I’ve been using the intuitive eating framework in my nutrition private practice for years and today I wanted to share how this approach can be used to improve hormone balance with PCOS. Most of the time we hear intuitive eating principles in the context of helping those with a history of an eating disorder, but intuitive eating is meant for everyone. You can be an intuitive eater with PCOS!
What is intuitive eating?
Intuitive eating is a nutrition framework developed by two dietitians, Evelyn Tribole and Elesche Resch. They describe this framework as combining “instinct, emotion and rational thought”.
Those of us who work in the nutrition field know that trying to improve health and managing medical conditions by focusing on weight or restricting foods is very ineffective long-term and can keep you in a cycle of guilt, shame and stressing about food. You likely have had this experience! SO many times, someone will come to me and say “I’ve tried every diet, I just can’t lose weight, and now my my labs are getting worse!”
Intuitive eating is a way you can free yourself from this cycle forever.
Intuitive Eating and PCOS
Intuitive eating is based off of 10 principles… I will go through each one and explain how it can be applied to those with PCOS.
1. Reject the Diet Mentality
The definition of dieting is making food choices in an effort to control your weight. The diet mentality is approaching eating in a way where you’re focused on your weight. If this is your focus, or you cannot envision what managing PCOS would look like if you’re not focused on weight, then I could completely understand why.
You’re not bad or wrong for wanting to lose weight. There’s a big misconception that intuitive eating dietitians judge people for wanting to lose weight and that couldn’t be further from the truth. But often times, moving past this can actually help you improve your health and well-being.
Whether it’s trying out the latest shakes, seeing a commercial for Noom, or listening to your friends and family members talk about how they need to lose weight, the diet mentality is all around us.
Trying to overcome the diet mentality can be especially hard for people with PCOS because you’re constantly being told that losing weight will improve PCOS symptoms (honest question: has that advice actually worked for you?). Doctors who are not up to speed about the ineffectiveness and harms of a weight-centric approach to medical care often “prescribe” weight loss… even though weight is an outcome, not a behavior.
This often leads to a spiral of trying every diet under the sun, trying to lose weight, gaining it back, and feeling hopeless with your PCOS. This is also why eating disorders are more common in people with PCOS.
For the general population, dieting is generally ineffective for improving long-term health…. 85-90% of diets fail long-term. I’m not aware of any studies related to dieting and PCOS specifically, but I think it’s safe to assume that it’s at least the same – if not higher. Thinking of all of the diets you have tried in the past. Did you stick with them forever? How did you feel when you “fell of the wagon?”. Many of my clients tell me they feel guilty, ashamed and hopeless when dieting leads them to binge, overeat, or take a long ‘break’ from even trying.
I do not recommend dieting with PCOS for MANY reasons Like I mentioned above, weight is an outcome and not a behavior. For about 2/3 of dieters who lose weight, they will regain the weight within a 2-5 year period. This is known as weight cycling. Weight cycling is associated with worsening insulin resistance, increased inflammation, increased blood pressure, and depression.
I know it can be hard to let go of the idea that dieting is the solution to your PCOS, but if you look at your dieting history then you can probably determine whether it has truly helped you.
2. Honor Your Hunger
The second principle in intuitive eating is all about taking that first step to reconnecting with your body by learning how to trust yourself and honor your hunger. When we are taught how to eat based off external factors (cleaning your plate, following a meal plan, measuring portions), we completely detach ourselves from how our body actually feels. This often times leads to suppressing hunger, which then in turn leads to eventually overeating and bingeing. If you’ve experienced this then it’s not your fault. It’s just another example of how dieting backfires.
Learning how to feel your hunger can look a little different for women with PCOS if you have uncontrolled insulin resistance. Elevated insulin levels can cause feelings of hunger because your body isn’t properly using carbohydrates. So treating your insulin resistance is an important part of being able to trust how your body feels and honor your hunger.
Even as you’re working on treating insulin resistance, it’s important to remember a few things:
- If you’re not eating enough, you’re doing to feel hungry.
- Trying to suppress hunger, no matter where your hunger is coming from, will likely lead to overeating or binge eating.
- You cannot overcome hunger with “willpower”. Your body isn’t made like that.
3. Make Peace with Food
This principle is often the most difficult to implement because it’s all about giving yourself unconditional permission to eat foods. Diet culture often assigns morality to certain foods by labeling them as “good” and “bad”. Many of the foods that we label as “bad” are often times my clients’ favorite foods, yet they are labelled as off-limits.
