• Paige Smathers

80: Why Women with PCOS Don't Need to Torture Themselves with Diets

PCOS (polycystic ovarian syndrome) is a metabolic and hormonal disorder that, in many cases, wreaks havoc on the entire body. The cause is unknown and the treatments are far from well-established and/or completely grounded in science.

Common advice from medical practitioners is to lose weight. Unfortunately, however well-intentioned the advice may be, the pursuit of weight loss through diets more often than not leads to even more pronounced and worsened disease state in the body. Women with PCOS are in a rock and a hard place: they're told to lose weight to help treat the condition, but attempting weight loss only makes behaviors and mental health worse off than they were initially.

So what should women with PCOS do with their diagnosis? Listen in as I speak with PCOS expert, Julie Duffy Dillon, RD, about what women with PCOS can do to pursue health in the face of their diagnosis.

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Full transcribed episode:

Paige: You’re listening to Nutrition Matters Podcast with Paige Smathers, Registered Dietitian Nutritionist. Hey everyone, it’s Paige. You’re favorite nutrition podcaster and dietitian. Nutrition matters podcast explores what really matters in nutrition and health with a sensitive and realistic approach. This podcast relies on the support of listeners like you and needs donations to keep this project running. To help support this podcast, please consider making a donation at If you find this episode interesting, engaging, or helpful in your life, please consider donating, sharing with friends and family and leaving a review on itunes. You can leave a review about this podcast straight from your podcast app. Search nutrition matters podcast, click reviews, and then write a review. You can also find me on instagram and FB @paigesmathersrd if you would like to have a little more food for thought. Thank you for listening.

Paige: Hi everyone, welcome back to Nutrition Matters Podcast my name is paige smathers and I’m your host. And I am so excited to bring you this episode all about PCOS and how you really don’t need to torture yourself with diets to treat it, manage it, and to live a happy and healthy life with a diagnosis of PCOS. If you don’t have PCOS I still think you should listen because there are so many kernels of amazing truths in what Julie talks about in this episode. And I think you’re going to get a lot out of it, no matter who you are and what your background is. So stay tuned. So I invited Julie Duffy Dillon to come on this episode who is a registered dietitian nutritionist in private practice and I’ve had her on the podcast before where we talked about recognizing disordered eating in a thin obsessed world. Julie is the host of the “Love Food” podcast and you know we’re good friends because we love to talk about podcasting and our mutual interests in terms of not dieting. So we bring you this conversation in this very same context of how do you take good care of yourself with a diagnosis of PCOS while avoiding some of those common pitfalls that people recommend, really restrictive diets which only really exacerbate the issues. So before we get into that, I just wanted to say that if you enjoy this podcast and if you like what you hear, you can do a few things to help give back. One is to leave a review on itunes and I love it when I see those reviews come through so thank you to those of you that have already done that. Another one is if you would like to continue the conversation outside of the show with some listeners, we have a FB group and you are welcome to check that out. It’s called Nutrition Matters Podcast Study Group and we would love to see you there! Also if you like what you hear and you wanna learn a little bit more about the how to and the really practical application of not dieting but living a healthy, happy life, you are more than welcome to join us over in my online course where you can check out more details on my website, This course is intended to help you move away from chronic dieting and find a way to hone in on healthy place with your food and with your sleep and with your self care. And also with your mindset towards food and we have a lot of fun in the course so I would encourage you to check it out! And with that, let’s go ahead and get on and talk with Julie Duffy Dillon all about her deep dive into the world of PCOS.

Paige: Alright, Julie Duffy Dillon, welcome back to NMP!

Julie: Thank you so much Paige! I am so excited to be here and honored to be a guest on your show. So thank you.

Paige: Yeah, you’re welcome and thank you for your time and expertise on such an important topic because this is of all the things, all the diagnoses that walk through my office door, this particular one, PCOS, tends to just kind of have some really common threads. And one of them is just utter confusion. I think there’s so much information out there that’s not necessarily good information a lot of holes in their research, a lot of sort of questions about what we really know and what we don’t know about this condition and the women who suffer with it often are just feeling really, really hopeless and really confused. So that’s why I wanted to bring you on, just to talk about this to provide hopefully a resource for people to kind of get introduced to a different idea and a different view on how to approach PCOS. does that sound like a good sort of foundation of what we’re doing here?

Julie: Yes, and I totally can appreciate that confusion cuz I feel like as a provider I was really confused too. Like my clients would come in with PCOS and I’m like, “ughhh I’m not really sure what I should be doing here.” cuz I feel like it’s something that is so under researched and is affected by lots of different systems in our world that are not really helping women with PCOS. so i’m excited to dive in cuz I’m hoping it will provide listeners who are affected by PCOS and maybe people in their family but also other providers, other therapists or dietitians or medical providers who work with people with PCOS. I hope it gives them some food for thought, like you always say. Hahah and just some, something to think about.

