A quick disclaimer before we get started: this information is meant for educational purposes only and is not a replacement for individualized medical care or medical nutrition therapy. Consult your healthcare providers before making any changes to your eating pattern, movement, or supplements.
I’m loving hosting these Coffee Chat webinars so much that I’m excited to share they’ll be continuing into the foreseeable future! Our most recent topic covered some of the basics of polycystic ovary syndrome (PCOS) and why diets are not the answer to PCOS. You can catch the replay below or keep scrolling to read a summary of the info!
To be diagnosed with PCOS, you have to meet two of the three following criteria (the “Rotterdam criteria”):
Irregular or absent ovulation/”menstrual dysfunction” (usually, long cycles and <9 periods per year)
Clinical or biochemical signs of hyperandrogenism (high testosterone) like facial/body hair growth, hair loss on your head, acne
Polycystic ovaries (diagnosed through a transvaginal ultrasound)
Note: PCOS is not necessarily the only explanation for some of these symptoms, so it’s important to not self-diagnose and to bring your concerns to a medical provider who’s willing to listen to you and order tests you may need. That being said, getting diagnosed with PCOS often takes multiple years and multiple providers despite it being the leading cause of infertility - so know that if you think something’s going on in your body, you deserve a provider that will listen to your concerns and guide you through your care.
Symptoms, Features, and Co-Diagnoses
PCOS is complex and presents differently for every person. Common symptoms include:
Hair loss on the head
Body & facial hair growth (referred to as “hirsutism”)
Irregular/long menstrual cycles
Common co-diagnoses include anxiety, depression, and type 2 diabetes. That doesn’t mean that if you have PCOS, you’re automatically going to develop symptoms of these conditions - or that if you have those conditions, you also have PCOS. It means that PCOS has a complex presentation that requires a multidisciplinary approach, and it means that you should get more information and care than being handed a brochure.
The “primary” pathology of PCOS is considered to be hyperandrogenism (androgens are the group of “male” sex hormones), but insulin resistance and high insulin levels are also common features. Androgens are usually produced by the ovaries and adrenal glands, which sit on top of your kidneys. In those with PCOS, it’s suggested that both the ovaries and adrenal glands overproduce androgens compared to those without PCOS. (source; CW - stigmatizing language)
I like to use a “lock and key” model to explain insulin and its actions to clients - all carbohydrates you eat get broken down to glucose, which circulates in your blood (this is what gets measured when your blood sugar is taken). Insulin is the key that unlocks cells so that circulating glucose can be taken in and used for energy. In insulin resistance, it’s like someone changed the locks without telling your pancreas, which produces insulin. Glucose stays in your bloodstream rather than being used for energy, which signals your pancreas to produce more insulin. This is called “compensatory hyperinsulinemia” and explains why those with PCOS often have high circulating levels of insulin. (Lock and key analogy adapted from this book)
Altered insulin/glucose metabolism can lead to fatigue and low energy (since glucose isn’t entering cells as expected) and increased hunger and cravings. Insulin is also a growth hormone, meaning weight gain can be a symptom of insulin resistance. I’m not sharing this (or anything, ever) to create shame around weight - but to objectively provide information about the relationship between PCOS, insulin, and metabolism.
Diets Aren’t the Answer
We know that the majority of dieters regain the lost weight within a few years (aka, that diets are temporary), but this can be especially true for those with PCOS. Because of underlying insulin resistance and other metabolic changes seen in PCOS, (temporary, because all diets are) weight loss is not only less likely, but more damaging and can slow the metabolism more.
Here’s a few more reasons restriction isn’t the answer for PCOS:
Diets are temporary. Research on diets is typically short-term (<2 years), and given that both PCOS and living in a human body are ongoing processes, that timeframe doesn’t measure up to the fact that your body deserves care always.
Diets come with side effects like increased hunger and cravings, slowed metabolism, and preoccupation with food.
Those with PCOS are at increased risk for disordered eating.
Diets are associated with weight cycling (weight loss/regain) which promotes inflammation. As PCOS is already associated with inflammation, diets likely exacerbate this rather than address it. (source; CW - stigmatizing language)
There is no set amount over which you’re “overeating,” but inadequate eating can lead to anxiety around food and binge-like behavior (the restrict-binge cycle explains this beautifully)
Let’s Press Pause
I’d like to take a moment to acknowledge that whatever you’re feeling is valid and well-placed, whether it’s excitement that you can stop restricting as a “treatment” for your PCOS, anger at the system that led you to dieting, disbelief or indignation with me for presenting another option, or relieved you can find better support for your body.
It’s important to acknowledge that weight is not a behavior and we cannot willingly control our weight. We can, however, shift our view of healthcare to one that is behaviors-based, that supports both physical and mental health as well as a flexible relationship with food and self. One thing I encourage clients to do when working through this shift in mindset is to begin declining weights at the doctor’s office - unless you’ll be receiving anesthesia or certain medications, it’s not medically necessary or indicated to take a weight.
How to Decline Weights At the Doctor’s Office
These phrases can help you assert yourself in not getting a weight taken. Know that if you’re uncomfortable jumping straight to declining a weight right off the bat, you can step on the scale backwards and request that your weight not be discussed with you.
“I won’t need to get a weight today”
“I’m not going to get a weight today”
“I’d like to decline a weight today”
“Focusing on weight in the past has led to disordered eating patterns and has not provided overall health improvement. What other suggestions do you have?”
“Could I please see the expected efficacy and side effects of the weight loss you are recommending?
“What would you say to someone in a smaller body?”
If not weight, then what?
When helping guide my clients in shifting focus away from weight, one common question I get is, “So what are we going to focus on, then?” Here’s a quick list of other indicators of progress in PCOS treatment we can hold:
Ovulation & period regularity
Symptoms of hyperandrogenism
Relationship with food
Decrease in disordered behaviors around food/exercise
Flexible relationship with self care
Emotions & mental health management
I think it’s important to note that when I reference stress levels, I’m not just speaking about mental or emotional stress - I’m also talking about physical, environmental, and sleep stressors. The sum total of these stressors is called your allostatic load and reducing the overall stress on your body can be a huge aspect of supporting PCOS. Other things to keep in your PCOS care toolbox may include: regular eating intervals, evidence-based supplements, medications, stress reduction, movement, gentle nutrition, and quality & adequate sleep.
Looking for three simple, actionable ways to support your PCOS today?
Seek support - work with a non-diet dietitian, find a HAES-informed physician, and build a team you can trust with your care.
Establish a regular eating pattern - I generally recommend clients go no longer than 3-4 hours without eating. By eating regularly throughout the day, you can begin to reestablish trust with your body, regain hunger/fullness cues, and support a healthy blood sugar.
Shift focus away from weight - read through the blog archives for actionable ways you can begin to break down the diet mindset!