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?
- Reject the Diet Mentality
- Honor Your Hunger
- Make Peace with Food
- Challenge the Food Police
- Feel Your Fullness
- Discover the Satisfaction Factor
- Cope with Your Feelings Without Using Food
- Respect Your Body
- Exercise: Feel the Difference
- 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.
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.
Vitamin D deficiency is relatively common in this country, and some studies suggest that over 60% of people with PCOS could be Vitamin D deficient. Vitamin D is best known for helping your body absorb calcium from food, which is important for keeping bones strong. Vitamin D could also benefit your immune system, keep muscles working well, and may possibly help prevent certain types of cancer, heart disease, and diabetes.
We make vitamin D when our skin is exposed to sunlight during certain times of the year and hours of the day. The problem is that we don’t have much exposure if we live in a northern climate in the winter, if we spend a lot of time indoors, if we have darker skin, and if we use sunscreen. And of course too much exposure to UV light can cause skin cancer. So some of the reasons are vitamin D levels are low could be because we don’t have as much sun exposure as previous generations did.
Vitamin D in Food
Food sources of vitamin D include egg yolks, fatty fish, and fortified milk/dairy, and fortified cereal. The RDA for most people is between 400-800 IU per day, which is hard for most people to get from foods.
Symptoms of Vitamin D Deficiency
Symptoms of deficiency include fatigue, hair loss, bone or muscle pain, depression, and/or frequently getting sick.
What role does vitamin D have in PCOS?
- Supplementing with vitamin D may improve insulin resistance. This is important since insulin resistance and high levels of insulin make PCOS symptoms worse.
- Supplementing with vitamin D may decrease inflammation. Inflammation can increase insulin resistance and increase your risk for heart disease.
- Several studies suggest that supplementing with vitamin D can help improve fertility for women with PCOS.
- Supplementing with vitamin D may help mood, which is important since people with PCOS have a greater risk of depression than the general population.
*** Since people with PCOS are at greater risk for vitamin D deficiency, symptoms for deficiency can be vague, we don’t have a lot of good sources of vitamin D, and there are a lot of potential benefits to getting your vitamin D levels up if you PCOS, you may want to consider supplementing.
If you suspect you have vitamin D deficiency, ask you doctor to test your levels since you may need a prescription strength supplement.
Most people can safely supplement with 1000-2000 IUs per day, though you can talk with your doctor about supplementing in even higher doses if they suspect deficiency. Some multivitamins have 1000 IUs of vitamin D you may want to consider taking (though the pill is big!). Here is the multivitamin I take.
Let me know if you have any other questions about vitamin D and click PCOS nutrition to contact me to talk about nutrition counseling for PCOS.
Because everyone’s situation with PCOS is different, there is not one perfect way of eating that is right for everyone. However, your PCOS symptoms can and will improve with changes to your lifestyle, including how you eat.
As I’ve mentioned before, the majority of people with PCOS have insulin resistance. It is this insulin resistance that causes ovaries to make more androgens and can lead to weight gain. Doing what you can to reduce insulin resistance can help improve your PCOS symptoms, which is why I’m saying that eating a diet to lower insulin resistance is the best diet for PCOS. Here are some strategies:
- Eat carbohydrates with protein. It’s even better to add fiber and healthy fat! Simple carbs on their own raise blood sugar really quickly. Protein, fiber, and healthy fat don’t raise blood sugar as much and will slow down how quickly the sugar from the carbs hits your bloodstream. When blood sugar spikes, your body makes more insulin which can lead to weight gain and cause your ovaries to make more androgens. Check out this blog post for a review of carbs, protein, and fat: Nutrition Basics: Macronutrients.
- Add more non-starchy veggies to each meal. Non-starchy veggies are low in calories and carbohydrates so your blood sugar will not be affected much by them. They are also high in fiber, vitamins, and minerals. Some tips – buy convenience vegetables. Frozen veggies are just as good as fresh and just need to be microwaved, which is the best way to preserve vitamins since it’s a fast cooking method. Also consider buying pre-washed and chopped veggies or salads that you can throw on your plate, in a salad, on a sandwich, or in a wrap.
