96: Intuitive eating with PCOS? Do I cut dairy, gluten and carbs?

Lyndi Cohen: 0:02

Oh, hi everyone, and welcome to today's episode of no Well Miswankery. Today we're talking about PCOS, or PCOS, however you want to say it, and if you haven't heard of it, then welcome Hi. Pcos is Polycystic Overy Syndrome and it is a common hormonal disorder in which the ovaries develop small cysts. So this can lead to irregular menstrual cycles, excessive angiogen levels, which is a male hormone, and a bunch of other symptoms. So it could be things like fertility issues, acne, excessive hair growth or even losing hair, and, according to the World Health Organization, pcos affects an estimated 8 to 13% of women who are of reproductive age. So it's a whole heap of people, and up to 70% of those people may not even be diagnosed. They might not even know that they have it. So it is an unfolding thing that we are discovering, so it's a big issue for a lot of people with ovaries.

Lyndi Cohen: 1:03

So I've recruited an expert. So the expert today is Sam Abbott. She is the PCOS Nutritionist, pcos Nutritionist from Charlotte, north Carolina, and Sam is passionate about helping people with PCOS have a more peaceful relationship of food and their body while honoring their desire to manage health with PCOS. I love this. She's combining these two very important things and she's helped hundreds of clients of PCOS have less stress and anxiety around food, feel more comfortable in their bodies, bring back their periods, reduce physical symptoms and improve health markers like blood sugar, a1c levels, triglycerides, cholesterol, liver enzymes, blood pressure all that without dieting or restricting food. I love that she takes a non-diet approach to nutrition, because we all know how diet advice harms people and PCOS is no different. In fact, I think it's often loaded with a whole bunch of diet culture. Welcome to the show, sam. I am so happy to have you here. I feel like I was saying before. I feel like everyone listening to Know Wellness Wankery will be very, very, very excited to hear from you.

Sam Abbott: 2:10

Oh, thank you so much. I am honored to be here.

Lyndi Cohen: 2:14

We're just happy to have you here. I actually wanted to start with a listener question that we had from someone called Yvette Howdy.

Yvette: 2:23

I have a question about PCOS. A while ago I gave up on diet culture. I put on a lot of weight. I've heard that PCOS makes you hungrier and also carbs don't react well in your body. So it's a good idea to restrict carbs. But then this goes against intuitive eating, like I've been trying to eat intuitively, but it said that it's like better for my body to eat less carbs. What do I do in regards to trying to give up diet culture but eat intuitively? I don't want to just keep putting on more weight.

Sam Abbott: 2:51

Yeah, thank you so much for this question. I think this is a really common question when we're talking about PCOS, and a big piece of letting go of diet culture is also dismantling that internalize anti-fat bias. So something that stood out to me with that question was when the the listener said better for my body, like what are we defining as what's better for your body, and are you defining that as whether or not you're losing or gaining weight? And, if so, how do we dismantle that thought process to where you're defining better for your body to be more about your overall well-being? Because when we think about our overall well-being, we think about mental health, emotional health, all of the labs related to PCOS and all physical symptoms related to PCOS.

Lyndi Cohen: 3:49

So what you're saying is the test results you get back from your doctor how you feel in your body, how much energy you have, how your skin feels, what are the more. I'm loving this tangent.

Sam Abbott: 4:04

Sleep quality is another one. Energy levels. When we talk about physical symptoms of PCOS, we have acne heuristicism, which is excessive hair growth, hair loss, a lot of times along the front of your hairline. So those are all things to look at With labs. We look at androgen levels and we evaluate insulin resistance. So looking at your fasting blood sugar or your hemoglobin A1C, looking at other metabolic markers too, like your cholesterol levels and your triglycerides and blood pressure. So kind of taking a look at the overall big picture of PCOS management, not just the number on the scale, and also evaluating your mental health too, because if being really restrictive with food is detrimental to your mental health, then we need to decide like what is the trade-off there with labs versus mental health or physical symptoms versus mental health?

