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Artificial Sweeteners and PCOS

Sugar or artificial sweeteners for PCOS?
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A lot of people ask which is worse PCOS – sugar or artificial sweeteners? Like a lot of topics in nutrition, it can complicated. Since insulin resistance is thought to be the root cause of PCOS, using artificial sweeteners sounds like a good idea for managing PCOS. These sweeteners don’t have any (or many) calories. This should keep insulin levels lower. But do artificial sweeteners improve our health? Let’s first take a look at sugar. 

What we know about sugar

  1. Sugar or sweeteners with calories such as honey, high fructose corn syrup, agave, maple syrup, brown sugar, or cane sugar will cause blood sugar to go up quickly. This causes the pancreas to produce insulin so that the sugar can get into the cells. Excess insulin drives a lot of PCOS symptoms. Having sugar as part of a meals with protein and fiber can help prevent blood sugar and insulin from spiking. Check out this blog on Nutrition Basics: Macronutrients for more information.
  1. We know that a lot of people consume a lot of sugar, especially in drinks such as soda, juices, iced tea, lemonade, and prepared coffees. There’s also a lot of added sugar in cereal, yogurt, and bars.
  1. Sugar is found in so many products because it makes food taste good and we humans like it. It is a cheap food additive, especially as high fructose corn syrup. Sometimes people may be taking in more sugar than they realize.
  1. Eating too much sugar can contribute to higher weight, higher cholesterol, fatty liver, and cardiovascular disease. Most people know that having too much sugar is not good for our health. This is why people are interested in trying an alternative like artificial sweeteners.

What are artificial sweeteners? 

The artificial or non-nutritive sweeteners which are “generally regarded as safe” (GRAS) according to the FDA include saccharin, aspartame, acesulfame potassium (Ace-K), sucralose, neotame, and advatame. Steviol glycosides (Stevia) and Luo hun guo fruit extract (monk fruit) are approved as food “additives”, but not as “sweeteners”. The products are sweeter than sugar without calories. Some people like that Stevia is marketed as a more “natural” product. It is still processed and more research needs to be done on it to see if it is a better choice than the other products. Here is a link for more information about the history and safety of these non-nutritive sweeteners from the FDA.

What we don’t know about non-nutritive (artificial) sweeteners

While the artificial sweeteners are regarded as safe for people to consume, there are still a lot of questions about how these products affect us long term.

  1. How do they affect the gut microbiota? Gut microbiome research is very new and is thought to have a large effect on our health including how we metabolize foods. Some research indicates that some artificial sweeteners can negatively impact the gut microbiome. This may affect weight and insulin resistance. If we have a more “unhealthy” make up of bacteria in our intestines, we may gain more weight or have blood sugar go up quicker than if we had more “good” bacteria in our gut.
  1. Do they increase our cravings for sweets? When are used to everything we eat or drink tasting sweet, it may cause us to want more sweets. There is also a theory that since artificial sweeteners are sweeter than sugar but have no calories, we are more likely to seek out extra calories to compensate later in the day. 
  1. Do artificial sweeteners affect blood sugar, insulin or metabolism? Research is not conclusive about how artificial sweeteners impact weight or insulin resistance, but it’s possible that these products are contributing to some of the very conditions that people are trying to avoid by using them. This could be due to how these sweeteners are affecting insulin receptors or hormones that affect fullness.
  1. If something is labeled “sugar free”, will you eat more of it? In my experience, people tend to eat a larger quantity of foods (or drinks) if they are labeled “sugar free”. It could be that foods sweetened with artificial sweeteners aren’t as satisfying as the “real” version so people need more of the sweet food to satisfy a craving. Or it could be that psychologically people feel like can overeat these products and they won’t impact their health. The problem is that these cookies, cakes, ice creams, and candies made with artificial sweeteners (usually) still do have carbohydrates in them and will raise blood sugar and insulin, especially if eaten in large quantities. 

So which is better, sugar or artificial sweeteners? Overall, I think it’s best to have small amounts of “real” sweeteners, preferably as part of a meal.

