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.
I have been in Vermont all week, busy teaching PCOS classes at Green Mountain at Fox Run. I have been so busy that checking email and answering my phone has been pretty much an afterthought. I realized how easy it is to drift into becoming attached to electronics in unhealthy ways.
I decided to Google"iPhone addiction" just for fun, and found a Stanford survey reporting the following results obtained from 200 students, most of whom had had their iPhones for less than a year:
When asked to rank their dependence on the iPhone on a scale of one to five, five being the most addictive, ten% said they were fully addicted. 34% ranked themselves a four and only 6% said they weren't addicted at all.
Nearly a third worried they may become addicted someday.
A full 75% admitted to falling asleep with the iPhone in bed with them, and 69% said they were more likely to forget their wallet than their iPhone when leaving in the morning.
Why is that an issue? When you are so attached to what is coming out of your electronic gadget, you are not paying attention to important cues your body may be giving you about stress, emotions, hunger…you may be so caught up in what is happening on Facebook that you fritter away time that you could be spending on yourself, in physical activity…your life is virtual, not REAL.
I see disturbing trends that show how detached we are becoming, such as people Tweeting from a meeting, reporting that they are at the meeting. How can you possibly be getting anything out of the meeting if you're not even paying attention to the people you are physically with?
I see people posting Facebook status reports from"getaways" in remote locations…when I thought the point of getting away to a remote location is to not be communicating with the rest of the world for a little bit.
I hear stories of people so attached to their iPhones that they actually feel phantom vibrations if they try to live without them.
If you bring your phone to bed with you, it's disrupting your sleep. And when your sleep is disrupted, you are more likely to be insulin resistant and hold on to weight.
Tell me…honestly…is that 3 am text you're waiting for really worth the 5 extra pounds you may be carrying just to get it?
Electronic food for thought: If you are really that important and indispensable, you don't have an iPhone. Your personal assistant does. If you're unable to detach from your Blackberry, you're a slave. Everyone you allow to contact you at 3 am is someone who has taken control of part of your life.
Take it back! Challenge yourself to leave the phone for a half hour or an hour. Leave it in the kitchen at night. Don't bring it to the gym. Give yourself one technology-free day a week. See what happens to your awareness. Of your emotions. Of your hunger/fullness. Of your choices of how to fill your time.
You might find that you start setting more limits with mailing lists, Facebook friend lists, Twitter follows, etc., because all that electronic chaos interferes with your life.
Technology isn't a bad thing, at all…my business is able to exist because of it. But if it is not used respectfully it may be one of the most important reasons your optimal health is so elusive.
You can't just read about, status report, tweet, electronically discuss healthy living. You have to LIVE it.
I was recently graciously shipped a jar of Tropical Traditions Gold Label Standard Virgin coconut oil for review. First of all, thank you to Tropical Traditions for their generosity! I use coconut oil twice a day on my skin and I love the noticeable difference it makes. I'm also learning to cook with it, and am happy to have this to work with.
This is a long, drawn out post. I'm putting my conclusion at the very beginning so you can decide if you want to sit through the rest:
I love coconut oil, I use it myself, both in cooking and on my skin. I love this particular brand and product, and it's clear that the company is very proud of the attention they devote to quality and sustainable practices. If you choose to incorporate coconut oil into your cooking, and I hope that you do, please consider supporting a company that works so hard on behalf of integrity.
My intention is to encourage more people to use coconut oil than currently do. It wasn't long ago that we discouraged coconut oil consumption and I still encounter people who think it's unhealthy. I'd also like to encourage those who may be creating problems with excessive use, to understand why that may not be a good choice.
My only reservation is that there is somewhat of a health halo hanging over coconut oil that encourages its use in quantities that potentially do not support improved health.
I'll be addressing those issues in this post. A little bit of feedback on the coconut oil information I found on the website.
