The Real Life RD

helping you find peace with food and your natural body size

  • the RD & NP
  • Online Courses
  • Women’s Wellness
  • Speaking
    • Facebook
    • Instagram
    • Pinterest
    • RSS
    • Twitter
    • YouTube
Hormones, Reproductive Health

Understanding PCOS Part 2: Lifestyle Changes That Don’t Include Dieting

June 13, 2018 By Robyn 3 Comments

If you missed part 1 where I talked about how PCOS develops, how to get diagnosed with PCOS, the different types of PCOS and how medications work you can read that post here. In this post, I’m going to share with you some lifestyle changes you can implement that don’t involve dieting and then in part three we’ll talk about supplements and medications as adjunctive tools as well. My hope is that these posts are informative, but they are certainly not prescriptive. Nutrition and medicine are highly individual – everyone has different genetics and biology, so it’s really important to work with your health care provider and dietitian to figure out what combination of treatment modalities will work best for you.

Everyone is at a different place emotionally, physically, mentally, financially, etc and therefore your care and treatment takes into consideration all of these things – that’s what makes it work for you. The optimal treatment approach for PCOS in multifactorial – lifestyle modifications, psychological treatment, supplements, and medications all play a role. I think the most important thing is that you as the patient and woman feel empowered in your decisions, that you feel well informed on the pros/cons of everything and that you know your treatment is 100% a personal decision and whatever works for you, works for you. You are not better or worse or doing things right or wrong for choosing or not choosing something to care for yourself.

Like we talked about in Part 1, the cause of PCOS isn’t totally known, but what we do know is that, along with genetics, environmental factors play a role – some of these factors we can control and some are out of our control. PCOS is a chronic inflammatory state, like many other diseases and conditions, and so decreasing inflammation in the body is a goal of treatment. The other goal is blood sugar regulation and improving insulin sensitivity. The word inflammation is quite trendy. Inflammation in normal amounts is a good thing, it’s how our bodies respond to infection and tissue damage and it’s crucial to the healing process. But when we have chronic, ongoing levels of inflammation we run into trouble. Decreasing inflammation is much more than cutting out sugar and eating an “anti-inflammatory diet” – there are many lifestyle factors (and factors out of our control) that contribute to inflammation.

I share these four components quite often because it’s a way to help take a look at and evaluate the modifiable areas of health. Although, we have to keep in mind that we will go through seasons of life that are rougher than others and so sometimes these areas will be less modifiable than other times in our life. And remember, there are environmental factors that we can’t control – like oppression, socioeconomic status, stigma, stuff in the air you breath etc and then non-environmental factors that are completely out of our control like genetics.

1. Nutrition

healthy eating

This could be several posts in and of itself, so I hope these tips will be helpful. With that said, if eating or not eating a particular food is causing you more psychological distress than the potential health benefits of that food, that food choice is no longer healthy. Stress is inflammatory, so that would be working against your body. I fully believe that with time, you can practice intuitive eating if you have PCOS, but it might look different than it does for someone without PCOS. Think about having two knobs, one for mind knowledge and one for body knowledge. In the presence of a medical diagnosis, you have to turn up the mind knowledge volume a bit more so you can best support your physical health. Also if you’re feeling new to IE or overwhelmed by the idea of IE, that is totally okay too.

It might not be the right time for you to implement the IE principles and instead, establishing a balanced, rhythmic eating pattern that supports your physical health along with your mental and emotional health will be the best place to start. Intuitive eating is a skill and it can take a lot of time, space and patience to develop that skill. No matter where you’re at with food, the goal with nutrition is to decrease inflammation and regulate blood sugar which in turn improves how your body utilizes insulin – the key player in the hormonal imbalances of PCOS. Some things to think about when nourishing your body in a way that supports your physical health include:

  • Eat frequently – about every 3-4ish hours. Eating in a frequent, consistent way not only let’s your body know “hey, she’s giving us food on a consistent basis so we don’t need to compensate and slow down metabolism” it also helps regulate your blood sugar which means your cravings feel more manageable and steady and so does your energy.
  • Eat enough – again, this helps your body’s metabolism and ensures your body is getting the fat and protein it needs for good hormonal function. Restricting calories only worsens the pathophysiology of PCOS and causes your body to release cortisol which contributes to more chronic inflammation. Dieting and restriction won’t help your body heal long term and they have the potential to be very harmful for your mental and emotional health. So all that to say, make sure you are nourishing your body with enough energy and macronutrients – if you’re not sure what that looks like or means, work with a knowledgable dietitian who can support you. If you email me, I’m happy to provide you with recommendations!
  • Include all the macronutrients in meals (carbs, proteins and fats) and include a healthy fat and/or protein source at snacks – this again will help stabilize blood sugar and help manage your insulin levels.

napa weekend

  • Eat omega 3 rich foods often such as walnuts, flaxseeds, chia seeds and salmon – these are great for fighting inflammation.
  • Choose high fiber and unrefined carbohydrate sources (whole grains, fruits and starchy veggies etc) as much as possible – these sources of carbohydrates are broken down more slowly by the body and enter your blood stream at a slower rate which is helpful for insulin resistance. Through this, you’re giving your body manageable amounts of glucose to process over a longer period of time, keeping your blood sugar more stable and reducing the risk of your blood sugar getting too high or dropping too low. Now, this piece of knowledge doesn’t mean sugar or white flour is off limits – that wouldn’t be good for your emotional health and would likely set you up for a chaotic experience with those foods. Enjoy those foods! The idea is to still be flexible with food, but to be more intentional about including unrefined, fiber filled carbohydrates most of the time to help support your blood sugar and insulin levels. If you do choose refined carbohydrates, pair them with a fat and/or protein source to help regulate your blood sugar. There has never been a study to show that any one food is “bad” – remember there is a lot of nuance when it comes to nutrition and health.
  • Eat as many colors as possible – all those colorful foods are filled with antioxidants and other anti-inflammatory compounds!
  • Try to make half of your plate vegetables, most of the time. Again, this certainly isn’t hard and fast and there is so much flexibility and grey area here. You likely won’t eat a bunch of veggies at breakfast. But see if you can add tasty veggies (cooked in a way that makes them enjoyable like roasting or in a salad with avocado and yummy dressing) to most lunches and dinners.

Start slow with implementing these changes since sustainable changes do take time. This certainly isn’t a race!

2. Stress

I probably sound like a broken record by this point after writing about stress forever, but it really has a lot of influence on our physical health. Which is why just saying, “change your lifestyle!” can be really harmful. Change is stressful! So with everything you have going on, try to be as kind and compassionate to yourself as possible. Women with PCOS tend to experience anxiety and depression at higher rates than women without PCOS. It can take a toll on your emotional and mental health which can effect not only your physical health, but your sleep too. Safe people you can process with, asking for help and self compassion are some ways you can help manage stress. Mindfulness is also a great tool. Mindfulness use to sound like a “woo-woo” word to be, but then I realized that it just means, “the state of being conscious or aware of something.” A mindfulness practice helps decrease your stress hormone cortisol, which has been shown to be higher in women with PCOS. High levels of cortisol has several metabolic effects, including increased insulin.

There was a study released in 2012 that found yoga was highly beneficial in females with PCOS. The adolescent girls with PCOS in the study had various body shapes and sizes. For 12 weeks, half practiced yoga and half followed a traditional exercise routine. At the end of the study, yoga was found to be more effective than traditional exercise on many levels. And I think the coolest part is that these results were independent of the participants body size or weight and independent of any body changes during the 12 weeks of exercise intervention. Regardless, yoga was beneficial. I love this study. That doesn’t mean you have to jump right in to a regular yoga practice, start slow and do what feels good for you given your life circumstances. There are tons of yoga videos for free on YouTube ranging from 10 minutes to 60 minutes or more.

Other mindfulness practice ideas might mean deep breathing for 5 minutes in the morning, going on a stroll in the evening without music or your phone, doing a 10 minute guided meditation. Whatever it is, know you can start slow and there isn’t one way to do this.