Paige: I love food puns.

Julie: Yeah me too.

Paige: I just love them.

Julie: But anyway, yeah, I hope it gives them just another kind of direction to go so then they feel less confused and more helpful.

Paige: Definitely, like helping without harming right? That’s always what we’re trying to do and just as a little side note, you’ve been on the podcast before when we talked about how to recognize disordered eating in a thin obsessed world. And my listeners will probably already know this but I wanted to just reiterate that I’ve gone through and I’ve deleted some of those first few episodes and one of your, that one that we did, is one that I did delete but I’m going to be republishing. So if you’re listening to this anytime in the future, you might be thinking, like wait-where’s her other episode? It’ll come soon. It’ll come in the next few months when I’ll republish it. And that was a really fun conversation too. And super super important. So, ok, so PCOS I think, ok, I wanna define PCOS but before we do that I wanna talk about how when you kind of come to this idea that diets just don’t work, and maybe your provider or maybe you’re not someone who is in the medical field but maybe you’re affected by dieting in one way or another, which we all are. And maybe you kinda say, diets don’t work and I don’t wanna do that, and the next thing you know, you’ve gotten slapped upside the head with this diagnosis of PCOS and the recommendation from your provider is, ok go on this really strict diet. Or you are a provider and you’re like, kay I don’t believe in dieting but this is all I’ve ever learned about how to treat PCOS-is this really strict diet. So that can cause some cognitive dissonance, right, where you’re like, wait a minute, how does PCOS fit into this non-dieting paradigm?

Julie: Mmhmm.

Paige: So that’s sort of what I see us trying to fill in the gaps today plus just provide some good basic information because like I mentioned earlier there is just so much out there on the internet about what to do and what not do about PCOS. And a lot of that information just contradicts themselves and causes a lot of confusion. So that’s kind of where I’m coming from.

Julie: Definitely. I’m ready.

Paige: Ok, perfect. So I think we’ve talked about this acronym of PCOS and some people are probably like, kay can you please tell me what that heck that stands for. So go ahead and let’s just talk about what PCOS is and we’ll kind of bounce ideas off of each other with this.

Julie: Yeah, I’m so happy to be the one to share this. Especially if someone has never heard of it or is new PCOS because there is a lot of really bogus stuff out there and this past summer i have a grad student, a nutrition intern, that has been working with me and she is a woman that also has PCOS and we’ve been really digging through the research and putting together a resource for women who if they wanna know about PCOS or if they have it. And it’s cool because i’ve learned more about it and PCOS starts, not starts, but stands for rather, polycystic ovarian syndrome and it basically is a set of symptoms that resolves from a hormonal imbalance. Honestly, it’s a condition that is a diagnosis of exclusion which is a really horrible thing to have because there is no exact thing, like, I don’t know, if you have diabetes or if you have I don’t know cancer, you have or there’s like these exact markers that they can find and with PCOS it’s just like, we know you don’t have this and this and this so you have this. Haha

Paige: Yeah.

Julie: It’s really, it’s really just uncertain for so many people. Like people often times will say, well I’m not really sure if i have it, even though they say I have it because it just is weird. And basically, it’s an endocrine disorder and it’s characterized by high levels of androgens which are also called sex hormones. So especially testosterone, that’s the one in particular that gets the most press with PCOS and women. And all of us, whether we have this condition or not, we all have testosterone floating in our body and women with PCOS just have more than women without PCOS. And they also experience some kind of irregularity with their menstrual cycle whether they have a miss period or it’s irregular or painful or they just never ovulate and so they never have a cycle. And they’ve changed over the years how to diagnose this, diagnose PCOS, and a lot of times this is important, especially lately because people will have a lot of the symptoms of PCOS and then go to the doctor and get an ultrasound done and the doctor will not find these “cysts.” I’m kind of using air quotes right now that you can’t see. These cysts in their ovaries and so like “Oh you don’t have it because you don’t have the multiple cysts on the ovaries” but really a woman can have polycystic ovarian syndrome and never have these really follicles on their ovaries.

Paige: So my understanding is that you need to have 2 out of the 3 symptoms. Right?

Julie: Yes. So one of them is these multiple cysts or these multiple follicles but the other two is just some kind of irregularity with your period or absence of ovulation and the other one is high levels of androgens or just a sign high of androgens like excess body hair, facial hair, or hair loss on the head. So they don’t even have to have a blood level drawn if they just have symptoms of it, that’s enough.

