In my experience, dietitians tend to come from one of two schools of thought: (1) those who believe in structured meal plans and (2) those who promote a concept known as intuitive eating. It is very all-or-nothing. Which is ironic, since intuitive eating is supposedly about eliminating all-or-nothing thinking.
I've worked with both, and at this point in my career, in my chosen specialty, I am a blend of both. And that is what seems to work best with PCOS.
It would be nice if women with PCOS could be intuitive eaters. But it isn't a natural talent, and it often isn't possible out of the starting gate.
Here's a story from my caseload to illustrate.
A few years ago, I met with a young woman with PCOS. We met for an hour and half. I sketched out a meal plan for her and explained how it would help her cravings and make it easier for her to eat intuitively. She was very polite and accommodating, but at the end of the session she asked me,"But what am I going to do about my cravings?" I reminded her that her cravings would decrease. She asked the same question again. We went in this conversational circle several times, and it finally hit me, that my poor client had struggled with her intense carbohydrate cravings for so long that she no longer even knew what hunger was. She had also been let down by so many health professionals giving her bad advice that she didn't trust mine.
I finally asked her to tell me what she normally did when she had cravings. She motioned me to follow her into her kitchen, where she opened a drawer and showed me her stockpile of Snickers, 3 Musketeers, and Baby Ruth bars. I was completely humbled. I realized that since I don't have PCOS myself, I had no way of relating at all to the women who had the syndrome who I wanted to help.
I told her to do her best to follow my meal plan, and if the cravings got to be really bad, to have a candy bar.
The good news was…she never once needed a candy bar.
Lesson two for ME was…now that we'd eliminated the cravings, I was working with a completely blank slate, with a person who really had never had an opportunity to learn what foods she liked and didn't like, or what hunger and fullness really were. She had been at the mercy of cravings for years.
We had to start with a structured meal plan in order to learn what many of us learn as children. I literally had to put foods on the list for her to commit to preparing and trying. Gradually, she started to understand what hunger and fullness was, and a good chunk of the time, she was able to use some intuitive eating skills.
But the story doesn't end, even THERE!
As the layers of disordered eating peeled off, and food became less of a priority, my client now had to deal with the reality that she now had quite a bit of free time on her hands that once belonged to food procurement. She had to learn to deal with that time in ways other than boredom eating, or eating in response to emotions she was becoming aware of.
Something else that I've learned is that there are times when intuitive eating can be the primary tool a woman with PCOS uses, and there are times when it simply won't work. You may need to be a little bit more structured when you are under stress, when you've got a cold, haven't slept well, are pregnant, etc. When you are insulin resistant, and you're increasing activity and decreasing food intake, you may have times when you feel very hungry, to a degree that doesn't match what you observe about your routine. It can feel scary, and it can be tempting to binge. You may need to gently back yourself out of that corner with some simple structure.
Each one of you has a different story, a different PCOS presentation, a different hormone function, a different brain, and a different response to food. The most important thing you can look for in a dietitian, is not one who is going to tell you that you need to be an intuitive eater, or a structured eater, but one who empowers you to discover who YOU are and to help you design a lifestyle that accommodates what you need to do in order to maximize your potential.
Our inCYST dietitians are all trained to help you map out this path of discovery. If you've tried the"all or nothing" approach to restoring eating sanity, and no way seems to work well, consider engaging the help of someone who understands that you are unique. Our referral page is getting longer as professionals complete the training. Be sure to check in the next few weeks as I add names and contact information for options that might work for you.