Good morning! It’s International No Diet Day. Let’s take the world by the horns today and eat kindly respecting hunger and fullness. Today, let’s move away from moralistic labels…clean, organic, raw, paleo, low kcal, low carb, unprocessed. Keep this perspective: it is food not your standing with your Higher Power. And, let’s think about what is important (and what dieting distracts us from): taking care of each other.
In the spirit of this celebration of our innate health wisdom, I have gathered some of my favorite non diet dietitian blogs. My own Food Peace Challenge Manifesto and related posts are here.
This week’s blog is doing cartwheels around the possibility of PCOS and food peace. This is the third of five posts. I hope you find this information invigorating and revolutionary. If you have PCOS, please know you don’t have to punish yourself anymore. You can find health without diets!
Weight loss, Weight Regain Hurts Health
PCOS weight loss often includes drastic measures that are impossible for 95% of the population to continue. Because of our human physiology, weight loss is followed by a period of rapid eating and weight regain. Have you ever lost weight only to regain more? I have heard many women with PCOS describe losing 50 to 100 pounds only to regain 100 to 150 more within the next few years.
If this is your history: it isn’t your fault.
On behalf of medical and health science, I apologize that we gave you the wrong solutions. We don’t have many good ones yet, regretfully. We do know that continuing the weight loss weight regain cycle will only make you sicker.
Because weight regain is the rule not the exception, weight cycling studies–the research word for yo-yo dieting–come in handy. Weight cycling studies suggest this process ends up making a body with more inflammation and higher insulin levels 1, 2, 3, 4. Remember, PCOS already includes astronomically high insulin levels. Why contribute to this?
Even more, the higher insulin levels rise, the more intense the carb cravings. When I say craving, I don’t mean a lurking thought. I mean an experience where every cell in your body screams: EAT CARBS AND EAT THEM NOW! Carb restricting may seem like a good idea yet please reconsider. We have neuropeptides that release messages to cells when carb or calorie intake is low or perceived to be low that further enhances this screaming. Carb abstinence only enhances binges. This hurts in 3 ways:
Further increases insulin levels from high carb binges
Places the woman at higher risk for eating disorder pathology
Contributes to weight cycling insulin and inflammation increases
If you have PCOS and want to lower insulin levels, do not diet. Don’t even think about it.
This week’s blog is doing cartwheels around the possibility of PCOS and food peace. I hope you find this information invigorating and revolutionary. If you have PCOS, please know you don’t have to punish yourself anymore. You can find health without diets!
Dieting, PCOS, and Eating Disorders
I am primarily an eating disorder behavior expert. My training in nutrition and counseling helps me understand the root of client pathological connections to food. Although not always understood, eating disorders have the highest fatality rate of all mental illnesses. Eating disorder research is providing answers to the question, “Why!?!” The textbook eating disorder recipe: genetic predisposition, negative body image, and a change in eating habits (here’s an article explaining this).
Negative body image occurs frequently with PCOS. Remember that facial hair, balding, and fat tummy? Not exactly fitting cultural ideals of beauty. Combine that with weight stigma and most women with PCOS dislike their body. Of course they will try everything to change it. Why is it so hard though?
Most women with PCOS have insulin resistance (IR). Of important note, insulin levels are tremendously higher in PCOS compared to folks with type 2 diabetes. This means women with PCOS feel more chaotic from IR. Insulin is a growth hormone so when it is high a person’s weight will not go down unless doing something drastic. I refer to this as extreme dieting and won’t go into details. I do witness women with PCOS losing weight from these methods yet the weight always comes back. This sucks yet what is even worse is it starts diet → binge cycle.
And an eating disorder is born.
From here, genetics take over whether it becomes anorexia nervosa, bulimia nervosa, or binge eating disorder or subclinical disordered eating. None are health promoting. Remember, eating disorders have the highest fatality rate of any mental illness. We don’t know a person’s genetics by looking at them. We do know women with PCOS typically have the other 2 parts to the eating disorder receipe: negative body image and change in eating habits.
Numerous twin studies suggest the more a person diets the more disordered their eating (article explaining many here).
Why are we prescribing a method (diets), that has no scientific proof to work and can cause a mental health condition with the highest fatality rate?
Keep asking this question because we must find a better solution. Women with PCOS: you deserve a better one.