Lyndi Cohen: 5:10

Right. So this leads onto this idea of stress anxiety playing into PCOS symptoms, and I guess if there's stress anxiety related to weight, then I think that's something we really need to talk about. And I think what you're saying is we absolutely need to suspend that desire to lose weight, to really become inquisitive about what it is that we've been taught, to attach our value to that number on the scale and disassociate that so that we can reduce the level of stress as well, because thinking about how much you weigh every single day is incredibly burdensome and it's something you don't need to live with. So what is the research behind your weight and PCOS? What you're saying to me, I hear, is that it's these physical markers, these mental health markers, that are far more important than the number on the scale.

Sam Abbott: 6:03

You know, I think the research around weight and PCOS is really interesting and I think people view weight gain as a PCOS symptom and I'm not saying that it's definitely not. But I know in some PCOS circles where we're talking about newer or updated research, we're seeing a little bit that weight is more dependent on geographic area rather than whether or not somebody has PCOS, which is another reason why I don't focus on that. As you know, the symptom that I'm measuring with PCOS management, you can definitely Google research that says you know, when people lost weight, their PCOS symptoms improved. And I think it's really important to remember that correlation doesn't necessarily mean causation, meaning that you know if somebody starts a new exercise routine or maybe they're balancing blood sugar a little better, you know, did their labs improve because of the behavior or because of weight loss? And a lot of times in research in general, when somebody has gone back and controlled for that controlled for weight, like we see improvements in health independent of whether or not somebody loses weight. So yeah, I think it's a very nuanced conversation.

Lyndi Cohen: 7:31

It can be incredibly tricky to untether ourselves from that desire to lose weight, and I just want to reiterate here that you know this constant pursuit I know I had trying to lose weight my entire life with which ultimately led to plenty of weight gain and eating disorder, complete preoccupation with weight, just to note that the biggest weight predictor of weight gain is dieting. And this mindset of I need to lose weight I think Sam is saying here is what we need to be doing is focusing on how your body feels, focusing on the health, and adding in habits that are going to actually feel good, that aren't rooted in restriction. So can we talk about some of those healthy habits, what they might be, what might make our body feel better? Let's start with. A very common myth is should I cut out carbohydrates?

Sam Abbott: 8:20

Yeah. So that comes up very commonly because a large majority of people with PCOS have insulin resistance. So we see, like this, underlying insulin resistance for a long time, and then we see prediabetes and type 2 diabetes. I think that when we're talking about nutrition and PCOS, we need to be thinking about what's sustainable, what's maintainable and what's going to help me feel my best, not just physically but mentally and emotionally. You know, if you're avoiding social situations or you're having anxiety over eating birthday cake, is that what you want your big picture to look like?

Sam Abbott: 9:01

So the advice to cut out carbohydrates comes from this idea that if you're not consuming carbohydrates, that's going to be a way to control blood sugar. And, of course, carbohydrates do play a role in our blood sugar, so if you completely cut them out, you're probably going to see lower numbers. However, when we're looking at like, general lifestyle, that's very difficult to just cut out carbohydrates. I mean a lot of the foods that we like and enjoy and that give us energy are carbohydrate sources. So instead I would recommend focusing on helping your body use carbohydrates more efficiently. Like what can we do to help our body slow down the digestion of carbohydrates? Which is better for blood sugar? So carrying carbohydrates with protein and fat and increasing fiber are two alternatives to focusing on restricting carbs.

Lyndi Cohen: 9:57

I love this. I think this is an often not spoken about idea that we ultimately can't go and cut out carbohydrates. If you can't do it for the rest of your life, what's the point in doing it just for a blip in time? We want to do is this is a very smart approach, and what it might look like practically is you know, let's say we're having a piece of toast. You're going to add in a source of fat that could be something like avocado spread on your toast. You're going to add in some protein. That could be something like an egg and wamo. We've got this awesome combination with the protein, the fat and the carbohydrate and swapping that to a whole grain, multi-grain, whole meal option with that added fiber. That's also going to change how our body uses those carbohydrates, sam, I think that is such an absolutely brilliant point. It's not a matter of cutting out those carbohydrates, it's just a slight rethinking about how we might eat some of these foods.

