There’s so much more to treating a PCOS diagnosis than weight loss and dieting. Here’s why it’s important to manage wellness from a whole-body point-of-view.
BY: AMY HANNEKE, RDN, LD
Affecting 1 in 10 women of childbearing age, polycystic ovary syndrome (PCOS) is complex and presents differently for every woman.
Along with a slew of metabolic issues and infertility, PCOS also impacts their overall health and appearance. To be diagnosed with PCOS, women have to meet two of the three following criteria (the “Rotterdam criteria”):
- Irregular or absent ovulation/”menstrual dysfunction” (usually, long cycles and <9 periods per year)
- Clinical or biochemical signs of hyperandrogenism (high testosterone) like facial/body hair growth, hair loss on your head, acne
- Polycystic ovaries (diagnosed through a transvaginal ultrasound)
However, it is important to note that PCOS is not necessarily the only explanation for some of these symptoms. That’s why it’s important to not self-diagnose, and to bring your concerns to a medical provider who’s willing to listen and order tests you may need.
With that being said, getting diagnosed with PCOS often takes multiple years and finding the right health providers.
As the leading cause of infertility, you deserve a provider that will listen to your concerns and guide you through your care if you think something’s going on in your body. Common symptoms include:
- Hair loss
- Body & facial hair growth (referred to as “hirsutism”)
- Irregular/long menstrual cycles
In addition, common co-diagnoses include anxiety, depression, and type 2 diabetes. This, however, doesn’t mean you will automatically develop symptoms of these conditions – or that if you have one of these conditions, you also have PCOS. It means that PCOS has a complex presentation that requires a multidisciplinary approach of care than simply being handed a brochure.
So what is the underlying pathology of PCOS?
The “primary” pathology of PCOS is considered to be hyperandrogenism (androgens are the group of “male” sex hormones), but insulin resistance and high insulin levels are also common features. Androgens are usually produced by the ovaries and adrenal glands, which sit on top of your kidneys. In those with PCOS, it’s suggested that both the ovaries and adrenal glands overproduce androgens compared to those without PCOS.
Insulin is the key that unlocks cells so that circulating glucose can be taken in and used for energy. In insulin resistance, it’s like someone changed the locks without telling your pancreas, which produces insulin. Glucose stays in your bloodstream rather than being used for energy, which signals your pancreas to produce more insulin. This is called “compensatory hyperinsulinemia”, and explains why those with PCOS often have high circulating levels of insulin.
Altered insulin levels and glucose metabolism eventually lead to fatigue and low energy (since glucose isn’t entering cells as expected), and over time can increase hunger and cravings. Insulin is also a growth hormone, meaning weight gain can be a symptom of insulin resistance. Given the correlation seen between PCOS symptoms and weight gain, many women are misguidedly prescribed to go on restrictive diets.
However, diets aren’t the answer.
The majority of dieters regain the lost weight within a few years, and this can be especially true for those with PCOS. Because of underlying insulin resistance and other metabolic changes seen in PCOS, temporary weight loss is not only less likely, but may be more damaging and slow one’s metabolism more. Here are a few more reasons restriction isn’t the answer for PCOS:
- Diets come with side effects, such as increased hunger and cravings, slowed metabolism, and preoccupation with food.
- Those with PCOS are at increased risk for disordered eating.
- Diets are associated with weight cycling, which promotes inflammation. As PCOS is already associated with inflammation, diets likely exacerbate this rather than address it.
- There is no set amount over which you’re “overeating,” but inadequate eating can lead to anxiety around food and binge-like behavior.
In this vein, it’s important to view weight not as a behavior that we can willingly control. We can, however, shift our view of healthcare to one that is behavior-based, that supports both physical and mental health as well as a flexible relationship with food and your well-being. By shifting the focus away from weight, focus on other indicators progress in PCOS treatment, including:
- Lab values
- Ovulation & period regularity
- Symptoms of hyperandrogenism
- Relationship with food
- Decrease in disordered behaviors around food/exercise
- Flexible relationship with self care
- Emotions & mental health management
- Stress levels
It’s important to note that stress is not only about your mental or emotional state – also consider your physical, environmental, and sleep stressors. The sum total of these stressors is called your allostatic load, and reducing the overall stress on your body can be a huge aspect of supporting PCOS. Other things to keep in your PCOS self-care toolbox may include:
- Regular eating intervals
- Evidence-based supplements
- Stress reduction
- Gentle nutrition
- Quality & adequate sleep
Most importantly, it’s about seeking support from a team of health professionals who you can trust with your care.
Your mind and body deserve it.
Adapted from the original article.
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Amy Hanneke, RDN, LD is a Registered Dietitian and owner of Satisfy Nutrition. Through an anti-diet approach in her nutrition coaching practice, Amy firmly believes in helping individuals live a life without restrictions, full of joy, self care, and delicious food. Learn more about Amy at Satisfy Nutrition.
Hi Amy, I totally agree with you that diet isn’t enough and rather we need to develop a better metabolism and revert the insulin resistance. Do you have any suggestions or worked out methods to achieve the same?