PCOS sucks. PCOS = polycystic ovarian syndrome. Never heard of it? Most people haven’t although the TLC reality series My Big Fat Fabulous Life is changing that. PCOS is poorly understood and takes over the whole body (more on that here). It causes facial hair, male pattern baldness, mood disorders, infertility, insulin resistance with ensuing intense carb cravings, and can lead to diabetes. The icing on the cake? PCOS makes some women fat especially around the stomach 1.
Women with PCOS often tell me the pressure they feel to lose weight. It’s no secret our world judges fat people as lazy, stupid, and without self-control. Do you know how hard clients with PCOS try to lose weight? Harder than you can imagine. Most of the time, women with PCOS see the scale go down only after extreme diets (read: eating disorder behaviors) that are impossible to continue. This is not lack of will power or self-control. This is human physiology. Even more, this sets up a human body with more disease.
I will break it down over the next few days why diets don’t help PCOS rather make it worse. First up:
Diets don’t work.
A fat person walks into the health provider office. She is given a diet.
No matter why they are there.
This is not a joke.
I am known to be a non-diet dietitian and many people try to convince me when diets are necessary: diabetes, high cholesterol and very fat bodies are common examples. And, I agree at times a person can eat in a way that is harming his or her body and possibly causing the body weight to be higher than his or her body would like it to be. Without fail, upon meeting a person with a very fat body, I find diets have been a central part of their eating experiences. Fat people seeking to lose weight are in a constant rotation of one of these:
Preparing to go on a diet.
On a diet.
Bingeing after a diet.
The length of time may vary and yet for most of the population this cycle continues as long as diets are pursued as an answer. My question: if diets work, why do we need to keep going on them?
There is no research to date that shows any diet keeps weight off for more than one year. Not one. Almost every scholarly journal publishing articles on a diet stops at one year or earlier. Those looking further out have incredibly high drop out rates (the eating or exercise plans are too tough to stick with) or correlational. And my college stats class taught me correlation does not equal causation. You too? We should expect more out of modern medicine and research.
We know diets don’t help health 2. Rather, they are the greatest predictor of weight gain 3 and 95% of dieters regain all of weight lost 4. Wait. What???
Say no to diets. Choosing diet free living is not neglectful rather healthful. It’s not letting yourself go, it’s letting yourself be.
This week’s blog focuses on insightful nuggets gained at last week’s 2015 International Association of Eating Disorder Professionals Symposium. Picture a worldly army restocking supplies for the war against eating disorders. The meeting of the minds rejuvenates my spirit and my toolbox is full with new ammo. I look forward to sharing them with you here, in sessions, and presentations. Enjoy!
Many of you participating in the Food Peace Challenge may have experienced a binge or even diagnosed with binge eating disorder (BED). Melainie Rogers RD and Marissa Sappho LCSW want you to know about their Reframing Recovery Model. It is for those seeking to help promote recovery from BED. I was shocked to learn that almost 10% of us has binge experience. If you have BED, keep in mind recovery is a marathon not a sprint. It takes twice as long to recover from binge eating disorder compared to other eating disorders. How long? 8 to 14 years. Don’t worry, I am with you for the long haul.
Binge eating disorder often serves a purpose during challenging times. It can be dissociative, soothing, [cussing alert] promote the “FUCK IT!” voice, or even punishment.
This eating disorder is worsened when a person tries to lose weight through food restriction. Remember, weight loss then regain is the dieting rule not exception. Whenever a person loses weight, fat and a little muscle is lost. Weight regained is only fat not muscle. When this happens, metabolism and strength are lost. Bummer! Even more, rapid weight loss breaks down even more muscle. Remember this next time you want to find a quick weight loss regimen!
The presenters had a word of advice: to stop bingeing, learn to avoid extreme hunger or panic hunger. Prioritize meal time (that means do not work through lunch nor skip breakfast because of a night-time binge). Many people keep food logs to keep up with meal planning self-care. Even though food logs tremendously help clients move toward eating disorder recovery, they can be tedious and shaming for many to keep. Do you agree?
If so, you will love this advice: instead of writing down your food intake, just put an “X” next to the meal or snack when you eat. Once pattern is as directed by your dietitian (not skipping meals and eating throughout the day), start noting hunger and fullness levels. Do NOT note food choices because WHAT you eat is neutral to we eating disorder RDs. WHEN and WHY information helps us to formulate recovery strategies.
Cussing Alert: The Fuck It voice is very common in binge experiences. It is symbolic and physiologic. Working toward repairing the Gentle Voice ™ helps those with BED to recover. The presenters noted practicing self compassion and mindfulness can help clients begin to repair this side of the conversation.
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