Whenever we make our favorite foods forbidden or we tell ourselves that we’re not allowed to have them, we often want them even more. This again leads to overeating and bingeing. Once we make peace with food and understand that food has no moral value, we can enjoy all foods and get in tune with making nutrition decisions based off of how we’re feeling.
Making peace with food can feel overwhelming if you’re used to restricting foods. This is often where I see people say that intuitive eating didn’t work for them, they ate everything in their pantry, and dieting is the only way they can move forward.
Think about ALL of the years you’ve spent with the diet mentality. Unlearning that is a long process the involves trial and error and a lot of introspection. It can be really helpful to work with a certified intuitive eating counselor in this journey.
4. Challenge the Food Police
The food police is the inner voice in your head reinforcing all of the unhelpful dialogue that keeps you in the dieting cycle. Whether it’s congratulating yourself for eating less one day or telling yourself that you suck and have no willpower because you ate a cupcake, the food police don’t actually help you improve long-term health or manage your PCOS. The next time you hear the food police in your mind, try to challenge her with thoughts of compassion instead.
Food police dialogue: “Are you kidding me? You ate a cookie? You’re never going to be able to manage your PCOS.”
Compassionate dialogue: “Eating a sweet is completely normal. I really enjoyed it.”
5. Discover the Satisfaction Factor
Have you ever eaten a meal that you knew was nutritionally filling, but you were still left wanting something else? This might be because of the satisfaction factor!
Enjoying the flavor, taste and texture of foods in an environment that is calm and enjoyable is so important for nutrition. Foods that you find pleasurable and satisfying may change throughout the day or week, so it’s important to check in with yourself and trust how you feel.
For example, you may find warm breakfasts extremely pleasurable but you’re trying to follow a meal plan that only has cold breakfasts. Being unable to stick to this meal plan would not be your fault! Meals and snacks should regularly include foods that you find satisfying.
6. Feel your Fullness
Your body has a natural ability to tell you when you’ve had enough to eat, and that is the feeling of fullness. If you’re conditioned to eat everything on your plate then it’s likely that you haven’t been in tune with feeling fullness.
The feeling of being comfortably full is your body’s way of telling you that you’ve had adequate food to nourish your body. Being able to put your fork down at this time, even when there is food on your plate, is part of honoring what your body needs. Working on being able to feel and honor your fullness when you have PCOS depends on a few things.
The first is making sure you’re working on hormone balance, especially managing insulin resistance, since intense hunger will make you feel like you’re never full. This is why I always incorporate gentle nutrition (see that principle below) when I’m working with clients.
The second is also giving yourself unconditional permission to eat when you are hungry. If you’re only allowed to eat (or enjoy) food at certain times, of course you are going to eat everything on your plate. Lightening up and putting the trust in your body’s feelings of hunger and fullness meals you don’t have to eat things on your plate when you’re full, because it will always be available to you when you want it in the future.
The topic of food waste comes up a lot when we’re talking about cleaning your plate. There’s a lot you can explore here, both physically and emotionally, but something important to remember is that you can put less food on your plate to avoid waste when you are giving yourself unconditional permission to have seconds if you want them.
With PCOS, it can really be a journey exploring hunger and fullness. This is where working with a registered dietitian who specializes in PCOS and intuitive eating can be really helpful.
7. Cope with Your Emotions with Kindness
This principle used to be called “Cope with your emotions without using food” and I love how they changed it to say kindness instead. A lot of people think that any type of emotional eating is always bad. In certain situations, food can certainly be an appropriate coping mechanism for emotions. Where you may want to address emotional eating is when avoiding addressing the emotion by turning to food instead is actually standing in the way of you living a full and happy life. Working on these types of situations requires kindness and compassion for yourself.
This is a huge area of work with my clients since so many people with PCOS suffer from anxiety, depression, poor self-esteem, and binge eating.
8. Respect Your Body
All bodies deserve to be respected, no matter what your body size. There are some important pieces of this principle:
One is that we should all respect that bodies come in different shapes and sizes. This is completely normal. Both of my dogs are shih tzus but Olive is twice the size of Winnie and has much longer legs. Wouldn’t you think I would be ridiculous to say that there was something wrong with Olive for being bigger? Yet we do it to ourselves all the time.
