This blog post marks the third and final installment of our 3-part series on PCOS and eating disorders. While the previous blogs focused on the relationship between PCOS and eating disorders, today’s post will focus on evidence-based recommendations for PCOS. If you would like some more context behind the “what” and “who” of PCOS and EDs, read blog #1 and blog #2 here.
Before we continue, let’s make one thing clear…
There is no magic cure or reversal for PCOS.
The point of this blog post is not to suggest that you can cure your PCOS with any of the mentioned lifestyle changes or supplements. At New Paths Nutrition, we firmly believe that your health-related behaviors should enhance your quality of life, rather than become a guilt trap. The information below cannot be used to diagnose or treat PCOS… that’s what a physician is for!
Weight-neutral PCOS care can be a needle in a haystack. Research on PCOS thus far centers around weight loss as an intervention, rather than specific behavioral changes. As a result of the existing weight-centric body of research, if you go an OBGYN or primary care physician, you will likely be recommended weight loss for PCOS. I say this neutrally and matter-of-factly, not to pass judgment for those providers who are following the research in a weight-centric world. The unique nature of healthcare means that every provider may interpret the same research entirely differently when recommending interventions to patients. Have you ever heard someone say, “I am going to insert healthcare professional here to get a second opinion.”? There is a reason why! Whether you’re a dietitian, physician, or therapist, your individual biases and experiences shape your perspective on patient care.
A reminder to all: Wherever you go, you take yourself with you! Even in the professional setting.
Now, let’s get into the purpose of this blog post: WEIGHT-NEUTRAL PCOS INTERVENTIONS! Weight-neutral interventions include lifestyle and behavior modifications that focus on your health and happiness without weight loss as a measure of success. These interventions aim to improve overall well-being through sustainable changes, such as nourishing your body with balanced nutrition, managing stress, prioritizing sleep, and engaging in enjoyable movement. By shifting the focus away from weight loss, weight-neutral approaches empower individuals with PCOS to care for their bodies in ways that promote long-term health, rather than pursuing short-term, potentially harmful goals. This approach is all about self-compassion, body respect, and realistic goals.
Hormone health involves more than just sex hormones (i.e., estrogen, testosterone and progesterone). Stress hormones (i.e., cortisol and epinephrine) and blood sugar hormones (i.e., insulin and glucagon) interact to signal immediate usage or storage of our body’s favorite energy source: glucose! People with hormonal dysregulation tend to experience heightened stress and/or heightened blood sugar (glucose) as a result of the poor communication between bodily hormones.
For folx with PCOS, a symptom that often has people scrambling for medical appointments is a change in weight. In our diet culture world, weight gain can be complicated and something people feel they need to go see a medical provider to address. PCOS-related weight gain can be attributed to insulin resistance, disordered eating, and a history of weight cycling (Madrid, 2022).
Wait, I know we covered PCOS and eating disorders... But what are insulin resistance and weight cycling?
Insulin resistance happens when the body's cells refuse insulin’s offer to take the blood sugar in for energy. Without the work of insulin, blood sugar stays in the bloodstream, leading to concerning lab values and an array of symptoms. For people with hyper or hypoglycemia, they may experience erratic changes in their hunger, mood, and even consciousness! (Think fainting and dizziness). Chronic conditions like diabetes mellitus type 1 & 2, metabolic syndrome, and PCOS are all characterized by insulin resistance, which explains their frequent overlap in diagnosis.
On the other hand, weight cycling is more straightforward. Sometimes called “yo-yo dieting,” weight cycling happens when a disordered eating pattern occurs for years. This chronic on-and-off restriction may lead to gaining and losing weight in a cyclic pattern. Research on weight cycling and related health outcomes is still new, but growing as more awareness comes to the dangers of disordered eating. Weight cycling may occur alongside PCOS due to “all-or-nothing” treatment mindsets. Weight cycling has also been found to be associated with an increased risk of insulin resistance, further showing the harms of focusing on dieting and weight loss to help with PCOS.
Clients with PCOS are often at different stages of understanding with their diagnosis and relevant symptoms. As anti-diet dietitians, we provide education in session on PCOS lifestyle interventions, rather than play the blame game with your weight. I certainly recommend seeing a OBGYN that you trust and emphasize your active ED or ED history. A doctor may prescribe metformin and/or spironolactone depending on the severity of PCOS. For someone with PCOS in a less stable place in their ED recovery, we would assess readiness for nutritional modifications from a medical and body image lens.
If I'm ready for change, what can I do?
