The Hemp Connection:
intuitive eating

One of the pieces of PCOS that I find intriguing, but which really is not well studied, is what is happening with appetite. This is such a crucial piece of the picture, because it doesn't really matter what ANY expert, medical, nutritional, whatever…tells you that you SHOULD be eating, if your appetite hormones are not supporting the advice.

In order for us to better understand what is happening, and therefore derive effective solutions for this problem, we need to toss a couple of assumptions we have about women with PCOS.

It may not be valid to assume that women with PCOS overeat simply because of emotional issues. (Note: I did NOT say there is NO emotional eating, but I suggest that it may be but one of the pieces of the puzzle.) It seems that the primary assumption on the part of many professionals is that once you lose weight, it is a sign that your appetite and intake are back in balance.

As I interview more women with PCOS, I'm learning that even lean women with PCOS struggle with appetite. A very common scenario, it seems, is to do everything right--eating, activity, sleep, stress management…and some days, despite all the effort, appetite seems to take on a life of its own.

If the experts aren't acknowledging this, some of the more strong-willed cysters may be able to learn to ignore these inappropriate hunger and fullness signals. In other words, the only tool they have to combat obesity is detached, restrictive eating. And if they own up to that with their caregiver, they may be diagnosed with an eating disorder.

Nowhere in there is there room for a physiological explanation.

Leptin, ghrelin, insulin, cholecystokinin, and endocannabinoids…all hormones affecting appetite, have been found to be out of balance with PCOS.

Given this and the stories that are accumulating in my files, it simply does not seem appropriate to advocate for an intuitive eating model as the therapy or the goal. It may be achievable over the long run, but it is not fair to recommend a paradigm that assumes that appetite mechanisms are intact, when in fact they are not.

I encourage you to share your observations with whoever is helping you. I have some work to do to collect more of the references and write about this phenomenon, so you have more science to support your advocating for yourself. It is coming.

For today, I just wanted to introduce the thought and encourage the dialogue. The more we hear from you, the more we can look for explanations and solutions.

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.

One of the most frustrating things about PCOS, from my perspective, is that, although we share a common constellation of symptoms (or else we wouldn’t have the diagnosis), every woman’s body is unique. So the dietary treatment of this condition is constantly evolving. I spend a lot of time studying the impacts of food on mood and brain health, and of course, in the great scientific tradition of self-experimentation, I’m always trying out new theories on myself. I wonder, watch, consume, and observe various foods, quantities, and combinations, and then see what happens. I also make observations based on my client’s self-reports, and my interpretation of what happens to their mood and overall sense of well-being, as affected by what they consume. My findings from this moderately unscientific study: • There are no absolutes • The rules change all the time • People believe an astonishing variety of things about food, many of them bearing absolutely no basis in science or reality • Science is probably way behind where it needs to be to support our health • M.D.s are highly unlikely to offer sound advice about food – far better to seek out the services of a dietician • The only thing the food police can agree on is that we should all be eating plenty of organic dark leafy greens • The body is fine with certain foods on some days, and not so fine on others • PMS induces chocolate consumption, wild carb cravings, and a desire for rare, salty beef • Almost everyone with PCOS gets out of control when they over-consume refined carbs • If you’re gluten-sensitive, you will get brain fog if you abuse gluten • It is true that weighing yourself daily, or multiple times a day, contributes to anxiety, and may well be a symptom of an eating disorder • Everything you ban is that much likelier to become the object of your obsession, unless you take steps to balance out your body and your brain chemistry • Details matter • Consistency matters • Treats are really good for staying on track, if they’re chosen wisely • Weight loss is rarely easy; maintenance is even harder • Depressed women with PCOS almost always overeat, not undereat • The less you sleep, the more you eat • Caffeine can be devilishly addictive, or of little consequence • Dairy is the subject of much debate, and a great deal of angst, given its popularity as a self-soothing food category • Carbs are not evil – they’re necessary for healthy brain function – but the belief that they are is remarkably fixed. My point here is that we must consider the challenges of modern dietetics, medical science, and brain treatment (from either a pharmacological or psychological/therapeutic perspective) as a process of constant evolution. If you’re doing something that isn’t working, change it up. If what you’re doing is working, but not working well enough, change it up. If you have a gut sense that something’s bogus, listen to yourself. And if you’re feeling burned out, disgusted, and hopeless about trying to figure this out, give yourself a break, retreat, do the best you can, and come back at it with renewed vigor, a calmer mind, and a more balanced perspective. Seek consultation with experts. Read up a bit. It’s all just information – no judgment. The ability to thrive depends upon your ability to adapt. Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She has completed the inCYST training. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses. If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at AskDrHouseMD@gmail.com. You can also follow her on Twitter @askdrhousemd.