Another part about this principle is recognizing that you can respect and take care of your body without loving everything about it. This is especially true for people with PCOS who experience a variety of symptoms with PCOS. These physical symptoms can feel so debilitating for self-esteem when you’re immersed in a society that narrowly defines beauty.
The biggest way I see clients disrespecting their bodies is by trying to wear clothes that don’t fit, or wearing clothes they don’t like as placeholders until they lose weight. I know how much it sucks to buy new clothes, but you deserve to feel comfortable in your current body in the clothes that you’re wearing. Imagine how you would feel if you woke up each morning and picked out your outfit for the day, and all of your options were clothes that you liked, fit you well and made you feel good about yourself.
9. Movement – Feel the Difference
You may notice that we had to make it through 8 principles before we got to nutrition and exercise! The creators of intuitive eating did this on purpose – most people really need to work on their thoughts and attitudes around food, dieting and letting go of food rules before it’s even appropriate to talk about nutrition and exercise.
How many times have you started an exercise routine just because it burned more calories, was the “in” workout or seemed like the type of exercise you should be doing to be healthy? OR how many times did you skip moving your body one day because the spare 20 minutes you had to go for a walk didn’t seem like it would be worth it?
The 9th principle of intuitive eating encourages us to move our bodies in ways that feel good to us, to prioritize movement as a way to enhance health and feel good.
There are a lot of nuances to this when it comes to PCOS and this is where working with a professional can be very beneficial. If you have been struggling with elevated adrenal hormones, high cortisol levels, poor sleep and/or insulin resistance then you may feel so fatigued that working on exercise may not be something that you focus on right away. Exercise isn’t really where I start with clients if they are struggling in the above areas.
You may also enjoy high intensity exercises that feel good in the moment without realizing they are actually making your PCOS symptoms worse. Studies actually show that slow, therapeutic exercises can improve hormones and high intensity exercises like spin classes can make increase inflammation. It can sometimes suck when you make this connection, but part of intuitive body movement is making connections and then deciding how you want to move forward.
10. Gentle Nutrition for PCOS
I really love the gentle nutrition chapter in the intuitive eating book, and I think it gives some great tips for people without any medical conditions. Many people think intuitive eating is just about eating whatever you want, whenever you want, but eating in a way that promotes health and wellness is definitely part of the intuitive eating framework.
I once heard intuitive eating described as combining mind knowledge (nutrition education) with body knowledge (your intuition, how you’re feeling). If you were to think of those as 2 dials on a radio, you may need to turn up the “mind knowledge” dial a little bit more when you have PCOS.
My first recommendation with approaching nutrition and PCOS is to not center your focus on cutting down carbohydrates. If you have elevated insulin levels (most people with PCOS do – this starts as high circulating insulin levels and then eventually progresses into elevated fasting glucose or HgA1c tests, aka prediabetes or type 2 diabetes) then you will likely be feeling intense cravings for carbs. This is not your fault… but trying to cut carbs out will not help.
Instead, try adding fat, fiber and protein to most of your meals and snacks. Also, eat regularly throughout the day. Skipping meals or going long period of time without eating will likely make hormonal imbalances worse. Adding in colorful fruits, vegetables and fatty fish can support hormone balance and decrease inflammation as well. Some nutrition changes also depend on your specific hormone imbalances since PCOS looks a little different in everyone – that’s what I help my clients with!
If you are someone who has PCOS and has struggled with nutrition and your feelings about body and weight then my heart goes out to you. I wish you received more compassionate, comprehensive medical care – I advocate for it because the stories my clients share with me are heartbreaking. If you want some support that is not beating you down over weight loss then follow my instagram account. I would love to have you!
In closing, I wanted to mention that how you approach nutrition with PCOS really depends on where you’re at in your intuitive eating journey. If you’re suffering from an eating disorder then you would want to reach out for some professional help before you started moving through the IE framework. If you’re someone who has had a very poor relationship with food then working on the first 8 principles of IE would be more beneficial for you before working on nutrition and exercise – even though I know this is hard to not just focus on nutrition :) If you’re someone who cannot move past focusing on your weight the intuitive eating would be really difficult for you, since intuitive eating is about turning towards internal factors and so much of the diet mentality is focused on external factors.
There’s also not a right or wrong way to follow the principles- you can focus on different ones at different times rather than tacking everything at once.
If you feel like you need some additional support on your intuitive eating journey then I’d love to work with you – click here for my services! I can help you feel comfortable and confident with managing your PCOS without the stress and anxiety of dieting.