In the FAQ section, there is no peer-reviewed reference provided to support the following statement:
The benefits of coconut oil are mainly from the nutrient value of medium chain fatty acids (MCFAs). The best comparison in nature as to the percentage of MCFAs being consumed in a diet is human breast milk. To equal the amount of MCFAs a nursing infant would receive in one day, an adult would need to consume about 3.5 tablespoons of coconut oil a day according to researchers.
1. With regards to fat, what an infant needs, nutritionally, is far different from what an adult needs.
For example, nutrition experts recommend 2% milk for children up to to years of age, then a drop to 1% or skim. The reason for this recommendation is that the extra fat is needed during the first 2 years of life to help fuel the rapid growth occurring during that time. As growth and development slow, so do needs for dietary fat.
Arachidonic acid (ARA) is an essential fatty acid for infants. The only place they can get it is milk, so if an infant is formula fed, ARA needs to be added to that formula. When that infant is weaned, however, and can get this fatty acid elsewhere, it no longer needs to be added to the diet.
It simply has not been proven that nutritional needs for infants are the same as nutritional needs for adults. Or that what you would feed an infant is even healthy for an adult. So I'm not entirely convinced that the extrapolation from an infant's saturated fat intake in breast milk, to a recommendation for adults of 3.5 tablespoons per day is a logical or healthy leap. (I am happy to adjust my stance if peer-reviewed research supporting the higher level becomes available. Our readers are in large part pursuing fertility and possibly in the midst of infertility treatment. I owe it to these high-risk situations to lean toward the skeptical and conservative. I don't want to heap more expense, stress, and/or disappointment on women who take our advice so seriously.)
Fat is fat, no matter where it comes from, it still contains calories, and the recommendations are still to keep saturated fat intake to about 10% of total calories. Regardless of the source of the saturated fat.
I did a long blog post calculating dietary amounts for different calorie levels that this translates to not too long ago if you want more specifics. I do think that when possible, saturated fat from coconut oil is better than saturated fat from meat, so the focus needs to be learning how to make that switch. (See the recipes I posted below.)
2. In moderate quantities, coconut oil can definitely be beneficial. A 2009 Brazilian study providing 1 tbsp per day of coconut oil to a group of women with abdominal obesity found that compared to 1 tbsp of soybean oil, the coconut oil group had higher HDL, a lower LDL/HDL ratio, and a reduced waist circumference. It cannot be determined from this study design if the change was due to the absence of soybean oil, the presence of coconut oil, or a little of both, but it does illustrate that when used in moderation, coconut oil can be part of a hormone-friendly eating program.
3. What IS showing up in the literature is that too much coconut oil can be metabolically deleterious. Individuals at risk for diabetes (and if you have PCOS that means you) need to use coconut oil with care. One recent study in particular (done with calves) compared coconut oil to a non-medium-chain triglyceride (MCT) diet as well as to another MCT, caprylate oil. The coconut oil-fed calves weighed pretty much the same at the end of the study, contradicting claims that coconut oil promotes weight loss. In addition, the coconut oil calves had heavier, fattier livers and contained 15% more fat than the livers of the other calves.
Bottom line, used respectfully, coconut oil has many health benefits and I do encourage its use. What I DO discourage, is using this product indiscriminately with the belief that it has any kind of magical quality that counteracts dietary indiscretions or which somehow allows you to ignore other important rules of nutritional balance.
4. I spent a long time on the company's companion website, http://www.freecoconutrecipes.com/ to see how others were using coconut oil in cooking. Most of the recipes were for baked goods and sweets, the use of which, due to the insulin resistance issue the readers of this blog deal with, should be limited. Cakes, cookies, etc., are not nutritionally dense and cannot be eaten in large quantities just because of the oil they were made with.
I did find a great recipe for coconut oil vinaigrette coleslaw, which nicely combines the concept I've been writing about recently, consuming a bit of vinegar before meals, with a nice, moderate use of coconut oil. I would so love to see more savory recipes like this, as it would help the readers inCYST most often works with, to use this oil to their benefit.