My Recommendations

  1. Try to get used to less sweet drinks. If you are used to sweet beverages (artificial or regular sugar), start by diluting them with water or seltzer. Or try water with lemon, berries, cucumbers. There are a lot of flavor seltzers out now you may like.
  1. If you want to sweeten coffee, plain yogurt, or oatmeal, try using a little of the “real” sugar (could be honey, maple syrup, or brown sugar too). 1 teaspoon of sugar is only 5 grams of carbohydrates which is not enough to impact blood sugar.  
  1. If you want something sweet, go for what you really want. Enjoy it. If you allow yourself to eat what you really want without guilt, you will probably find you need less of it. Avoiding sugar completely is not necessary and trying to completely avoid it may cause you to binge on it. 

Bottom line: I don’t recommend that people with PCOS frequently use artificial sweeteners. More research needs to be done on artificial sweeteners and their effects on metabolism. I suggest reserving the sweet tastes for foods you really enjoy and try to cut back on some of the incidental sweets (sugar or artificial) you may be taking in. Check out this review article from December of 2018 in the Journal of Endocrinology and Metabolism for a review of recent research on how non-nutritive sweeteners affect metabolism.

Are you interested in learning more about nutrition and how it affects PCOS? Click PCOS Nutrition to contact me about nutrition counseling!

10 Tips for Managing PCOS Hunger

We all are born with natural hunger/fullness feelings
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One of the symptoms of having insulin resistance and excess insulin production for people with PCOS is often intense hunger! This can be because insulin is a storage hormone and having more insulin in your blood triggers your body to crave more food to store. Also, a huge side effect of restricting your calories and/or your carbohydrate intake is strong, biological hunger. Since so many people with PCOS have tried a lot of diets, this kind of hunger is really common.

Here are 10 tips to help manage both the hunger that comes from dieting and restricting food AND the hunger that happens as a result of excess insulin production in PCOS. If you have questions about carbohydrates, protein, and fat, check out this link to my blog on Nutrition Basics: Macronutrients.

1. Plan to Eat 3 Times per Day 

If you fuel your body at regular intervals around the same time each day, you can get into a pattern of eating when you are just starting to get hungry and stop before you are uncomfortably full. You body can learn to expect meals and snacks at certain times and you may find you get hungry around those times. Most importantly, eating frequently (without skipping meals) prevents you from becoming too hungry at later meals. Getting too hungry can lead to overeating or binge eating. See my blog Start with Eating Three Time a Day.

2. Have Protein with Carbohydrates

Carbohydrates are broken down to glucose which all of our cells use for energy and are digested relatively quickly. Protein helps our body with growth and repair and digests more slowly than carbohydrates. People feel most satisfied with meals and snacks when they combine carbohydrates with protein because you get the quick energy from the carbohydrates and feeling of fullness that protein provides.

3. Plan for Snacks

Most people feel best when they eat something every 3-5 hours they are awake. Having snacks can be a way to make sure that you don’t get too hungry before a meal. When you get too hungry, it can lead to overeating or binging. Snacks are most effective when you plan for them, so try packing them for when you are out of the house and keep healthy snack options available for when you are at home.  

4. Increase your Fiber Intake

Fiber is found in plants and provides bulk to foods. This bulk can take up a lot of space in our stomach and provide feelings of fullness. Our bodies break down fiber but we do not absorb it. This can help keep your bowel movements regular, bind to fat and cholesterol which can reduce blood cholesterol levels, and promote the health of “good” gut bacteria. Good sources include fruits, vegetables, beans, seeds, and whole grains. 

5. Decrease Refined Carbohydrates

Refined carbohydrates are foods or drinks made primarily from white flour or sugar without much fiber, healthy fat, or protein. These foods digest very quickly which can cause blood sugar to spike and then drop quickly. This “drop” can lead to rebound hunger soon after you eat since the increase in blood sugar causes your body to produce a lot of insulin. When you eat or drink something that is high in refined carbohydrates, you can try having a small portion, have it as part of a meal with protein, and/or go for a walk after eating to help bring blood sugar down. 

6. Add Heart Healthy Fats to Meals and Snacks

Adding unsaturated fats such as avocado, olive oil, nuts, nut butter, seeds, or fish to meals and snacks can contribute to feelings of fullness and satisfaction. Unsaturated fats will not spike blood sugar or insulin the same way that carbohydrates alone can. Swapping these unsaturated fats for saturated or trans fats (like butter, fried foods, processed meats, or cheese) can help improve your cholesterol numbers too. 