Paige: Right.

Julie: And so, you know a lot of times people will be like, well I just never had cysts on my ovaries so I don’t think I have it. And I’m like, well, you have it. Hahah you know?

Paige: And something to clarify in case people haven’t caught on, this is only a problem in women. Alright? S we’re talking about polycystic ovarian syndrome and so we’re talking about…

Julie: Well, yes and no. Because there’s been some people who are finding something similar with men. Soo…

Paige: Is that right?

Julie: Yeah. But I’m not prepared to talk about it but when I go to conferences that are talking about this, it’s kind of the buzz. But yeah, there’s something similar that men experience.

Paige: Interesting. I did not know that. I just..

Julie: Well, you know.

Paige: And gender isn’t binary as we think anyway right? I mean,

Julie: Exactly. I mean that’s a good point too. And you know, something that is kind of a side note, but I think is important is that some people say, well if I have high testosterone does that mean I’m less of a woman? Or does that mean my sexual preference will change? And those are all no. It doesn’t affect those kinds of things. But yeah, if men end up having something similar then you know that there’s gonna be more research dollars put into it because the feminist in me is kind of like, well at least they’re gonna start researching it

Paige: Yeah.

Julie: That’d be good for the rest of us.

Paige: That’s fascinating, Julie. I had no idea that there’s sort of a cousin to this in men perhaps. Interesting.

Julie: Well, the thing about PCOS that we know if that it’s genetic and environmental so it’s passed down through families. I’ve talked to a lot of people, this is just clinical observation but, most of the people I’ve talked to they notice a pattern on the male side of their family so that’s why I’m like, there’s probably is one for men too because there’s a genetic side to it. And there’s also this environmental connection because of just how food has changed over the years and so people with PCOS have a susceptibility that’s different than other people to some environmental changes that are kind of interesting. But in the end, to put this all in perspective, like a nutshell here, is that PCOS basically with it’s genetic connections starts in the brain, specifically in the hypothalamus. And that’s where the hormones are made that end up getting disrupted with this condition and it ends up affecting like literally every part of a woman’s body. Because the hypothalamus is where our mood center is so mood disorders are really common like anxiety, depression, bipolar disorder, even ADHD or ADD or just some kind of attention deficit kind of differences are really common with PCOS. And then also because of this hypothalamus being like the hub of PCOS ends up affecting insulin is a hormone that ends up getting out of whack basically so it affects how a woman digests the food that she eats. So it affects for some women it ends up affecting what their body looks like and it affects like their energy levels or lack thereof and you know, so the whole body ends up being affected by it and most women what happens is that if they get diagnosed with it, they’re basically given a pamphlet or they’re just told like as the doctor’s walking out, Oh yeah you have this PCOS thing and just come back when you’re trying to get pregnant. And you know, they kind of just brush it under the rug and they don’t really say anything.

Paige: Or they say, here’s a very restrictive amount of carbohydrates you’re allowed to eat in a day.

Julie: Well yeah, I don’t like when I hear that either cuz basically the common practice if you google it or you even webmd it. The primary treatment for PCOS is weight loss and when I started seeing people with it, I really didn’t know what to do and I also was starting to really reject diets but when I looks through all of my training in PCOS which wass really small at that point, all I knew to do was help them lose weight. And so I did that and not only did it feel crummy cuz it was this like, this ethical kind of dilemma I was experiencing but it didn’t help anybody you know, people’s symptoms just got worst and they felt worse about themselves so it made me really look at some different ways to treat it and luckily there was a woman who had this network called InCYST and she developed this multidisciplinary network and training. Her name is Monika Woolsey and she’s a dietitian, basically retired from working with PCOS at this point but she was really into the endocrine system and the research behind it. Not only was she a dietitian but she was also an exercise physiologist so she just was really savvy and this was about 10 years ago that I got the training and what I found is that by treating the symptoms and also pursuing weight loss, made it so much worse and there’s ways to get to the core, like to get to the hypothalamus basically. You can’t cure PCOS but it can definitely heal what’s going on from the PCOS so then long term a woman can make peace with food, she doesn’t have to fight her body, she doesn’t have to pursue weight loss or cut out carbs. There’s ways you can do it that end up helping them actually feel better long term without the torture. So yeah, that’s one of my big messages for women, like if you have this don’t believe the hype. You can still you know, continue on your journey for food peace because we have this other, we have so many other options and I think things like weight stigma unfortunately have affected women with PCOS more than anyone else because it’s just slapped on there like, oh they just need to lose weight and that’ll treat it. Or even some people are told, like oh you’ve gained weight and that caused it which that’s totally false. No one caused their PCOS.

