Hey all! I'm back for part 2 of my series on PCOS and Intuitive Eating. Today I'm going to share specific non-diet lifestyle interventions I work on with my clients diagnosed with PCOS. Here's part 1, where I talk about what PCOS is, the symptoms, and why "just lose weight" is the absolute worst advice.
If you have PCOS, there are two main goals of lifestyle therapy - decreasing underlying inflammation, and keeping blood sugar levels steady.
If you remember from the last post, no one knows the exact cause of PCOS, but chronic inflammation seems to fuel the hormonal shifts that cause symptoms. Some amount of inflammation in the body is normal, and healthy, but chronic inflammation is a problem. When I talk about chronic inflammation, most people's mind goes straight to nutrition and anti-inflammatory diets and avoiding sugar/processed food/whatever else has been labeled inflammatory. If you look at the big picture of eating habits, eating lots of plants and whole foods and not eating excessive amounts of added sugar is important, but other factors contribute to chronic inflammation as much as diet, and likely more - sleep, stress, medications, digestive health, genetics, etc. This post isn't just about food, because that's only a piece of the puzzle.
Here's some of the things I focus on with clients diagnosed with PCOS.
First things first - we need to make sure you're getting adequate fuel. PCOS can slow metabolism, so many women with PCOS have experience unexplained weight gain. In an attempt to lose weight, they cut calories, and when the scale doesn't budge, they keep cutting. By the time they come to see me, they're eating very little food. This severe calorie restriction is harmful to the underlying pathology of PCOS. For one, the body needs fats and protein (the building blocks of hormones) if it has any hope of improving hormonal function. Dieting and restricting calories is also stressful, both physically and psychologically, further fueling chronic inflammation. Weight loss and low carb diets are commonly recommended for women with PCOS, and while you may notice a difference in how you feel short term, long term calorie and carbohydrate restriction will cause damage and lead to weight cycling.
Insulin resistance is a major challenge in PCOS. Cells are less responsive to insulin, the hormone that ushers glucose from the bloodstream and into the cells to be used for energy. This means the cells can get "hungry" for the energy that's floating around in the bloodstream, but not getting inside the cells where it can be used. Add a low carb diet on top of that and your cells will be screaming for glucose. If you have PCOS and have gone on a low carb diet, then I'm sure you know just how intense those sugar cravings can be. The answer isn't low carb, it's consistent carbs - getting moderate amounts throughout the day. I encourage clients with PCOS to eat three meals a day, plus snacks if they're going longer than 5 hours between meals, and getting a source of carbohydrate every time you eat.
Choose more high fiber carbs.
Carbohydrate sources that are also rich in fiber (i.e. whole grains, beans, fruits, and starchy vegetables) break down into sugar a little more slowly, giving it a sorta extended-release effect as glucose enters the bloodstream. This is helpful for insulin resistance, because the body is getting smaller amounts of glucose to process over a longer period of time, reducing the risk of both high blood sugar and low blood sugar.
That said, you can still eat refined carbohydrate. Y'all hear me? White bread is not the devil. White pasta will not kill you. Sugar is still on the menu. Aim to eat more high fiber carbs, but don't treat it as a rigid rule. If you feel like you're overeating sugar, work with a dietitian trained in intuitive eating, because cutting out or purposefully trying to limit sugar will likely lead to just eating more.
While you're at it, pair those carbs with fat and protein. Not only will it help keep you satisfied, but the fat and protein will help stabilize blood sugar levels as well.
Catch some zzz's
Nothing to do with food, but just as important than what's on your plate (I'd argue more), is how much sleep you're getting. Inadequate sleep, even just an hour or two less than what you need, activates the stress response, releasing a cascade of inflammatory compounds. Sleep loss has also been shown to affect glucose metabolism. Just a night of getting 25% less sleep than you need can make a difference (ever wonder why you're starving after a restless night?) The occasional late night isn't the end of the world, but if you're chronically sleep deprived, this can make a big difference in managing your PCOS.
If you have PCOS, practice good sleep hygiene. Avoid caffeine after about 2 pm. Get in bed about the same time, even if you're not going to sleep. If you can, turn off the TV and iPhone an hour before bed, as the blue light can be stimulating (or try a blue light filter). Try to get some movement in during the day, preferably outside in the sunshine, which helps with your circadian rhythm. Keep the temperature cool in your bedroom. Make sure your bed is cozy. Kick out your snoring dog (sorry Fido). Manage stress, which can affect your quality of sleep. Speaking of which...
Chronic stress has a profound affect on the body's ability to regulate inflammation. Job stress...family stress...financial stress...trying to not lose your mind in 2017 stress...our bodies are designed to deal with short term stressors, not living in stressful conditions for extended periods of time. Then there's the added stress of dealing with the symptoms of PCOS. Things like fatigue, acne, infertility and facial hair can be a chronic stressors of their own. Not to mention anxiety and depression can be a symptom of PCOS. This is just another reason I encourage intuitive eating for PCOS - why add the stress of dieting onto all that?
If you have PCOS, it's important to have an outlet for your stress, whether it's a friend, family member, meditation, exercise, therapist....or all of the above.
Speaking of inflammation, women with PCOS probably need larger amounts of omega-3 fats, a type of fat mostly found in fatty fish that's especially beneficial for reducing inflammation. I recommend food first, but if you have PCOS, you may also need supplementation, so talk to your doctor or dietitian. Since the health benefits are stronger when it comes from food vs a pill, I would still aim to eat fish regularly, especially fatty fish like salmon, tuna, mackerel, herring, trout and sardines. Other smaller sources of omega-3s, like grassfed dairy, pastured eggs, walnuts, chia/hemp/flax seeds, leafy greens, and winter squash, can add up.
Talk about supplements and/or medication with your dietitian and/or doctor.
Generally speaking, I think supplements get overprescribed and I like to look to food first. That said, there are some supplements that can be helpful with PCOS. The PCOS Nutrition Center has a really good section on supplements if you want to learn more. Just be sure to talk to your dietitian/doctor before starting, because a.) you shouldn't have to take a cocktail of pills every day and b.) supplements can interact with other medications or each other.
Metformin, a medication that helps increase insulin sensitivity, is commonly prescribed for PCOS. It's been used for decades, and is considered very safe and effective. There's a lot of stigma around taking medication, but sometimes lifestyle alone can't fix things. Once you've learned the pros/cons, it's 100% a personal decision, but just know you are not better or worse for going one route over another. Medication is for when you are sick, and PCOS counts.
I hope this post gives you some usable strategies for dealing with PCOS. These are basically the big things I work on my clients with, but there's a lot more we can do with nutrition and lifestyle to target symptoms you might be struggling with. If you need help, please don't hesitate to reach out for help. I work with clients locally in my Columbia, SC office, and virtually throughout the US. Here's a link to my coaching philosophy and nutrition services page for more information.
Also, if you are a dietitian interested in learning more about PCOS and intuitive eating, register for the RD Roundtable webinar I'm doing with Heather Caplan of RD Real Talk Podcast on women's health. Me and three other dietitians who specialize in women's health will discuss nutrition at different stages of life, PCOS, amenorrhea, and fertility. Here's a link with more information and if you'd like to join, here's my affiliate link. With full registration, you also get a 20 minute coaching call with one of us panelists!