Polycystic ovarian syndrome is the most common endocrine dysfunction in women, affecting 1 in 10 women worldwide. Yet, you can say it’s often misunderstood. Once you have your PCOS diagnosis, your doctor will tell you to drop the weight to find relief from your symptoms, without offering you any guidance on how to go about it. And often, this unfortunate emphasis on PCOS weight loss can become the beginning of PCOS and eating disorders.
I remember when my second bout with PCOS. The doctor asked me to lose weight, yet again, and I found it was easier said than done. I started cutting back on calories and often found myself working out at the gym for 2 hours every day. I was obsessed with dropping the weight. Sadly, I still held on to the abdominal fat that had appeared mysteriously, and found myself more fatigued than ever. This started a vicious cycle of dieting and weight cycling — which left me feeling more frustrated than ever before. It wasn’t until I learned the secret of eating right for PCOS that my weight started to come down, and my energy levels were restored.
Truth is – it’s not easy to lose weight with PCOS. Thanks to insulin resistance (which often goes hand-in-hand with PCOS) the body starts to store weight, especially in the midsection. This is why traditional weight loss strategies – a.k.a. extensive exercise and dieting alone don’t work for PCOS weight loss. Studies report that both obese and non-obese PCOS women have beta-cell dysfunction as well as insulin resistance. This is why an effective weight loss plan for PCOS has to focus on treating the insulin resistance — using nutrition, exercise, and the right supplements. When lifestyle modification interventions are aimed at improving insulin sensitivity, rather than just losing weight, real improvements can be seen.
However, often times, your doctor will not tell you this. And that is why this obsession with PCOS weight loss can easily turn into an eating disorder.
Also, some women dealing with complicated and frustrating symptoms of PCOS – example hirsutism, thinning hair and persistent cystic acne, are even more susceptible to PCOS and eating disorders. Since these symptoms have an adverse effect on quality of life, they can trigger depression and anxiety, encouraging an unhealthy relationship with food.
In a UK based study, scientists found that prevalence of PCOS and eating disorders was 36.3% in PCOS patients suffering from hirsutism. The results were rather alarming.
Scientists also found that depression, anxiety, low self-esteem, and poor social adjustment were more common in participants suffering from an eating disorder.
Research from UK found that women with PCOS showed a significant increase in abnormal eating patterns, suggestive of clinical bulimia.
In a Hungarian study, researchers tried to determine the prevalence of PCOS and eating disorders. A total of 318 women were included in this analysis. The findings were rather surprising. Researchers found the prevalence of:
These research studies clearly indicate a clear association between PCOS and eating disorders, with bulimia nervosa being the biggest threat.
Many women with PCOS start walking the path to disordered eating in an effort to lose weight. What’s worse, some scientists believe that PCOS could trigger bulimic behavior. Because excess androgens produce an appetite-stimulating effect, which impairs impulse control.
On the other side of the spectrum lies binge eating, also caused by the same impaired impulse control in women with PCOS. Binge eating disorder shouldn’t be confused with mere over-eating. It’s a distinct medical condition recognized by the American Psychiatric Association and is more prevalent than anorexia and bulimia combined.
Scientists from Iowa conducted a survey on 60 women suffering from PCOS in 2007. The overall prevalence of depression was 40% (24 women out of 60). Total subjects with mood disorders in this study were 56.6% (34 women out of 60), including 11.6% with anxiety syndromes and 23.3% with binge eating disorder.
BED or Binge Eating Disorder is characterized by regularly eating far more food than what a normal person would eat in a similar time period. Binges occur weekly, and for a minimum of 3 months before an official diagnosis, according to the Binge Eating Disorder Association. Those who suffer from this disorder are well aware that their eating patterns are out of control during a binge and are riddled with guilt afterwards. For women with PCOS, binge eating disorder can often co-exist with Bulimia, wherein impaired impulse control makes you want to binge on unhealthy foods and then purge afterwards.
Studies suggest that psychological distress, hyper-androgenemia and menstrual disturbances are associated with greater food cravings. That’s a recipe for disaster for PCOS. The emotional toll of having PCOS and coping with all the frustrating symptoms directly impacts a woman’s body image and self-esteem, triggering an unhealthy relationship with food. Craving foods considered ‘bad’ for you can become a coping mechanism to deal with the emotional pain of PCOS.
It’s not surprising then when a woman with PCOS who is trying hard to lose weight through traditional methods gets frustrated and demotivated, and turns to comfort food to feel better. And this overeating triggers the desire to purge when guilt takes over, leading to bulimia.
PCOS is a manageable disease once it is identified and correctly treated. And to ensure that your PCOS doesn’t make you more susceptible to eating disorders, you can take these simple steps to develop a healthier relationship with food…and your weight.
You’ll often hear stories of how an LCHF (Low Carb-High Fat) Diet or a Ketogenic Diet produces excellent results in women with PCOS. This is true for some women wherein PCOS is triggered primarily by insulin resistance. Cutting back on carbs can improve insulin sensitivity, resulting in an improvement in PCOS symptoms. However, it’s important to note that a very low-carb diet may not be sustainable for every woman suffering from PCOS. There are some instances wherein long-term ketosis is not the best choice. These include:
As you can see, quite a few of these apply to women with PCOS, who suffer from irregular menstrual cycles and very heavy menstrual flow. Additionally, women with PCOS who are dealing with adrenal fatigue or thyroid imbalances (both of which are rather common in PCOS) also need to eat some carbohydrates.