7. Drink Plenty of Low Sugar Fluids

When we are not properly hydrated, our body can sometimes mistake hunger for thirst. Aim to drink around 64 ounces of water, tea, coffee, milk/non-dairy milk, or sparkling water each day. If you drink non-dairy milk, choose ones with the least amount of sugar (unsweetened is best). You don’t need to drink more than 24 ounces of any milk per day. Limiting caffeine to the morning can help make sure you get enough sleep. The best way to tell if you are hydrated is if your urine is a pale yellow color. 

8. Eat Slowly and Mindfully

Our brains take around 20 minutes to register fullness after we eat. Sometimes if we eat too quickly, we end up eating past the point of being comfortably full. This can sometimes happen if we let ourselves get too hungry. We also tend to eat more food if we are distracted by phones, computers, or TV. Eating slowly and without distractions is the best way to pay attention to our natural hunger and fullness cues and to tell if you have eaten the right amount of food you need at that time.   

9. Get Enough Sleep

Getting at least 7 hours of sleep at night can help reduce feelings of hunger and cravings the next day. Our bodies will often crave more food when we are tired as a way to “wake up” or  get that burst of energy that (especially refined carbs) foods can provide. 

10. Work on Stress Management and Emotional Eating

While all people eat for emotional reasons at times, if you find that you are leaning on food to manage stress or difficult feelings often, you may want to work on other strategies for managing stress. Look for other activities you can do that can provide the same feelings of calm and wellbeing that eating does. This can be talking to a friend or family member, reading, watching TV, going for a walk, taking a bath, or writing in a journal. If you need help with managing emotions and stress, consider meeting with a therapist for more support.

If you would like more help dealing with PCOS hunger or other PCOS related symptoms, click here to contact me about nutrition counseling.

Clean Eating and PCOS

"Clean Eating" foods and PCOS
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The terms “clean eating” or “eating clean” have gotten very popular in recent years, even though these words might mean different things to different people. You may be interested in clean eating if you have PCOS and are looking to improve your symptoms with nutrition. But what does clean eating mean?

While there is no clear definition, it usually means avoiding or limiting processed foods, eating mostly organic foods, and avoiding GMOs. Let’s take a closer look at these topics.

Processed food

Most foods you eat are processed to some degree. Any kind of washing, chopping, freezing, fortifying, preserving or drying is a type of processing. Foods that are considered minimally processed are: fruits, vegetables, eggs, nuts, beans, milk, and meat.

Foods may be further processed by milling, grinding, extracting, combining ingredients, heating, canning, pickling, and fermenting. A lot of these foods can be very healthy choices for everyone, including those with PCOS. Some options include: whole grains such as brown rice, oatmeal, or quinoa, whole grain flours, whole grain products such as bread or pasta, oils, yogurt, canned tomatoes or beans, soy milk, edamame, peanut or other nut butters, tofu, or tempeh. 

Highly processed foods often have a lot of added sugar, salt, and fat and these tend to be the ones that give processed food a bad name. Here are a few: sweetened drinks like soda, iced tea, juices, or energy drinks, chips, shelf stable cookies or cakes, sausages, hot dogs, candy, ramen noodles, and some frozen prepared meals. 

Bottom line: Processing foods doesn’t automatically make them unhealthy. However, eating foods with a lot of sugar, salt, and saturated or trans fat (whether you add them or someone else does) can negatively affect your health and make your PCOS symptoms worse if you eat them often. 

Organic food

In order for foods to be labeled as organic, they must meet the standards that the USDA have set in place. This standard can be expensive and difficult for farmers to achieve, but ultimately the foods are produced without banned chemicals including synthetic fertilizers, pesticides, hormones, or antibiotics.

While there are definite environmental benefits to organic farm practices, there is limited evidence that organic foods make people healthier. The nutritional benefit of organic foods depends on the food itself. Eating foods with skins or peels that are exposed to pesticides can increase the levels of these chemicals in our bodies, but more evidence is needed to see how this affects us. Organic dairy and meats may have higher levels of omega 3s and some organic produce may have higher antioxidant levels than conventional produce. 

Bottom line: Eating foods made with organic practices can be beneficial for the environment and may help you to avoid some exposure to excess chemicals. However, don’t avoid eating foods like fruits and vegetables if you feel like you can’t afford the organic version. There is plenty of evidence that eating a lot of fruits and vegetables is one of the best things you can do to reduce your risk for heart disease, diabetes, and cancer. Click here to learn more about the organic label from the USDA site. 

