorporating lots of types of foods, with an emphasis on adequate protein, fat, and fiber. You don’t need to cut carbs and please, for the love of god, do not do a keto diet or some wacky hard 75 or something.

Eat breakfast, lunch, and dinner and at least one snack. If you want more guidance here, download my free Non-Diet PCOS Guide! This guide explains how to think about nutrition with PCOS and what to prioritize with your self-care. Check out this post if you want to explore what working with a HAES dietitian would be like.

Mindful Eating Practices

Practice mindful eating and intuitive eating to rebuild a healthy relationship with food. Pay attention to hunger and fullness cues, eat without distractions, and savor your food, which can help reduce binge eating episodes.

Check out The Center for Mindful Eating for more ideas.

Seek Professional Support

A multidisciplinary team, including a dietitian familiar with PCOS and eating disorders, a HAES-aligned therapist, and an endocrinologist or gyn, can offer tailored advice and support for managing both PCOS and binge eating.

Regular Physical Activity

Exercise can help manage PCOS symptoms, improve insulin sensitivity, and boost mood. Find activities you enjoy and aim for consistency rather than intensity. I like to use a 5-pronged approach to joyful exercise that will not exacerbate eating disorder symptoms, but will absolutely be in favor of your health.

  • Make sure you are enjoying the movement while you’re doing it (for the most part)
  • Practice embodied and mindful movement – check in with yourself while you’re exercising about how you’re feeling and if you’re still enjoying it and staying connected to your body
  • Find body positive community – you need to feel safe to exercise, so finding other people in bodies like yours to move with can work wonders. Check out my resource guide for tips on this.
  • Know your limitations – be careful not to push yourself too hard!
  • Decouple exercise from weight loss. Find movement that feels good (or mostly good) while you’re doing it. This can feel complicated at first, but you can do it!

Check Your Stress and How You Manage It

There is so much going on these days, so many reasons that we’re all stressed out. I want you to be gentle with yourself, but recognize that stress raises cortisol levels, which can raise blood sugar. Having too much stress or not well managed stress can exacerbate the inflammation present with PCOS. Stress is also a huge trigger for binge eating. Take a good look at what is causing you stress in your life to see if there are some beliefs or actions you might want to tweak.

Techniques such as yoga, meditation, deep breathing, or hobbies can help reduce stress levels.

Nutrition Matters Too – Try These Gentle Tips

Polycystic ovary syndrome is a complex hormonal and metabolic disorder. These steps are here to guide you with a gentle nutrition and a Health at Every Size approach to nourish yourself and your hormones well with PCOS. Good, balanced nourishment can absolutely help your hormones. These are the four main targets for managing PCOS with nutrition.

Consistent Nourishment

You want to eat a meal every 3-4 hours. Going too long without eating is not good for your blood sugar, your gut, or your brain. Calorie restriction is stressful on the body so it’s important to eat enough. I know that weight loss and restriction can feel like the answer, but they can backfire and may cause more stress than benefit.

Don’t Skip Breakfast

High cortisol can make appetite poor in the morning, but try and eat anyway. Find breakfasts that are easy to prepare and eat within an hour or so of waking up. Ideally, your breakfasts have protein, fat, carb, and fiber. Whole grain bread with an egg or two works just great (add avocado if you’re feeling fancy). A breakfast taco or burrito with egg. Oatmeal is also a great breakfast for managing PCOS, believe it or not. Here’s a whole post about how to make breakfast easier for you if you have PCOS.

Add Fiber and Color

No need to cut anything out of your diet. Instead, think about small additions you can make that add more fiber and anti-oxidants to your routine. Whole grains, nuts and seeds, fruits, vegetables, beans and lentils are all packed with this stuff. If adding foods in without cutting foods out feels tricky, try to stop labeling food as good and bad and look into healing your relationship with food.

Get Those Omega-3’s

These are powerful anti-inflammatory foods. Salmon, tuna, sardines, anchovies are all high. But other fish are great too. Nuts like walnuts, chia seeds, and flax seeds are great vegetarian sources. And a supplement won’t hurt too, but check with your doctor first.

Diet is important, but it is not the only thing that can help, and sometimes not the most important thing for you. Take a look at where you could use improvement with your overall stress, lifestyle, and inflammation. Make sure that you’re looking at your relationship with food and if body image distress or stress about eating “perfectly” is causing you lots of anxiety or resulting in disordered eating.

If you have a history of disordered eating or weight concerns, the most beneficial thing you can do it make peace with food. Once you feel more neutral around eating and your body image, it gets easier to make health-promoting changes to diet and exercise.

I work with people 1-1 and in my group intuitive eating coaching program, The Love Food Again Program, on healing binge eating and PCOS. Reach out for help if you need it! I’d love to be your guide.

About Emily

Emily Van Eck, MS, RDN specializes in Intuitive Eating, eating disorders, body image, women’s reproductive health, and healing from years of weight-bias and disordered eating. She helps women+ 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 practice, values, and experience here.

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Emily Van Eck sitting on the couch smiling

Hey there, I´m Emily

A non-diet and weight-inclusive dietitian, intuitive eating coach, and body image healer. Here on the blog, I focuses on exploring intuitive eating, gentle nutrition, the complex arena of body image and feminism, anti-oppression, and all the ways these things intersect. I want us all to be free to own our appetites, and our desires, and eat really, really well. 

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