- This may sound redundant, but add foods that are high in fiber to your meals and snacks. This includes veggies, but also fruit, beans, and whole grains. High fiber foods digest slower and are more filling, which is helpful if you find that you are hungry a lot.
- Choose unsaturated fats instead of saturated fats most of the time. Eating foods high in saturated fat can cause an increase in insulin resistance, even shortly after eating a fatty meal. Unsaturated fats can actually help improve insulin resistance.
- Limit sugary drinks. This includes juice, drinks with honey, and sugary coffee drinks. Liquid sugar makes our blood sugar spike the fastest since our body does not have to break down the food to be absorbed. The sugar hits your blood quickly. My suggestion is to save your sugar for desserts instead of drinks.
- And the final tip of the day – work in those treat foods. That’s right. Don’t aim to eat a perfect diet all of the time because you are very likely going to feel deprived if you never eat sweets or chips again. You are much better off allowing yourself to eat these foods when you really want them so that you won’t feel the need to eat a lot of them all at once when you “fall off” your diet plan.
Changing what you eat is not the only way to improve insulin resistance. Stay tuned for more ways to improve insulin resistance with other lifestyle changes.
Click on PCOS nutrition counseling to learn more about working with me for individual nutrition counseling!
While I’ve already mentioned carbs, protein, and fats in previous blog posts, I feel like it might be helpful to take a step back and explain what each of these nutrients is and why they are important.
Macronutrients are the major nutrients that our bodies need to properly function. Most foods contain a combination of carbohydrates, protein, and fat but tend to have one dominant macronutrient.
- Provide us with energy. Breaks down to blood sugar which is the fuel that all of our cells run on for energy.
- Sources of carbs include grains, foods made from flour, starchy vegetables (corn, peas, beans, sweet potatoes, and potatoes), cereal, oatmeal, fruits, juice, milk, and anything made from sugar (honey, brown sugar, corn syrup, or maple syrup).
- Non-starchy vegetables (greens, tomatoes, carrots, cucumbers, peppers, broccoli, green beans, cauliflower, cabbage, etc.) are made up of carbohydrates, but have a lot of water and fiber, and therefore are not a large source of carbohydrates or calories. (They are a great source of fiber, vitamins, and minerals!)
- Carbs are not “bad”. When people avoid them to lose weight, they are very likely to “binge” on them later since our body craves the energy that carbohydrates provide.
- Carbohydrates digest quickly, especially if they don’t have much fiber, protein, or fat. Having a lot of carbs at one time can make blood sugar and insulin spike.
- 45-65% of calories should come from carbohydrates.
- All of our body is made up of protein. Our body uses protein to build and repair itself, keep fluids and pH balanced, and can act as chemical messengers (hormones). Enzymes are a type of protein which helps with digestion, moving muscles, and clotting blood.
- Concentrated sources of protein include meat, fish, chicken, beans, tofu, tempeh, soy, milk, cheese, yogurt, and “veggie meat”.
- Protein digests slower than carbs and doesn’t make blood sugar rise as quickly.
- 10-35% of calories should come from protein.
- We use fat to help store energy, regulate body temperature, protect our organs, and send hormones throughout our body.
- Unsaturated fats are considered “heart healthy” and are more commonly found in plant sources and fish. These fats are liquid at room temperature and can be found in olive and canola oil, avocado, nuts, nut butter, and seeds. Omega 3 fatty acids are most commonly found in fish, flax, chia, and some algae.
- Saturated fats are solid at room temperature and are associated with increasing risk of heart disease. This type of fat should be limited and examples include high fat dairy (butter, whole milk, high fat cheese), processed meat, fat you see on meat, and coconut or palm oil.
- Trans fats are created when unsaturated fats are chemically processed (hydrogenated) and turned into a solid fat. These fats cause the most damage to our hearts and have been taken out of a lot of foods in recent years. Sources can still be found in shortening, non-dairy coffee creamers, shelf stable cookies, pies, and pastries, fried foods, and some margarines and oils. Look for the words “partially hydrogenated” on ingredient lists and avoid these foods as much as possible.
- 20-35% of calories should come from fat, with the majority coming from unsaturated fat.
Are you interested in learning more about nutrition and how it affects PCOS? Click PCOS Nutrition to contact me about nutrition counseling!