GMOs

Genetically modified organisms (GMOs) are foods where the genes have been manipulated with bioengineering so that they have some traits that are considered beneficial. Usually it is done so that foods can hold up better when shipped, have a higher yield, and increased resistance to disease. There are environmental concerns about how these new plants affect other organisms and the amount and type of fertilizer these plants need.

We don’t have evidence that suggests that nutrition quality is worse with GMOs compared to non-GMO foods or that people who eat GMOs have worse health than those who don’t. The technology is still pretty new so this could change in time. 

Bottom line: Just like organic foods, you may want to limit your exposure to GMOs for environmental reasons, but there isn’t any reason to avoid GMOs for health reasons at this time. Click here to learn more about GMOs from the Genetic Literacy Project site. 

Final thoughts about the word “clean”

The labeling of foods as “good”, “bad”, or “clean” can have some consequences for you. If you eat something “good” or “clean”, then you may feel like you are being good or are a good person. And on the other side if eat something “bad” or processed, you may feel  like you are a bad person and your self esteem and health may suffer. 

Your thoughts are powerful and will drive your behavior. Having a healthy relationship with food includes making room for all foods without judgement. Ultimately I don’t like the term “clean eating” because in addition to being vague, it may cause you to judge how you eat which is more likely to make you feel badly about yourself than improve your health. 

If you want to make changes to your diet to improve your PCOS symptoms, cooking more at home and adding in more fruits, vegetables, healthy fats, and whole grains can make a big difference. But let’s not call it “clean”. Check out my post on the best diet for PCOS in this link.

Interested in learning about nutrition counseling for PCOS? Contact me for a discovery call!

Diets, Weight Loss, and PCOS

finding peace and freedom from dieting
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Most people I talk to who have PCOS are interested in losing weight. That is why they are looking to talk to a dietitian. They may have been told by a doctor to lose weight. They probably have tried many different diets to lose weight. 

I understand the desire to lose weight. We live in a culture where dieting and being a certain size or weight is seen as the answer to all of our mental and physical problems. People with PCOS are particularly vulnerable to these messages since weight is blamed as a root cause for PCOS and losing weight is seen as a solution. Many women in larger bodies who have trouble with fertility, even beyond PCOS, are told to lose weight. 

What’s the problem with dieting to lose weight? It doesn’t work 80-95% of the time. The biggest predictor of weight gain over time is dieting. You may say that a certain diet “worked” for you, but if you ended up gaining the weight back and more, how did this diet work for you? 

We also know that weight cycling or “yo-yo dieting” puts you at greater risk for heart disease and diabetes than if you had never lost the initial weight. Stress from body dissatisfaction, food restriction, overexercise, and weight stigma can also increase your risk for these metabolic conditions.

So if dieting is not the answer to improving PCOS symptoms, what is the answer?

The answer is learning how to be an intuitive eater. The 10 principles of Intuitive Eating, by Evelyn Tribole and Elyse Resch, have been around since 1995 and can help improve your health by learning how to listen to your body’s messages about what to eat and how much to eat. It is the answer to ending the diet cycle and making peace with food. Over 60 research studies have shown that Intuitive Eating helps people have lower rates of disordered eating including binge eating, increased well-being, improved blood sugar and cholesterol, reduced stress, and higher self esteem. Click here for a link to Evelyn Tribole and Elyse Resch’s website devoted to Intuitive eating.

With PCOS, you can learn how to eat intuitively, give yourself permission to eat all foods, and still work in some food strategies (gentle nutrition) to improve the metabolic and physical symptoms of PCOS. 

Learning to become an intuitive eater can take some time, especially if you have been dieting for a long time. Getting support can be crucial as you take this journey since you will still be bombarded by diet culture in your everyday life. However, the rewards to making peace with food are immense. You will learn to truly enjoy food, notice how your body adjusts your intake based on what it needs, and feel like you don’t have to spend so much time being worried about what to eat. And this huge reduction in stress alone can help your symptoms of PCOS. 

What are the Intuitive Eating Principles?

  1. Reject the Diet Mentality
  2. Honor Your Hunger
  3. Make Peace with Food
  4. Challenge the Food Police
  5. Feel Your Fullness
  6. Discover the Satisfaction Factor
  7. Cope with Your Feelings Without Using Food
  8. Respect Your Body
  9. Exercise: Feel the Difference
  10. Honor Your Health: Gentle Nutrition

Will I lose weight if I eat intuitively? 