3. Sleep

Women who have PCOS actually experience more sleep disturbances than those without. Sleep issues are a contributing factor to insulin resistance so it can be a double edged sword. Sleep loss can also alter your appetite hormones ghrelin and leptin and increase your craving for carbs – when your body is tired it wants fast energy! So try not to be too hard on yourself if you haven’t gotten great sleep and your appetite and cravings feel off. Here is a great post with practical steps on how to improve your sleep. In addition to those tips, try to go to bed at the same time every night and sleep in a cool room. Your body temperature is naturally lower when you sleep so that helps support your body’s natural temperature regulation. Melatonin and magnesium are helpful supplements you could also try (always check with your doc first of course) to help you in falling and staying asleep.

4. Exercise

Appropriate exercise is beneficial to our health. It’s worth noting that if you’re struggling with health issues where exercise is an underlying contributor, resting from exercise might be the healthiest thing for your body right now. For women with PCOS, exercise can help with ovulation and fertility, increase insulin sensitivity and improve metabolic markers totally independent of body weight. Everyone’s body is different, so what works for one women might not work for another woman. Choosing exercise that you truly enjoy and meets the unique needs of your physiology is important. Walking for 30-45 minutes most days of the week is great for improving insulin sensitivity. Perhaps you enjoy riding your bike or going to Zumba class. Or maybe you enjoy hiking or rock climbing. Maybe you like to vigorously clean your house (hey, somebody out there probably does!) All these things are exercise. If you enjoy higher intensity exercise and that feels good for your body, you can do that too. But do keep in mind that too frequent or long sessions of high intensity exercise can keep cortisol levels elevated which furthers the inflammatory process. I usually suggest no more than two, 30 minute high intensity exercise sessions per week. Choose movement that you enjoy – which could be yoga like we talked about above – and incorporate it into your life in a fun way most days of the week.

If you’ve made it thought this long post, cheers! Next week we’ll continue this series with talking about supplements and medications and some really cool research on the two.

 

Resources

Van Son J, Nyklícek I, Pop VJ, Blonk MC, Erdtsieck RJ, Spooren PF, Toorians AW, Pouwer F. The effects of a mindfulness-based intervention on emotional distress, quality of life, and HbA(1c) in outpatients with diabetes (DiaMind): a randomized controlled trial. Diabetes Care. 2013;36(4):823-30

Fernandez, R. C., Moore, V. M., Van Ryswyk, E. M., Varcoe, T. J., Rodgers, R. J., March, W. A., … Davies, M. J. (2018). Sleep disturbances in women with polycystic ovary syndrome: prevalence, pathophysiology, impact and management strategies. Nature and Science of Sleep, 10, 45–64. http://doi.org/10.2147/NSS.S127475

Nidhi, R., Padmalatha, V., Nagarathna, R., & Amritanshu, R. (2012). Effect of holistic yoga program on anxiety symptoms in adolescent girls with polycystic ovarian syndrome: A randomized control trial. International Journal of Yoga, 5(2), 112–117. http://doi.org/10.4103/0973-6131.98223

Yaprak Engin-Üstün, Yusuf Üstün, M. Mutlu Meydanli, Ayşe Kafkasli & Gülay Yetkin (2009) Are polycystic ovaries associated with cardiovascular disease risk as polycystic ovary syndrome?, Gynecological Endocrinology, 22:6, 324-328, DOI: 10.1080/09513590600630447

Farrell, K., & Antoni, M. (2010). Insulin Resistance, Obesity, Inflammation, and Depression in Polycystic Ovary Syndrome: Biobehavioral Mechanisms and Interventions. Fertility and Sterility, 94(5), 1565–1574. http://doi.org/10.1016/j.fertnstert.2010.03.081

Salama, A. A., Amine, E. K., Salem, H. A. E., & Abd El Fattah, N. K. (2015). Anti-Inflammatory Dietary Combo in Overweight and Obese Women with Polycystic Ovary Syndrome. North American Journal of Medical Sciences, 7(7), 310–316. http://doi.org/10.4103/1947-2714.161246

Brinkworth GD, Buckley JD, Noakes M, Clifton PM, Wilson CJ. Long-term Effects of a Very Low-Carbohydrate Diet and a Low-Fat Diet on Mood and Cognitive Function. Arch Intern Med. 2009;169(20):1873–1880. doi:10.1001/archinternmed.2009.329

