In the venn diagram of people attempting Intuitive Eating and those with PCOS chances are there’s quite a lot of crossover.
PCOS - or to give it its full title Polycystic Ovary Syndrome - affects approximately 5-10% of individuals of reproductive age, although this varies depending on source and I’ve seen some articles claim up to 20% - the truth is many go undiagnosed so the number may even be higher.
The NHS website currently lists the three main symptoms as irregular periods - often without ovulation, excess androgens (often causing excess facial / body hair) and polycystic ovaries (enlarged and containing fluid filled sacs). The cause is unknown but is thought to be genetic and environmental.
The three main hormones involved in PCOS:
Androgens - those with PCOS experience higher levels of androgens (you may hear them called ‘male hormones’)
Progesterone - insufficient progesterone production means the uterus lining does not shed regularly.
Insulin - normally higher levels are experienced as well as insulin resistance (your cells don’t respond to the insulin you make and can’t take glucose up from your blood for all the uses in your body).
It should be noted that these hormones interact with a whole range of others and have knock on effects, often when trying to get a diagnosis it’s recommended to get a blood test to see what is being affected.
Currently there is no cure for PCOS, just a range of treatments using medication and / or lifestyle changes. Similar to many medical conditions the NHS recommends losing weight and eating a ‘balanced diet’. But what if you don’t want to enter into the diet cycle or you’re worried about your relationship with food if you embark down this route. That’s natural - and a great thing, you’re seeing your health holistically and want to improve your condition without putting yourself at risk.
And chances are if you embark upon this diet / ‘eating balanced’ you are likely to end up weight cycling or yo-yo dieting - read the latest blog post on this here.
So I’m going to outline a little bit of how you can adapt the Intuitive Eating framework for PCOS - please note that I myself don’t experience PCOS and so will not give a first hand account of symptoms. You may also experience symptoms differently, and so I ask you to use this information within the context of your experience.
Why dieting doesn’t work for PCOS
PCOS symptoms can include chronic inflammation, something that weight cycling can exacerbate.
Another symptom of PCOS can be experiencing insulin resistance - and although short term weight loss can improve insulin sensitivity, weight cycling can increase insulin resistance in the long term.
Those with PCOS have over four times the risk of reporting eating disorder behaviours than controls (Lee et al 2017). And it has been well documented that dieting is one of the strongest predictors of an eating disorder.
PCOS has been shown to slow your metabolism - coupled with high insulin levels this means your body will naturally store more fat. Studies hypothesise that androgen levels might also be involved in this. Weight loss will therefore be harder from the offset, and the focus on the thin ideal in dieting will cause more guilt and shame than positive outcomes.
Hunger and low mood are linked - those with PCOS are more likely to experience high levels of stress and mood swings due to hormone levels and irregular periods, adding in restriction and any associated effects of such restriction will just exacerbate any negative mood.
PCOS isn’t caused by your weight - so losing weight isn’t a quick fix, and shouldn’t be treated as such.
The quickest run through of Intuitive Eating;
Intuitive Eating is a framework of 10 principles
Intuitive Eating is a framework devised by Evelyn Tribole and Elyse Resch based on their clinical experience in the nutrition field. It is composed of 10 principles which can be undertaken in any order - but it is often recommended to start with Rejecting Diet Culture and finishing with Gentle Nutrition.
Reject the diet mentality, honour your hunger, make peace with food, challenge the food police, discover the satisfaction factor, feel your fullness, cope with your emotions with kindness, respect your body, exercise - feel the difference and gentle nutrition.
Intuitive Eating focuses on listening to your internal cues when it comes to eating and movement, as well as acknowledging that a whole range of factors contribute to our relationship to food including diet culture, emotional state, types of hunger as well as family history and cultural influences.
Listen to the podcast episode on Intuitive Eating here.
How to eat intuitively with PCOS symptoms
Intuitive Eating can be done by this with PCOS (yay) you just have to be aware of your symptoms and take some things into account:
Authentic health - a part of gentle nutrition, that means taking anything external in relation to nutrition and movement and fitting it in with what works with your body. PCOS has been around for quite some time but is very new and upcoming in terms of research and treatment options. Therefore when taking in advice on foods to eat, movement styles that help and more keep in mind what feels good in your body currently and works with your lifestyle.
Be flexible - Intuitive Eating is about improving your relationship to food and movement long term, experimenting with diets (meaning intake not diet diet) and seeing if they fit with your life and make you feel nourished, full etc. or if they make you feel worse or any symptoms to worsen. It may be that you try something for a few weeks and feel it isn’t for you - as long as you’re listening to your internal cues and making decisions from a place of understanding of your body, not guilt or shame.
Cravings - especially when it comes to carbs those with PCOS can experience overwhelming cravings. This is due to the insulin resistance they may experience. Within the Intuitive Eating framework cravings are met with a curiosity of what does my body want and how can its needs be met. Therefore when cravings occur it is not a source of shame or guilt but checking what the body needs - if you experience insulin resistance it may be a good idea to have an idea of meals or snacks that allow the slow release of glucose - sometimes called low GI. This can include quinoa, most vegetables, legumes and pulses as well as nuts / nut butters, - but remember this is a start point not a rule or list of foods you ‘should’ eat.
Know that it may take you longer to reject diet culture and move on - whether it’s medical professionals constantly pushing diets on you to treat your condition or dieting affecting your hormones a little more long term it will take a while to move away from dieting as the norm. It’s all about being patient with yourself and reinforcing why dieting doesn’t work for you.
You may need higher protein - due to increased cravings and fatigue you might need protein to help you feel full and energised. Protein also plays a role in the synthesis of hormones involved in PCOS. Intuitive Eating is focused on tuning into your body rather than strict meal plans, so make a list of protein sources you like to eat. And go from there.
Fatigue - Know that insomnia is common with PCOS. and this will affect what you would like to eat, your moods etc. cope with this with kindness and be patient with yourself.
Respecting your body may take time - symptoms of PCOS can include thinning of the hair / hair loss or excess body hair. We live in a culture that idealises a certain look and so it can affect our body image to experience such things.
Movement - Dependent upon your PCOS symptoms different forms of movement might feel better / worse for you. Make an effort to find the movement styles that work with you
Feeling your fullness will take time - PCOS has been documented to make it harder to feel fullness, and hormone levels can also affect this.
As I said, PCOS is still emerging in the research field even though people have been struggling with it for years. No doubt amendments will be added to the above as we know more. But the main thing is using your lived experience in conjunction with what you’re told by professionals. Authentic health is what we’re aiming for here.
Any questions please do get in touch.