A strict Keto diet reduces not just insulin levels, but also leptin levels. Leptin is an appetite-suppressant hormone, but is also crucial for maintaining female hormones necessary for menstruation, fertility, lactation, and reproduction. When leptin levels are thrown out of whack – be that from a very high carb diet or prolonged ketosis – it can result in hormonal problems for us women.
What I am trying to say is this – low-carb recommendations are not sustainable for some women with PCOS, so don’t choose a low-carb diet blindly, assuming that it will bring about improvements in PCOS symptoms. Work with experts to find out what’s the best diet for your PCOS.
Since some PCOS patients need to eat carbs to feel better, it’s important to do this the right way. At the end of the day, all carbs turn into sugars, which mean they elevate insulin levels and fuel insulin resistance.
The best carbs are those high in fiber – think vegetables, quinoa, buckwheat, sprouted grain bread and steel cut oats that don’t cause a spike in blood sugar + insulin levels. Also, it’s important to distribute your carbs throughout the day.
Don’t eat 1 carb-rich meal and try to compensate at other meal times. Every single meal you eat should have a balanced amount of protein, fat, and carbs — this allows for a slower digestion of carbs compared to eating carbs alone.
Train your body to welcome food every 2-4 hours. The idea is to not wait until you’re starving to eat your next meal. Based on your metabolic rate, you may need to eat more mini-meals than stick to 3 main meals. This ensures that your blood sugar and insulin levels stay stable throughout the day, preventing food cravings.
On the other hand, this is not a free ticket to binge eat. Remember, we’re trying to fight eating disorders? A simple trick I often use is to cook my three meals as regular. I will have breakfast, lunch and dinner prepped. And then I will divide each meal into 2 boxes. So I have 2 boxes containing my breakfast, 2 for lunch, and similarly 2 for dinner. I then proceed to eat 6 balanced mini-meals throughout the day. This ensures control over portion sizes, and also keeps my appetite in check.
Surprisingly, I have found that when I eat like this, I am often full at every meal time and never seem to want the other half right away.
We all have triggers. And your triggers for binge eating will be unique for you. Identify them, know them, and write them down.
For some, this trigger could be a particularly hard day at work or a fight with a colleague/boss/partner. For others, something as simple as a poor night’s sleep could be a trigger. Once you’ve identified your triggers, you’re armed for the next step.
If you find yourself with a strong urge to binge, and you know that you already ate your meal and can’t possibly be hungry, you’re probably craving food for emotional reasons. There are many ways to cope with your triggers, and you will have to find what works best for you.
The key here – distract yourself with something you like to do, not something you ‘should’ do. You could take a long, relaxing bath or draw/color/paint. A relaxing walk or chatting on the phone with a loved one can also help.
I personally like to watch YouTube videos when I find myself in such a situation. I usually queue up videos on You Tube from all the vloggers I follow (and yes, many of them are health and fitness-based) and I watch them until I can ride out the wave of emotional binging.
You’ve heard that exercise is great for PCOS, and there’s no denying that. But sometimes, exercise can make things worse when a woman has PCOS and eating disorder. Stressful-compulsive exercise that leaves you fatigued and too tired to do much else rest of the day is not only much less sustainable in the long-term; it can worsen your binge-eating.
You may think you have a free pass to eat whatever you like because you’re working extra-hard at the gym. But that’s far from the truth. It is extremely hard to create a caloric deficit with exercise alone. You need to run on the treadmill for a whole hour to burn off that bag of crisps. And probably run for 2 hours if you eat a single doughnut.
On the other hand, it’s much easier to stick to a healthy diet when your exercise routine comprises of joy-based movement.
Enjoy your workouts. Try walking, Zumba, Yoga, gardening, biking, and swimming or dancing instead of multiple, long sweat session at the gym.
When you enjoy your exercise and are not obsessively spending hours at the gym in an effort to lose weight, you will find you have more patience to let a healthy diet and lifestyle modifications take their time to show real weight-loss. If you are prone to eating disorders, avoid compulsive exercise.
Don’t let food become the only way you know of coping with emotions in an unhealthy way. While these 6 tips can help you beat a mild eating disorder, sometimes it’s difficult to overcome eating disorders on your own. Don’t be afraid to seek support. By working closely with experts who understand PCOS and eating disorders, you can become more conscious and mindful about your eating habits.
Polycystic ovary syndrome and bulimia – http://www.sciencedirect.com/science/article/pii/S001502821654117X
Prevalence of eating disorders among women with polycystic ovary syndrome – http://europepmc.org/abstract/med/27244869
Bulimia nervosa and polycystic ovary syndrome – http://www.tandfonline.com/doi/abs/10.3109/09513599509160199
The prevalence of eating disorders in women with facial hirsutism: An epidemiological cohort study – http://onlinelibrary.wiley.com/doi/10.1002/eat.20527/full
Hyperandrogenemia, psychological distress, and food cravings in young women – http://www.sciencedirect.com/science/article/pii/S0031938409002200
Beta-cell dysfunction independent of obesity and glucose intolerance in the polycystic ovary syndrome – https://academic.oup.com/jcem/article-lookup/doi/10.1210/jcem.81.3.8772555
Risk of depression and other mental health disorders in women with polycystic ovary syndrome: a longitudinal study – http://www.sciencedirect.com/science/article/pii/S0015028207040873