Tomiyama, A. J., Mann, T., Vinas, D., Hunger, J. M., DeJager, J., & Taylor, S. E. (2010). Low Calorie Dieting Increases Cortisol. Psychosomatic Medicine, 72(4), 357–364. http://doi.org/10.1097/PSY.0b013e3181d9523c

Mullington, J. M., Simpson, N. S., Meier-Ewert, H. K., & Haack, M. (2010). Sleep Loss and Inflammation. Best Practice & Research. Clinical Endocrinology & Metabolism, 24(5), 775–784. http://doi.org/10.1016/j.beem.2010.08.014

 


YOU MAY ALSO LIKE...

  • Understanding PCOS [Part 3: Evidenced Based Supplements]Understanding PCOS [Part 3: Evidenced Based Supplements]
  • Things You Might Not Know About Your Reproductive Health & HormonesThings You Might Not Know About Your Reproductive Health & Hormones
  • 5 Thoughts [hormone labs + serving sizes + end of summer]5 Thoughts [hormone labs + serving sizes + end of summer]
  • Getting Your Period Back Without MedicationGetting Your Period Back Without Medication

Filed Under: Hormones, Reproductive Health

« 5 Thoughts
Meet Crystal! RD, RDN »

Comments

  1. Sydney says

    June 14, 2018 at 10:41 pm

    Hi Robyn! Thanks so much again for this series. Also thanks for including your research articles! I am a nerd so I enjoy referencing those sometimes. One question I had was whether you found anything in your research about avoiding dairy in PCOS? It seems to be the new thing out there, something to do with the fact that something in dairy increases testosterone production and should be avoided. Not sure if there is actually any research to back that up though and I love my milk, cheese and yogurt so would really hate to give it up unnecessarily! Thanks again!

    Reply
  2. Verity says

    August 31, 2018 at 12:13 am

    This is great, thank you.

    Reply
  3. Sarale says

    February 24, 2019 at 12:04 am

    Hello Robyn,
    I thank you for this insightful article. Do you think my daughter could have PCOS? She is 14, and she reached menarche at age 13. Since then, she’s gotten five periods. It’s important to note that after a five month stretch without a cycle, her doctor recommended insotil without seeing her—just to try it out, and that regulated it quite a bit—she just had a 39 day cycle. She is lean with no signs of excess hair, but I am also a healthy weight, and I have PCOS. My gynecologist told me she might have it, just because it’s genetically linked. Any insight would be appreciated! You can email me back at [email protected]. Thank you so much!

    Reply

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

A non-diet dietitian and nurse practitioner helping women find peace with food, accept their natural body size and heal from hormonal issues and period problems.

More On Lady Hormones

How Birth Control Methods Affect Your Hormones, Period and Fertility

What Your Cervical Fluid Can Tell You About Your Reproductive Health

women's reproductive health

Women’s Reproductive Health 101

I have yet to experience postpartum myself, but I've had many clients and readers that have been through that season of life. Or perhaps you are currently living through the postpartum period. Every woman's body is different, therefore every woman's experience after giving birth will be different. What works for one woman, might not work for the next. While one woman might go through postpartum and adjust to newborn life quiet seamlessly, another woman might find it much more difficult. She might need the support of medication, therapy, extra help and many other things. One way is not better than the other - they are simply two different ways of navigating the postpartum period. I hope this post helps you better care for yourself, whatever that means for you. There's no right or wrong way to care for yourself as a mom or your new baby.

Postpartum Hormones: what’s happening in your body and how to care for yourself

* indicates required

Categories

Get in Touch!

Follow Me!