Sam Abbott: 10:47

Definitely, and I would encourage anybody listening to trust their personal experiences. We do see an increased risk of eating disorders, especially binge eating with PCOS and if you're being really restricted with carbohydrates but then your binge eating or going through cycles where you're overeating or you recognize in yourself that you have a lot of disordered thoughts and feelings around food, like there are other ways to approach nutrition outside of just restriction.

Lyndi Cohen: 11:17

That's what I love about you specifically is how you're so aware of the fact that, according to research, 80% of women have a degree of disordered eating. That's like, sadly, that is the norm and of that many are going to have a diagnosable eating disorder. I so feel like so much health advice basically says we'll just follow this restrictive pattern in spite of the fact that you have this underlying disordered eating, and it's like ignoring this huge elephant in the room when we're creating this healthy relationship of food. It's so important. I feel like a lot of PCOS advice is rooted in diet culture, and so I'm tethered. So can we talk about the idea of needing to cut out gluten and dairy? Should you do other things that you often hear? Oh my gosh.

Sam Abbott: 12:03

Well, I will say this I just was privileged and honored to sit on a panel that gave feedback for the new, updated, evidence-based guidelines for PCOS. This is an international document, so no matter where you live, this document applies to you. There's no information in there about cutting out gluten and dairy. I think that the idea of it came from the fact that PCOS is an inflammatory condition. We see that in folks who have PCOS they tend to have higher levels of inflammatory markers, and so if you're looking at an isolated study that says dairy is inflammatory or gluten is inflammatory, then people are kind of making the connection of like. Well then you should eliminate this for PCOS.

Sam Abbott: 12:51

First of all, there's no research about PCOS and gluten to even make that connection, and also many sources of gluten are whole grains, which we know can be great sources of a variety of nutrients, including fiber, which is really important for lowering blood sugar. Another thing is that the research with dairy is really inconclusive. Like we have some research that shows it might not be ideal. We have other research that shows dairy is actually good for fertility. We do see in research that full fat dairy seems to be more optimal for PCOS, but I do think in general, this advice is just really heavily steeped in diet culture, and what I see a lot when people are eliminating gluten and dairy is they're making a lot of nutrition changes, and so for anybody listening, just make sure you're not making the connection of did you cut out gluten and dairy, but you also increased your fruits and vegetables and you're sleeping better. You started a new supplement. Are you attributing improvements in your PCOS to the elimination of something when it could possibly be from the addition of something else we have?

Lyndi Cohen: 14:08

to do these little micro experiments, getting to know our body, and not make huge assumptions, because it can take us down the rabbit hole.

Sam Abbott: 14:15

Yeah, and in research about gluten intolerances what we see is that in double blind research we see that people who feel like they have a gluten intolerance actually don't a large majority of the time. And there's such a large mind gut a very strong, I should say mind gut connection to where, if somebody truly feels like they're intolerant to something, they may experience symptoms of intolerance. And I always want to trust my clients and their own personal experiences. So if I'm working with somebody and they tell me they feel like they're intolerant to gluten, I'm not going to question that. But I do think it's important for anybody listening to kind of understand that.

Lyndi Cohen: 15:02

And just throwing out the idea right now of gluten load. And we each are going to have a certain degree of sensitivity to gluten, right? So personally, if I ate a whole pizza and I had beer, I'm going to end that meal going oh, I feel I don't feel so great. Is that because I'm gluten intolerant or is that just because my personal gluten load was probably maxed out for the day? So just considering as well that we're all going to have a certain degree of personal gluten load and it's about determining as well a tolerance level, because there is variation in that.

Sam Abbott: 15:32

And also, I mean, who's really going to feel great after they eat a whole pizza and have beer too?

