By Megan Perez, dietitian at Nourishing Minds Nutrition

When I was diagnosed with PCOS, I thought it was just another problem to add to my list. I was diagnosed while looking for answers to my missing period and fertility issues. I had already suffered for many years from anxiety, which re-surfaced while trying month after month to get pregnant. On top of that, I also had past experiences with disordered eating, poor body image, and digestive distress for a large period of my life. Now, PCOS. Here we go again, I thought…

As a dietitian working with disordered eaters on improving gut and hormonal issues (funny how our past experiences really shape our future!), I was familiar with PCOS and had worked with a few women on Intuitive Eating and gentle nutrition to help manage their symptoms and improve their labs. I felt like I understood what actions to take next, but I decided to research this condition a bit further. I came home from my appointment and proceeded to fully immerse myself into everything PCOS.

I was blown away by what I learned. I actually felt incredibly understood and validated. All of these past experiences were (or could be) connected!

PCOS is incredibly complex and multifactorial. Women with PCOS can experience different symptoms and may need very different treatment plans. This condition is so interesting to me for many reasons. One of the most fascinating reasons, however, is the link between PCOS and eating disorders.

PCOS and Eating Disorders

If you have been diagnosed with PCOS, you may have heard the statistic that women with PCOS are 4 times more likely than women without PCOS to meet the criteria for an eating disorder (1). More specifically, almost 40% of these women experienced clinically significant binge eating (2). Does this sound familiar? Have you ever asked yourself why you can’t stick to a diet or why you “always give in” to binge eating?  

Binge Eating

One reason for the strong link between PCOS and binge eating is because women with PCOS have higher rates of anxiety, depression, and body dissatisfaction compared to women without PCOS (3). These psychological factors increase the likelihood of attempting diets and using disordered eating behaviors as coping skills. Dieting often results in either physical and/or mental restriction, which leads to the body wanting to compensate by increasing hunger hormones and preoccupation with food. This is how the Restrict-Binge cycle begins.

Another reason for this link is hormonal. Women with PCOS tend to have higher circulating insulin levels (about 75-95% of all PCOS cases). Insulin is a helpful hormone and aids our body in blood sugar regulation, however it is also a growth hormone. In high amounts, insulin makes losing weight incredibly difficult, if not impossible without extreme and unsustainable changes. Elevated androgens such as testosterone are also known to stimulate appetite. Many women with PCOS describe intense carbohydrate cravings and feelings of guilt or shame when eating these foods. This often leads to the desire to restrict due to fear of being out of control around carbohydrates, and the belief that carbohydrates are the problem. The inability to stick to a diet is not weakness; it’s biology!

The third reason that I believe to be incredibly important is cultural. Diet culture is everywhere, even in the medical field. Because weight gain and insulin resistance are common in PCOS, the primary advice given to those with the diagnosis are to diet or lose weight. Besides the fact that dieting does not lead to long term weight loss for the majority of people (and actually leads to weight cycling), women with PCOS have an even harder time losing weight because of the hormonal reasons addressed above. Women with PCOS are also incredibly susceptible to fad diets and quick weight loss promises in hopes of it improving their symptoms that are usually causing embarrassment and shame. Medical providers who are recommending diets and weight loss are adding fuel to the fire. Calorie restriction not only can lead to binge eating and disordered eating behaviors, but it also can worsen PCOS symptoms and further slow metabolism.

It’s worth noting that weight stigma can worsen PCOS symptoms. When people feel ashamed of their body size or their inability to lose weight, they are more likely to avoid appointments with their health care providers, which could result in worsening labs or undiagnosed co-morbidities. Shame is NOT a motivator and is one of the worst ways to promote change.

Is there a solution?

Yes! Intuitive Eating and gentle nutrition for PCOS can help!

If you haven’t already read my blog post on Gentle Nutrition for PCOS, I highly recommend it! I absolutely believe that intuitive eating is perfect for those with PCOS. Intuitive eating can help you get off the diet roller coaster, learn coping techniques for your emotions, reconnect to your body’s hunger and fullness cues, and also eat in a way that improves hyperinsulinemia and combats inflammation. It’s a win-win.

If you are a medical provider who is interested in treating those with PCOS, I can not stress enough the importance of weight neutral treatment and a Health At Every Size approach. Weight loss attempts increase the likelihood of women with PCOS developing eating disorders. Instead of focusing on weight as an indicator of health, focusing on sustainable lifestyle changes would be more helpful. Non-weight factors to discuss include eating enough overall, stress management, sleep, water intake, and joyful movement. Another recommendation is to routinely screen women with PCOS for eating disorders, as well as mood disorders. This process could help to identify the need for interventions such as medication, therapy, and treatment centers.

RESOURCES:

Lee, Iris et al. “Increased Odds Of Disordered Eating In Polycystic Ovary Syndrome: A Systematic Review And Meta-Analysis”. Eating And Weight Disorders – Studies On Anorexia, Bulimia And Obesity, vol 24, no. 5, 2018, pp. 787-797. Springer Science And Business Media LLC, doi:10.1007/s40519-018-0533-y.
Jeanes, Y. M., et al. “Binge Eating Behaviours and Food Cravings in Women with Polycystic Ovary Syndrome.” Appetite, vol. 109, 2017, pp. 24–32. Crossref, doi:10.1016/j.appet.2016.11.010.
Paganini, Chiara, et al. “The Overlap Between Binge Eating Behaviors and Polycystic Ovarian Syndrome: An Etiological Integrative Model.” Current Pharmaceutical Design, vol. 24, no. 9, 2018, pp. 999–1006. Crossref, doi:10.2174/1381612824666171204151209.