  • Email
  • Facebook
  • Instagram
  • Pinterest
  • Twitter
  • YouTube

I talk a lot about moving, eating, and living intuitively so you can be well hormonally and live a fulfilling life in line with your values

The Real Life RD on Pinterest

  • Instagram Find: Viktoria's Awe-Inspiring Kids Rooms Filled With Pretty Design - NordicDesign
  • 10 X DE MOOISTE KINDERKAMERS VAN INSTAGRAM OKTOBER
  • Wooden Rainbow Lamp Wooden night light Kids room decoration | Etsy
  • This cute little walk-in wardrobe for kids is too cute of an idea! Loving the white tones with a pop of teal drawers
Follow Me on Pinterest
We veered from our usual Friday night homemade piz We veered from our usual Friday night homemade pizza (minus the dough, we leave that to @albemarlebakingco) because we are eating pizza tomorrow with some friends - instead I called my mom and asked her how she makes her chicken fingers and we fried up a big ole batch of chicken nugs 🙌🏻🤤 along with a sheet pan full of sweet potato fries and a simple arugula salad dressed with parmesean, olive oil and s&p. Oh and my moms honey mustard recipe for dipping. It’s SO DANG GOOD.  Over the past 6ish months we’ve been practicing (and practicing and practicing bc it doesn’t come naturally) unplugging from technology and slowing down and resting and just being for one day a week. Some call it Shabbat. Some call it Sabbath. Maybe you call it something different. All I know is IT IS SO GOOD FOR MY WEARY SOUL and the day I look forward to ALL WEEK. Sundown on Friday to sundown Saturday. Nothing but rest. For us that means hiking (or something outside) and napping and reading and being with friends and eating really good food. And drinking some really good wine or craft beer. Sometimes whiskey. 😛  And because I know I’ll get asked about the chicken finger recipe and also because it’s too good not to share and Momma Coale said I could, here ya go:  Cut chicken breast into thin strips or small pieces (I prefer nug size bc the breading to chicken ratio is perfection). Salt and pepper those babies really well. Then dredge them in all purpose flour, then egg, then panko - just like you would bread anything else. Then fry them up in a light oil - I use avocado oil because that’s our everyday oil. You could also use canola or peanut oil. Just fill a pan with an inch or so of oil on medium high heat. They only take 2-3 minutes per side. You can always temp them to make sure they are at least 165 degrees F to really make sure they are done. Dunk in all the sauces and enjoy!  Happy weekend!
I am not a craft mom. My version of crafts is baki I am not a craft mom. My version of crafts is baking because 1) my toddler actually engages with it and 2) we have tasty things to eat in the end.  Wanna know how long crafts last in our house? Approximately 23 seconds. Maybe 51 on a good day. So we just stopped crafting a long time ago and instead started baking.  And when I need my toddler to stay in one place, I turn on the faucet. I am still utterly amazed at how long water can entertain a small human. And it’s FREE. 🙌🏻 well, mostly..  Send me all your favorite baking recipes because we are on a roll over here 👩🏻‍🍳
Just left my mom vacation. 💆🏻‍♀️ I do Just left my mom vacation. 💆🏻‍♀️  I don’t know what this says about me. Anybody else find the dentist weirdly relaxing? For the most part, I love being with my two tiny humans all day, but BLESS does it feel good to lay in a chair for 60 minutes with my eyes closed and do nothing except hold my mouth open.
🙌🏻🙌🏻🙌🏻🙌🏻💃🏻💃🏻💃🏻 two babies are asleep at the same time in their beds (and not on me) for the FIRST TIME IN 7657 DAYS and dear lord I could cry tears of relief straight into this latte and bowl of chocolate chips bc I woke up this morning exhausted and weary and told Nick I didn’t want to parent today 🤣 Not even calling this self care. It’s sanity right now. And even if it lasts 5 minutes it will be 5 minutes of freaking glory. p.s. yes that brick is crooked bc v uneven floors are part of the charmed package of this old house
Learning over and over again in this season that f Learning over and over again in this season that feels unsettled and chaotic and longgggggg that sometimes, you just need the viewpoint of a toddler to remind you that the seemingly insignificant things & moments really are....straight up magical. And that yes, these mundane days are packed full of goodness & beauty if I keep my eyes fixed on what actually matters.
Spent two hours at Lowe’s this morning and wow, Spent two hours at Lowe’s this morning and wow, wowww 🤯 Asked at least six people where to find something and their opinion on all the options bc holy decision fatigue. Nursed my newborn on the floor of the paint aisle. And BLESS my new contractor friend Matt I found in the lumber section that pushed my cart around and helped me avoid the mistake of buying exterior wood for some DIY bathroom shelves.