When you start to eat intuitively, you will either lose weight, have no weight change, or you may even gain weight. You have to fully nourish your body on a consistent basis before seeing if and how weight is impacted. Your body has a set point that it likes to be at and it is hard to know what your natural weight is before you let your body adjust with intuitive eating. The goal for learning to eat intuitively is not weight loss. The goal is to learn to trust your body to make food decisions without judgement. When you let your body be your guide, you will likely enjoy a large variety of foods and eat enough to satisfy your hunger without letting yourself get too uncomfortably hungry or full. 

That sounds great, but what if I still want to lose weight?

It’s okay that you still want to lose weight. Most people can not undo a lifetime of negative thoughts about weight with the “flip of a switch”. 

You can still start working on becoming an intuitive eater, even if you haven’t fully embraced it. This is a process, and for many people it’s a long process. Starting to work through the principles will likely benefit you. It’s not another diet where you have follow a set a rules. You can and probably should take baby steps.  

As you know, PCOS can impact your whole body including mental health. It affects you throughout your entire life, not just when you are trying to get pregnant. It’s best to think about improving your physical and mental health for the long term. Quick fixes (diets for weight loss) will not serve you in the long run if they are leaving you hungry, tired, bored, and stressed. 

If you would like some help with learning how intuitive eating can improve your PCOS symptoms, contact me to set up a time to talk and see if nutrition counseling is right for you!

What is Nutrition Counseling?

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As you search online about what you can do to improve your diet and manage your PCOS symptoms, you are likely to encounter the term “nutrition counseling”. Since this is a term that dietitians use to describe our services, I thought I would explain a little more about what nutrition counseling and why you may want to consider it. 

A lot of people are understandably nervous to make an appointment with a dietitian. You may think that you will be judged or “yelled at” for what you are doing or not doing. This could be because you’ve had another health professional judge or scold you in the past. You may also think that a dietitian will tell you to give up all of your favorite foods, eat a really low calorie diet, cook all of your foods from scratch, and work out 5 times a week. You also may think that dietitians eat a “perfect diet” with no chips or sugar, that we work out all the time, and/or we’ve never had any health problems before. (This is not true.)

So what does happen in an appointment with a dietitian?

In the first visit we ask a lot of questions and really try to get to know you. We want to know what you eat, but also how you sleep, what your schedule is like, who cooks and shops at home, what is your medical history, what medicines and supplements do you take, and what “diets” have you been on before. We ask about emotions and food, any symptoms or intolerances you feel with food, cravings, how hungry and satisfied you are with food, and what health goals you have. We need to find out a lot about you before we can begin to work on goals to change things. A lot of people say that it feels like they are going to a therapist when they talk to a dietitian, since we really do dive into a lot of aspects of your life when we talk about food. 

Follow up appointments for PCOS

After gathering information about you, we can map out a plan for feeling better depending on where are at. I like to do some education about what PCOS is and why you have the symptoms that you do, depending on what your knowledge is.  We will talk about strategies that may include modifying what you eat, modifying how you eat, adding in more movement, taking supplements, stopping to take some supplements, improving your sleep, and reducing your stress. We may talk about adding in more food since you are not eating enough. Which strategies we do depends on what your goals are and where you are starting from. We typically will meet every week or every other week for around 5-6 sessions depending on how things are going. It works best to make a few small changes each visit instead of a lot of unsustainable changes from the beginning.

My goal for all clients

No matter what other goals you have for your health, my goal is for you to enjoy eating and eat the foods you love. You may not think this is something you need to work on, but if you are someone who has been on a lot of restrictive diets in the past you may not find much joy from food. Eating and thinking of what to eat may make you feel stressed or guilty. You can have a positive relationship with food again, and making peace with food will make your health improve. 

Dietitians are people

Finding the right fit with the right person for you will help you to get the best care. This also goes for therapists and maybe even doctors. Nutrition counseling works when both the client and dietitian are fully engaged and communicate well with each other. We all have different personalities so sometimes you need to find the right person who works best with your personality and is aligned with your health goals. 


So if you are a woman with PCOS who wants to decrease your symptoms, end diet cycling, improve fertility, increase your energy levels, and learn to trust your body with food, I may be the dietitian you are looking for. Click on nutrition counseling to contact me to set up a discovery call.