I did my best to walk the walk, as well, and asked the members of our Facebook fan page to share any savory recipes they might have using coconut oil. Here are a few provided by culinary school graduate Alyssa Fritts.
Coconut Green Beans Blanch fresh green beans by dumping them in boiling water for about 20-30 seconds. Strain them out and put them in ice water to s top the cooking. Melt a tsp or less of coconut oil in a pan. Add 1/2 clove of garlic and the strained green beans, toss around a few times. Add chopped almonds and salt and pepper to taste.
Coconut Pork Chops Put a little bit of coconut oil in a pan, salt and pepper pork chop with all fat trimmed Brown on both sides. Remove chop, add garlic, and chopped onion. Saute until garlic is fragrant. Add veggie or chicken stock and a LITTLE bit of apple jui ce. Put chop back in and let it reduce down by about half. Remove chop and place on plate. Add a scoop of stone ground mustard, and a sprig of fresh rosemary. Let it thicken. Finish with a swirl of coconut oil to give it the smooth fullness butter would. Pour over your chop.
Miso-Ginger Salmon 1/2 tsp coconut oil 1 clove minced garlic 1/8 in piece peeled ginger in matchsticks 1 tbs chopped onion 1 tsp miso paste 1/4 cup white wine 1/4 cup veggie stock or water 1/4 tsp coconut oil
Melt 1/2 tsp coconut oil in pan. Salt and pepper salmon. Place in pan skin side up. Brown on both sides. Set aside on a plate. If needed as a tiny bit more coconut oil. Add ginger and garlic. Add onion and sautee for a few seconds. Add wine and stock. Add salmon back to pan and cook for about 5 min. Remove salmon and turn heat up to high. Add miso and reduce down until thick. Swirl in a tiny bit (up to 1/4 tsp) of coconut oil and pour over salmon.
What Alyssa is illustrating, beautifully, is that one of the best ways to use coconut oil is to switch out other oils for coconut oil in your regular cooking, being careful with quantities just as you would any other fat. It adds a nice flavor while it helps your metabolism.
If any of you use Tropical Traditions Coconut Oil, and you've developed some savory, hormone-friendly recipes you'd like to share with our friends at Tropical Traditions, I would love if you would do that. I'd like their customers to see just how much potential this oil can have in the kitchen. I'd really love to see this company, which clearly has a heart for wanting to do something good, succeed at that goal. I'm in love with the creativity of inCYST fans, and encourage you all to step up and share it in a way that can have benefit far outside of this blog post.
Bottom line: Used intelligently and respectfully, Tropical Traditions gets a thumbs up. Stay tuned, as tomorrow we're going to announce a giveaway encouraging you to think about and incorporate the concepts presented in this blog post!
Assunção ML, Ferreira HS, dos Santos AF, Cabral CR Jr, Florêncio TM. Effects of dietary coconut oil on the biochemical and anthropometric profiles of women presenting abdominal obesity. Lipids. 2009 Jul;44(7):593-601. Epub 2009 May 13. Talbott, Shawn M. and Kerry Hughes. (2006). The Health Professional's Guide to Dietary Supplements. Lippincott Williams & Wilkins. pp. 60–63. ISBN 9780781746724.
Mills JK, Ross DA, Van Amburgh ME. The effects of feeding medium-chain triglycerides on the growth, insulin responsiveness, and body composition of Holstein calves from birth to 85 kg of body weight. J Dairy Sci. 2010 Sep;93(9):4262-73.
A few years ago I stumbled on a website that is a great resource for people wanting to learn about the relative health benefits of individual foods.
This website, www.nutritiondata.com, provides some PCOS-pertinent information in addition to the the traditional calories/carbs/vitamin content most other websites provide:
1. Fullness Factor: An indication of how physiologically full a food is likely to leave you feeling. For those of you who are trying to lose weight, the closer to the upper right hand corner you get, the more supportive of your weight loss goal that food is likely to be.