.
I’m giving all our bathrooms a DIY makeover and I couldn’t be more of a rookie. So shoutout to all my Lowe’s buddies and YouTube 😜 You’re making this happen.
We are now officially homeowners. WUT? We didn’t We are now officially homeowners. WUT? We didn’t plan to close on a house 10 weeks after having a baby, but here we are. And we are so, so grateful.  And I’m also terrified. We’ve moved three times and lived in three different states since we got married three years ago. After six years spent living in New York City and Boston, moving back to Charlottesville was really, really hard for me. I cried a lot those first six months because my heart ached for the northeast and for city life. I wanted to pack up and go back to Boston ASAP. It felt so different and so quiet here and at times, very lonely. Even though it felt like the next right step, I second guessed our decision A LOT.
.
But here we are 10 months later ready to continue investing in this neighborhood we’ve come to love. And this community of people that have become so dear. Ten months later and it feels so, so right. And although committing to settling down here for a good bit feels really scary to me, it also brings so much peace to know we aren’t moving again anytime soon. We are here to plant and grow. And raise our babies in this house as we make it a home. It’s also really fun to have one of your best friends be your realtor. We love you @kelli.teter.nesting 🤗
.
Now, to see if we make it out of this kitchen renovation all in one piece 🤪
my go-to breakfast these days is two fried eggs in my go-to breakfast these days is two fried eggs in ghee with sautéed spinach (also in ghee) and an english muffin with more ghee + some sort of jam on half for that sweet & savory combo. we discovered these local english muffins (from The Bread Basket) and they are doughy and delicious and we are obsessed.
.
I’ve found that I need a solid source of protein and lots of fat for breakfast to keep me full while breastfeeding this time around vs with Cal, I was so into big bowls of pb & chocolate chip banana oatmeal. just goes to show our bodies know what they need and change cravings accordingly. also, just a psa: go pick up the maple butter from @traderjoes bc it is bonkers 🤤 and lastly, shout out to my husband bc a lot of mornings he is making this bfast for me while I nurse & try to pull myself out of bed - don’t for a moment think I’ve got it together 🤪
I’ve had many thoughts rolling around in my brai I’ve had many thoughts rolling around in my brain of if/how to use this platform in a way that aligns with how I want to live my life. I’m finding it tricky to discern that when 90% of my use on this app is for professional purposes. But I’m not sure if even professionally, it makes sense for me. Because I feel more aligned with what matters to me when I’m not regularly present here.  I’m not really sure what things will look like moving forward, but for right now I’m here to share with you that I somehow found some spare minutes between newborn & toddler life to write a post with some semi-coherent thoughts on life lately. 🤪 You can head there by clicking the link in my profile.
I’ve been completely disconnected from social me I’ve been completely disconnected from social media and that’s been vital for me during this tender postpartum period of transitioning from a mama of 1 to 2. But today, I’m bopping on briefly to share how Teddy entered this wild world with you - if you’re into a lengthy, detailed birth story, the link in my profile will lead you to the blog post 💙
Theodore “Teddy” Lars Nohling joined our famil Theodore “Teddy” Lars Nohling joined our family at 12:48am on Wednesday after a quick and swift labor & birth at home 💙 Thank you Father for another healthy baby boy & your abundant, tender love for us. What an undeserved gift.
Very grateful to be carrying another baby past his Very grateful to be carrying another baby past his due date, but also....LET’S GO DUDE. Still over here eating dates (check out the @ebbirth article on the research showing dates can help ripen (aka soften) your cervix, reduce the need for medical intervention in labor and can overall, improve birth outcomes) drinking red raspberry leaf tea and sleeping as much as possible with a 19 month old running around. And also trying to survive July in VA without public pools or splash pads bc it is BLAZIN HERE (and I’m a wuss with the heat 🤪)

Copyright © 2021 · The Real RD· Blog Design by Little Blue Deer


Terms and Conditions | Disclaimer | Privacy Policy