Lyndi Cohen: 15:39

Indeed, you know you nailed it. You nailed it, so can we talk about this then? What we're doing? We want to be focusing on how our body feels instead of what we see in the mirror. Of course, you know we want to have that energy. We want to have our lab results coming out the way that we know are going to help make us feel good. What things can we be doing, or should we be doing, because we want to feel like we have a degree of autonomy here to make our bodies feel good.

Sam Abbott: 16:38

Yeah, I think the biggest thing is making sure you're eating enough and that you're eating regularly. I know this is going to sound very surprising, but for a large majority of the clients that I personally work with, those are the two first things that we address, because if you're not eating enough, you're going to have cravings, you're probably going to go through cycles of overeating and binge eating. Not eating enough can affect your sleep, it can affect your mental health. So, yeah, making sure you're eating enough and then making sure you're eating regularly. The two biggest issues that I see are skipping breakfast and then avoiding snacks when a snack is necessary. So those are two things Also making sure you're getting enough sleep, making sure you're managing stress those are also very important and then, like we were talking about earlier, looking at the aspect of blood sugar management and balancing blood sugars as best as within of what's within our control.

Sam Abbott: 17:41

And then, I think also too kind of expanding on what you were saying, like, yes, labs are a component and feeling good as a component too, but so is participating in life and just moving forward in life too, and I think that when there's a big degree of like healthism within PCOS, where people are trying to control every single symptom in every single lab, and I think there's a really good balance of like trying to support yourself and control, like what's within your control, and then having some acceptance for things that might be outside of your control. And sometimes that does involve body grief If we're told like the best way to live life is to have amazing energy every single day and you've done what you can to improve your energy and it has improved, but you don't always feel amazing, like there is a sense of grief there. So just understanding how to process that can be helpful too.

Lyndi Cohen: 18:42

Yeah, amen, I mean who has amazing energy all the time.

Lyndi Cohen: 18:46

I think that is. You know, I think it's very high bar to set for ourselves. And just a reminder, I love that you bring up this point of eating enough food, because it is so rife within anyone who's ever been on a diet. And just to remind everyone that we gasp for air, we have been holding our breath and in the same way, we binge on food when we have not been eating enough. And this is just such a crucial issue we see with people who have been constant dieters. Can we talk about what this might look like?

Lyndi Cohen: 19:13

You know, I think people have this idea. I know, when I was given a meal plan at the age of 11, that was the first moment when I thought, okay, this is what I should be eating, this is what I am allowed to eat. As we venture into an intuitive eating, we realize that some days we eat more, some days we eat less. What might eating enough look like for someone? And of course, there are different dietary patterns completely, but I sometimes think people think that they're only allowed to have one slice of toast, or you're not allowed to eat a sandwich, or they're scared of eating something that's got rice in it, and I just want to break down that fear.

Sam Abbott: 19:47

Yeah, I think that in terms of how your meals are built or what's on your plate, that's going to be so different for everyone, but I think being able to eat to a point of comfortable satiety and that you're making it to your next meal without feeling overly hungry, you know, if you're going into your meals to where you're feeling starving, that's a really good indication that either you didn't eat enough at your last meal or maybe it's been so long we need to add a snack in there.

Lyndi Cohen: 20:21

Then, practically speaking, it might be a matter of, as you said, adding in more snacks or giving yourself permission to have those snacks. So it could be, if you're getting, as you said, not feeling like you're feeling too hungry, at your next meal you might go okay. Well, I know I need to eat a little bit more earlier. I could add in a yogurt. Let's say you're having an apple, you could have. All right, let me add in some peanut butter.

Lyndi Cohen: 20:41

Maybe you're having a piece of bread, or maybe I need another piece of bread, and maybe I need to balance that out with having some fats and some protein. So it does feel satiating enough, as you said so beautifully, with a full fat yogurt. And just to use on that, why that might be, you know the fatness, the fat from the yogurt can be really satisfying to eat and, you know, may also be good for blood sugar levels, and I think we've been taught to fear things like fat, and so just what we're going to do is run a little micro experiment. What if you stopped to a full fat yogurt? How does that impact how satisfied you feel after that meal? Or maybe you need to eat a little bit more of that yogurt? All we're doing here is we're doing these micro experiments to see oh, how did this change and how did this make me feel at the other end of it?