2. Caloric Ratio Pyramid: If you've been advised to eat a certain percentage of carbohydrates, proteins, and fats, this section will tell you how closely you are meeting that goal.
3. Estimated Glycemic Load: Gives you an idea how your food choices are promoting…or discouraging…good insulin function.
4. Inflammation Factor: Since PCOS is a disease of inflammation, your goal is to have as anti-inflammatory of an eating pattern as possible.
You can keep your food diary here and see how a daily total adds up.
It's important to remember when using a tool such as this, there is no perfect way of eating, and no good or bad food. A food that is more inflammatory or less filling isn't bad, it's just one that needs to be eaten in smaller quantities in order to not throw your daily nutritional value in the pro-inflammatory direction.
I italicized the word physiological above because this tool does not work with emotional hunger. If you're using food to cope with depression, in response to negative pregnancy tests, or as an outlet for feelings you may have about PCOS-induced appearance issues…it's important to ask for help in learning outlets with less potential to be self-destructive.
Our"Food of the Week" feature is designed to help encourage a variety of foods, since many women dealing with PCOS have been on so many restrictive diets and yo-yoed back to an even higher weight, they often find themselves in a place where they don't even know how to get started on truly healthy eating. We can't possibly tell you every single food that will work, but we can trigger some ideas. With a tool such as this website, you can hopefully take the information you've learned here and apply it to your entire daily intake.
I've been a dietitian for 26 years now. I've seen, at this point, thousands of clients for dozens of reasons. And despite all of the new information available, medical advances, and my own experience, one thing has not changed.
Meal plans do not solve medical problems, they do not cause weight loss, and they do not improve your fertility.
If I had a dollar for every time someone called me, asked for an appointment, politely listened to everything I had to say, then changed the subject and asked for a meal plan, I wouldn't have to write this blog to earn a living.
Face it. If a meal plan was what you needed, you could buy one for $15 at Borders. Better yet, you could get it for free at the public library. By the time you likely asked for help, you'd probably tried several meal plans…and none of them worked.
Or, you tried the meal plan, and it worked, but you quit using it. And started looking for another meal plan.
The definition of insanity is trying the same thing over and over and over and over and over and over again…and expecting a different result.
If you are bouncing from meal plan to meal plan, and either not trying them long enough to see them work, or not following a meal plan that works and hoping that dropping money on a consultation with a nutritonist will produce results that you didn't get the last time you didn't try something…
…you are participating in insanity.
So for the benefit of women everywhere looking for help with their PCOS, here is a list of considerations. If you are honestly (and I mean honestly) looking to learn how to eat better, here is a list of what meal plans can and cannot do.
1. A meal plan can help you to get a handle on realistic portion sizes. No dietitian out there expects you to weigh and measure your food for the rest of your life, but our estimation of portion sizes tends to creep up over time. Getting back on track with portion sizes can be useful.
2. A meal plan can remind you to eat from a variety of food groups. My experience is that people eat best when they focus on what they CAN eat, rather than on what they CAN'T. Most people who are not eating well are not eating fruits and vegetables. A meal plan can remind them to get enough of these important foods, and most people who DO are full enough to not be hungry for foods that get them into trouble.
3. A meal plan can encourage you to try foods you weren't hungry for when your carbohydrate cravings were in control. This is an important one. Many women with PCOS are clueless when it comes what to eat, because they have spent so much time trying to satisfy cravings that originate from their hormone imbalance. Once those cravings are corrected, which our program is very good at doing, a meal plan can teach you what normal eating is like.
Now, here's what meal plans WON'T do.
1. Meal plans won't cause weight loss. Following a meal plan can correct a calorie imbalance and encourage weight loss. But you have to follow it. Buying one from a bookstore or a dietitian and letting it collect dust on your desk, won't give you results.
2. Meal plans won't make babies. We're pretty good at correcting hormone imbalances, but even so, we cannot make guarantees. We do know that women who have the ability to make changes over an extended period of time are more successful at correcting hormone imbalances that make it hard to have a baby. But the keywords in that last sentence are make changes and over an extended period of time. Buying a meal plan is not making changes. Following a meal plan is making changes. One week is not an extended period of time.