For those with PCOS feeling firm in recovery, we would explore blood sugar management techniques. Managing blood sugar protects PCOS patients from further hormonal extremes, which is why many patients are prescribed diabetes medication (i.e., metformin and GLP-1 agonists). Behavior change for PCOS may include consistent carbohydrate intake, knowledge of simple versus complex carbohydrates, and exploring low-impact movement (American Society for Reproductive Medicine, 2023). All of these interventions can support improving PCOS symptoms and blood sugar management, no matter what may happen with weight.
Once lifestyle changes are successfully and consistently implemented, I may recommend supplementation for PCOS, if budget allows. Believe it or not, a cozy cup of tea could be what your daily routine needs. Spearmint tea has been found to lower the androgen hormones that may exacerbate acne and hirustism (Shen, W. et. al, 2021). Additionally, raspberry leaf tea supports menstrual regularity and a healthy pregnancy.
If tea isn’t your ‘cup of tea,’ I often recommend an inositol supplement for blood sugar management. Inositol was formerly known as one of the many B vitamins, but then later discovered to be a naturally-occuring derivative of glucose (ScienceDirect, n.d.). Produced in capsule or powder form, inositol can be effective for fertility and blood sugar, but pricey. Plenty of foods are rich in inositol, including fruits, beans, and bran foods (ScienceDirect, n.d.). Another diabetes melitus treatment measure option, berberine is an herbal supplement sourced from the roots and stems of plants (Ionescu, O. et. al, 2023). New research on berberine and PCOS reveals improvement of insulin resistance with sustained, safe supplementation (Ionescu, O. et. al, 2023). Consult your physician about any potential drug-supplement interactions.**
This blog marked the final installment of our three-part series on PCOS and eating disorders, shifting the focus from their relationship to evidence-based interventions for managing PCOS. Once again, remember that there is no magic cure for PCOS, and recommendations are designed to improve quality of life, not as a cure. Weight-neutral interventions—such as balanced nutrition, stress management, and enjoyable movement—are key to long-term health without focusing on weight loss. Working with a registered dietitian can provide personalized support in managing PCOS. With expert guidance, you can approach PCOS care in a way that promotes well-being and self-compassion, without the pressure of diet culture.
Thanks for reading this series 🤩
**As a side note, if you have hypoglycemia, please avoid these supplements and any supplementation that lowers your blood sugar further.
References:
American Society for Reproductive Medicine. (2023). Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. https://www.asrm.org/practice-guidance/practice-committee-documents/recommendations-from-the-2023-international-evidence-based-guideline-for-the-assessment-and-management-of-polycystic-ovary-syndrome/
Cowan, S., Lim, S., Alycia, C. et al. Lifestyle management in polycystic ovary syndrome – beyond diet and physical activity. BMC Endocr Disord 23, 14 (2023). https://doi.org/10.1186/s12902-022-01208-y
Greff, D., Juhász, A. E., Váncsa, S., Váradi, A., Sipos, Z., Szinte, J., Park, S., Hegyi, P., Nyirády, P., Ács, N., Várbíró, S., & Horváth, E. M. (2023). Inositol is an effective and safe treatment in polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials. Reproductive biology and endocrinology : RB&E, 21(1), 10. https://doi.org/10.1186/s12958-023-01055-z
Ionescu, O. M., Frincu, F., Mehedintu, A., Plotogea, M., Cirstoiu, M., Petca, A., Varlas, V., & Mehedintu, C. (2023). Berberine-A Promising Therapeutic Approach to Polycystic Ovary Syndrome in Infertile/Pregnant Women. Life (Basel, Switzerland), 13(1), 125. https://doi.org/10.3390/life13010125
Madrid, C. (2022). Weight and PCOS: Chicken or the egg? Feed Your Zest. https://www.feedyourzest.com/blog/2022/2/2/weight-and-pcos-chicken-or-the-egg
National Health Service. (n.d.). Polycystic ovary syndrome (PCOS): Treatment. NHS. https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/treatment/#:~:text=Polycystic%20ovary%20syndrome%20(PCOS)%20cannot,discussed%20in%20more%20detail%20below
ScienceDirect. (n.d.). Inositol. In Topics in Agricultural and Biological Sciences. Retrieved September 27, 2024, from https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/inositol
Shen, W., Pan, Y., Jin, B., Zhang, Z., You, T., Qu, Y., Han, M., Yuan, X., & Zhang, Y. (2021). Effects of Tea Consumption on Anthropometric Parameters, Metabolic Indexes and Hormone Levels of Women with Polycystic Ovarian Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Frontiers in endocrinology, 12, 736867. https://doi.org/10.3389/fendo.2021.736867
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