PCOS & Eating Disorders
What is PCOS?
PCOS stands for Polycystic Ovary Syndrome and is the most common endocrine disorder found in women of reproductive age. Signs and symptoms of PCOS include irregular menstrual periods, elevated levels of androgens (male hormones), cysts on ovaries, excess hair on face and back and weight gain. PCOS is a hormonal condition associated with reproductive, metabolic and psychological problems.
Physical Symptoms of PCOS
· Menstrual Irregularities
· Infertility and increased rates of miscarriage
· Elevated male sex hormones
· Weight gain & abdominal fat
· Insulin resistance
· Ovarian cysts
· Fatigue
· Abdominal bloating
· Hair loss on the hair and excess hair growth on the face & body
· Acne
Psychological Symptoms
· Anxiety
· Depression
· Low self – esteem
· Poor body image
What causes PCOS?
The exact cause of PCOS is unknown, but it is thought to be associated with abnormal hormone levels, specifically Insulin. Insulin is a hormone secreted from the pancreas and its main job is to transport nutrients from the food we eat into our cells to be used for energy or stored energy.
For example, let’s say you eat something. The food will be broken down into simple sugar molecules called glucose. The brain will then signal the pancreas to release Insulin in response to the amount of glucose in the blood. Insulin will take the sugar into the cells to be used for energy. You can think of Insulin like the keys to the cell doors.
When insulin is stimulated over and over again (due to poorly controlled blood sugars) cells start to become unresponsive, as if the key doesn’t fit the the lock anymore. This is known as Insulin resistance. To compensate the body instructs the pancreas to secrete more and more insulin. High levels of Insulin then stimulates the cells in the ovaries to make testosterone & decrease SHBG resulting in higher levels of free testosterone in the blood. The high levels of Testosterone can increase symptoms seen in PCOS such as irregular periods, acne, excess hair growth on the face & back, abdominal fat, and hair loss.
The link between PCOS & Eating Disorders
PCOS is often associated with higher weight and a predisposition to weight gain. As a result women with PCOS are often advised to restrict their calories and increase their exercise. Restrictive diets and eliminating food groups can be a risk factor for developing an eating disorder.
Lifestyle changes are often the primary treatment recommendation for PCOS. Since many of the symptoms of PCOS are related to insulin resistance, weight loss is recommended. Many patients diagnosed with PCOS are not supported with dietary advice and put themselves on restrictive diets such as avoiding carbohydrates in order to lower glucose & insulin. It is so important to note that these restrictions are NOT sustainable long term and can lead to increased cravings (for sugar and fats), preoccupation with food & binge eating. In addition removing carbohydrates reduces dietary fibre (carbohydrates are a fantastic source of fibre) and therefore negatively impacts the health of the gut, which plays a major role in managing PCOS.
Dietary restraint will ALWAYS lead to binge eating, and usually greater weight gain. In addition, when rules are created around food such as “I shouldn’t eat this” or “I am not allowed that” it can lead to feelings of guilt and shame when those rules are broken. This can lead a person to engage in compensatory behaviours such as purging, laxative abuse and/or excessive exercise. This weight cycling can lead to increased levels of insulin which exacerbates the problem that weight loss was attempting to solve.
In addition when food groups are restricted (specifically carbohydrates) this will have a profound effect on a person’s mood which can perpetuate feelings of depression and anxiety already associated with PCOS.
PCOS Treatment Aims
A better and more sustainable way of treating PCOS is to eat regular balanced meals, including complex carbohydrates, protein & fats throughout the day. Eating Complex carbs alongside protein & fat will help to slow the release of glucose into the bloodstream, reducing glucose spikes, promoting satiety and preventing bingeing episodes. Increasing diversity of colourful fibrous plants is known to feed the beneficial bacteria within the gut and associated with numerous health benefits.
I work with many women who have PCOS and I like to shift the focus away from weight loss and instead focus on healthy behaviours and habit changes. This includes increasing diversity and variety of whole foods to feel satisfied and nourished, planning and prepping meals, eating regularly, reducing stress, and encouraging moderate movement that is enjoyed.
If you have been diagnosed with PCOS or suspect that you may have it, then please do get in touch. I wanted to encourage you that with lifestyle and behaviour changes you can safely take back control.