3. Meal plans won't teach you how to recognize hunger and fullness, and how to distinguish hunger from cravings. A dietitian, if you trust him/her, can guide you through that process. But you have to look up from your meal plan and listen…and try…what they're excited about teaching you.
4. Meal plans won't stop you from emotional eating or binge eating. If you have a history of yo-yo dieting and binge eating, a meal plan may actually set you off. You may rebel against it. But why? The only person you rebel against, when you rebel against a diet…is yourself. A meal plan is an attempt to impose superficial structure over chaos. Not all that different from putting a shiny new paint job on a rusted out old beater, hoping no one will notice the inside. And when you fail, you end up reinforcing with yourself that you do not deserve to succeed. A dietitian can help you succeed. But only when that is what you are ready to do.
Next time you ask a dietitian for a meal plan, be sure you have been able to verbalize, out loud, just what it is that you expect the meal plan to do for you. Better yet, go into your bathroom, look yourself in the eye in the mirror, and say out loud,"I would like a meal plan because it will help me with __________________. I commit to following the meal plan for __________ weeks before I determine that it is not working. And before I quit, I will ask the dietitian I asked to give me a meal plan for help in problem solving why it didn't work. I will ask her how to help me succeed."
Then write your commitment to yourself on two pieces of paper. Post one on your refrigerator and the other on your bathroom mirror.
If the thought of doing this leaves you feeling uncomfortable, it's time to be honest with yourself. Maybe a meal plan is not what you're looking for.
Do you eat when you aren't physically hungry? Do you eat when sad, mad, anxious or bored? Do you have the desire to eat what you want when you want and still maintain a healthy weight? Do you have long lists of “forbidden” or “bad” foods? Do you have a hard time recognizing hunger or fullness?
Starting February 20th from 9-10:30 am Join this weekly group while you can. The group will be 12 weeks long. We only have 8spots and once they are filled, the group will be closed.
Call 714-914-0673 to find out if this is the group for you!
Marissa Kent Nutrition 26461 Crown Valley Pkwy, Suite 100 Mission Viejo, CA 92691 Phone: 714-916-0673 Email: marissakentrd@cox.net
This is a common complaint I hear. Let's work backwards to understand what is happening…and what can be done about it.
Your hunger and satiety (fullness) is regulated by a number of factors. Only one of those is how physically full your stomach is. Another very important mechanism is your blood chemistry…primarily, your blood glucose.
Your blood glucose is strongly linked to your insulin levels. Insulin is a storage hormone, and its job is to pull glucose and fat out of the bloodstream and store it. One of the first things that happens with PCOS, before you develop full blown insulin resistance, is hyperinsulinemia (elevated insulin levels). This extra insulin is always in the blood, which means you may have more of a tendency than average to experience drops in blood glucose.
It takes awhile for food you've eaten to be digested, absorbed, and to get into your blood. So if your blood glucose dropped precipitously before dinner, it may take awhile to bring it back up to a place where you're not feeling hungry. Even though your stomach might be feeling physically full, you may not have enough energy in your system for your biochemical radars to trust that you're ok.
And so they tell you that you are hungry.
The very best solution to this, is to eat a diet higher in protein. About half of the protein that we eat is converted into glucose, and that process tends to kick in just about the time the carbohydrates we're eating have been used up. So if you're having trouble feeling hungry just as you're finishing up dinner, try having a snack with about 10 grams of protein mid-afternoon.
This is one reason why it can be challenging (and not appropriate) to use a 100% intuitive eating approach when you first start to change your diet. If you acted on that post dinner hunger, you would likely binge. Intuitive eating is what you're aiming for, but you may need to be a little bit more conscious about structuring your diet in the early phases of a nutrition plan so that your hormones aren't interfering with your ability to detect true hunger and satiety.
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.