Sam Abbott: 21:26

Yeah, I 100% agree, and fat is actually really important for hormones. Fat plays a role in helping our body use fat soluble vitamins, so vitamin A, d, e and K. And I do see usually folks with PCOS are not eating enough fat because fat is more dense in calories. So if you're used to restricting calories which a lot of people with PCOS are, because you've been told to lose weight a lot of times, those higher fat foods tend to be the foods that are on the chopping block. And then there's the fear around carbohydrates too. So fat and protein give our food staying power. They really help with fullness, and then carbohydrates are a great source of energy. So together those are kind of like the trio. You will probably feel your best with all three.

Lyndi Cohen: 22:20

I love this. So, rather than this current obsession with protein, which, honestly, yes, so exhausting Obsession is a good word. You're saying is if we need a combo of all three. Every single decade it feels like we're villainizing one of these macronutrients. We do not need to count and obsess over our macros, but what we're looking for is a little bit of that balance. That, I think, is a really nice takeaway from today.

Sam Abbott: 22:46

And most people, especially at lunch and dinner, are getting enough protein, especially if you're eating animal products, and usually when somebody's not getting enough protein at breakfast, it's because they're just not including protein at all. So, yeah, I'm on TikTok and I see some of these wellness influencers and they're talking about meals with 40 or 50 grams of protein and it's completely unnecessary for the average person to consume that much protein in a meal and if you are super focused on protein, that's probably going to be taking away from another macronutrient group, either a carb or the fat, Spot on.

Lyndi Cohen: 23:28

I love that. And also can we just say, in this climate at the moment, with grocery prices as expensive as they are, protein can be quite an expensive thing to constantly be adding in especially when it's not necessary. So you have these protein powders. It's like a few dollars per scoop. You just don't need it, so let's add that load as well into your life.

Sam Abbott: 23:50

Mentioning TikTok again, I was watching one of these wellness influencers make overnight oats and she was saying it was rich in protein and I just felt like she kept adding different protein sources of yogurt, and then the protein powder, and then a different nut powder, and I'm like you could have just stopped at the yogurt, like you were good there.

Lyndi Cohen: 24:13

Right, like for $28 for a serving. Yeah, crazy protein meal. I know I'm so glad that you call out those wellness influencers. I really they are why we exist, sadly, and to help people like you. Listening, sam, I love talking to you. Just to finish off with one thing that anyone with PCOS, any additional tip that you can give to us or tips, please do share.

Sam Abbott: 24:38

I think we hit some of the biggest ones. I would say, to just remember, we don't have research that supports the idea that you or your diet caused PCOS, and I think a lot of people carry that guilt or shame with them, and so I would shift your focus from trying to, like, get rid of every single symptom to instead trying to support yourself and your body, and that's going to look different for everyone.

Lyndi Cohen: 25:09

Sam Abbott, you are divine. I love what you talk about. I'm very happy that everyone has listened. If you do not follow Sam already, please go and check her out. I want to leave all the notes to go and find her in the show notes Instagram. She's PCOSnutritionist, so please go check her out. And all the other links will be down below. Thank you, sam, for coming on this podcast. I'm so grateful.

Sam Abbott: 25:32

Thank you so much for having me.

Lyndi Cohen: 25:34

Hey everyone and thank you for listening to today's episode. I really hope you learned something from it. I certainly got a lot of value from it. If you feel like this episode is something a friend with PCOS might benefit from listening to, please do share it on. It makes such a big difference to us. And also, you know, I would really appreciate a review of no. Well, miss Wankery, hopefully you've got some lovely things to say so you can just review it on your podcast listener. Thank you for listening. I'm so grateful and we'll see you next week.