Written by Megan Hoffman, RD
Why is long-term intentional weight loss so hard for people with PMOS anyways?
As we discussed in Part 1 of this blog post, one of the endocrine dysfunctions of the condition may be something called insulin resistance which can contribute to very pronounced levels of fatigue and low energy.
This is because energy cannot effectively enter the cells. If we think about the muscle or the brain cells not getting adequate energy, it makes sense that those cells will become fatigued and contribute to feelings of low energy.
For people with PMOS, the reason that the energy has difficulty entering the cells of the body is due to insulin resistance.
Insulin is a hormone that is released in the blood after we eat carbohydrate containing foods. The carbs are digested into glucose (our body’s main source of energy) and released into the blood and this results in an increase in blood glucose levels. Insulin is then released to shuttle the glucose from the blood into the cells of the body to be used as energy to carry out their functions.
When there is insulin resistance present, the cells are not as sensitive to the circulating insulin and thus, the glucose does not get into the cells and remains in the blood.
When the cells of the body are not getting the energy (glucose) they need to carry out their functions, the body perceives that there is a shortage of energy, despite there being adequate glucose onboard. When this occurs, the body will respond by trying to get more energy. To accomplish this, signals are sent to the brain to increase hunger which increases cravings and urges for food/eating, particularly for foods that are a source of carbs. These cravings can be extremely strong and can cause a person to feel out of control with their eating.
We often might see low carb meal plans suggested for PMOS management with the claim that less carbs will result in less insulin resistance. While technically this is true, a low carb diet can be very difficult to follow especially for someone with PMOS who is experiencing these starved cells and increased drive/cravings for carb containing foods. This may cause a person to yo-yo diet with strict adherence to plans and then experience out-of-control eating. These cycles can result in feelings of failure, guilt and shame when weight loss isn’t accomplished or when weight gain occurs.
The research also suggests an increased risk of eating disorders and disordered eating amongst people with PMOS, regardless of body size.¹ As we touched on in Part 1 of this blog, the weight stigma that is so prevalent in our healthcare system often contributes to people being missed for diagnosis and treatment of eating disorders if they do not present in the way that someone might think an eating disorder may look. People in all body sizes experience eating disorders and it is a serious mental health condition that has serious health consequences regardless of a person’s weight.
There is also a high prevalence of moderate to severe depression and anxiety in people with PCOS.¹ Health professionals should be aware of this and screen for it and refer to mental health specialists when appropriate.
What can I do instead of pursuing intentional weight loss?
While we know that making “diet” and “lifestyle” changes is often recommended to manage the condition. That does not really provide specific guidance or direction, and will likely lead a person to search for answers in the wild west of the internet or social media.
The research states that there is no evidence of any one type of diet composition over another for the management of the condition.¹ In addition to this, there is also a lack of evidence supporting any one type and intensity of exercise being better than another for condition management.¹
Taking these into consideration, the consensus recommendations for people with PMOS is to follow a diet consistent with population guidelines for healthy eating.¹ In other words, balanced eating that includes adequate macronutrients like carbohydrates, protein, fat and fibre and micronutrients like vitamins and minerals that support the body's overall health.
Eating regularly and in a way that supports pleasure and enjoyment and avoids strict plans or protocols provides a relationship to food that is more peaceful and does not result in feelings of guilt and shame and extreme behaviours around food and eating.
The consensus recommendation for physical activity is to choose and engage in sustainable movement practices that are in line with an individual’s preference or goals.¹ This means that we do not need to do “X” amount of exercise per day for “X” amount of time for it to count.
When we have a more flexible relationship to movement, we are not using it in a punishing or disciplined way. We are simply moving the body regularly in a way that we enjoy that provides us with mental, emotional and physical benefits.
The other pillars or “lifestyle” may be managing and reducing stress; getting adequate sleep and hydration and having support and community to help us feel less alone in navigating the ups and downs of the condition.
It can also be helpful to have the support of a well-informed multidisciplinary healthcare team to empower a person with PMOS in understanding the condition and the treatment options that are right for them. This may or may not include medication management for some of the metabolic and endocrine impacts of the condition.
The bottom line
The combination of physical symptoms like extreme fatigue and strong cravings, poor body image, increased risk of disordered eating and eating disorders, and the presence of depression and/or anxiety can make this condition very complex when it comes to treatment. One size does not fit all.
Navigating some of the recommendations that a person may receive from healthcare providers and the messaging in the media around PMOS management can be downright confusing and even contradictory.
You are worthy of a balanced and holistic approach to your PMOS management. Working closely with your care team to find strategies that are best suited for your unique situation is a supportive way to honour all the parts of you, and adapt to changes over time.
If you would like support in managing your PMOS, we would be honoured to be a part of your team.
Reference:
Teede, H. J., Tay, C. T., Laven, J. J., Dokras, A., Moran, L. J., Piltonen, T. T., ... & Joham, A. E. (2023). Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. European journal of endocrinology, 189(2), G43-G64.