Paige: You can be any body size and have PCOS. That’s an important thing to know.

Julie: Oh yes, oh for sure. I’ve seen people in every shape and size.

Paige: Yeah, me too.

Julie: Ethnicity. I had one or more than one, I’ve had a number of clients that have like lighter skin and lighter hair color and their doctors will be like, no, it’s only people with, with dark hair.

Paige: oh! What?

Julie: Really? Like she could have dyed her hair first of all.

Paige: Right. Oh that’s funny.

Julie: I mean, yeah. It’s in everybody.

Paige: Ok, Julie, let’s talk about just to paint a picture cuz I’m kind of imagining, I’m hoping there are providers listening and sometimes I think just with the nature of medical care it can be really hard to have enough time to sit down and really hear someone’s story about what it’s like to live with PCOS like what, let’s highlight that let’s talk about what we’ve heard our clients say and especially you with all the deep dive you’ve done into this world. I just really want to paint the picture of what life with PCOS looks like for some and it’s gonna look different for every person but what to do want to say about that?

Julie: Oh my gosh, yeah there’s, everyone’s story is different but there are some tremendous like, patterns and themes and I love when women with PCOS get together and talk because then they’re like, oh my gosh, I’m not the only one that does this. And you know, when a woman with wakes up with PCOS everyday, she is usually sleep deprived cuz sleep disorders are super common and so usually they didn’t get a very good night sleep and already feeling kind of weird kind of craving and also not really not having any interest in eating because of the way insulin levels are already gonna be messed up when they’re waking up. And so for a lot of women with PCOS they don’t usually end up eating until later in the day because it’s just how their circadian rhythms for eating have ended up. And so because they’re so sleep deprived, so many end up relying on like coffee cuz they’re like, I need to get work done or have kids to take care of today so I need to do this. And what ends up happening then too is there’s like when they walk out into the world they’re feeling really unfeminine because of lots of hair on their body especially on their face and losing hair on their head. Feeling less feminine because of that and then for not everyone, but I’ve seen ranges of 60-70% of women with PCOS are women of size and so carrying a lot of weight around their midsection which for some women, not all of them, but for some women that’s a symptom, just a symptom that their insulin levels are high. It’s not something that they caused and so they’re walking into the world where they feel like defeated because they’ve probably tried and tried and tried to change their weight and what they end up trying to do are a lot of fixes that they’re told to do like cut out carbohydrates or cut their calories lower and what ends up happening to them is it ends up making cravings really, really like to the cellular level unbearable and so when a woman gets hit with a craving with PCOS and it usually happens around like 2, 3, 4 o’clock in the afternoon. And then again later at night it’s not just like how you and I will be like, huh that brownie looks good. It’s more like you have to eat that. Like it’s like a cellular level like their biology is telling them they have to eat it.

Paige: Well then we can talk about like about their reason why with that is the elevated insulin levels of their hyperinsulinemia

Julie: Yes

Paige: I have a way of explaining this but it’s not very scientific but it helps people to understand it. Do you want me to roll with it? And you can correct me.

Julie: Yeah. I’m sure it’s right.

Paige: Ok, I mean. It’s the general idea, it’s not accurate on the scientific level. So with a woman who doesn’t have PCOS let’s say she eats the equivalent of like 10 glucoses this is how I explain it. You eat 10 glucoses which is just carbohydrates broken down into its form that feeds cells. And the average woman might, might use 6 of those glucoses to feed the cells of the body and then keep 4 of it in the blood stream. To kind of keep the blood sugar levels where they should be because you need blood sugar, you need sugar in your blood at a continuous level like you don’t want to have zero.

Julie: Or you’d be brain dead. Yeah

Paige: It wouldn’t be good. But a woman with PCOS in that hyperinsulinemia what’s going on is that insulin is what brings the glucose into the cells and so when she eats 10 glucoses instead of getting you know, giving 6 to the cells, she might give 8 or 9 to the cells and then only have like 1 left over for her, for her blood. And then her body detects, oh know! Blood sugar is low, I must find something with sugar in it to eat. And it’s because that elevated insulin level got way too much glucose into the cells not enough still in the blood. So what that does is it really leads to an elevated feeling of I have to find sugar and I need it know and if I don’t get it, I might die. And that’s really kind of how it feels. What do you think? Did I do ok?

Julie: Yeah, and I you know the thing that is really, one of the hardest parts about specializing in PCOS is that the research is just not really there yet for us to understand exactly what’s going on but yeah, I mean, one of the things that I notice is that, or what I often talk about is how insulin like the doorman for the cell.

Paige: Right.

Julie: It’s trying to open the cell door and one part of research that is emerging that’s super exciting is that the doorbell to the cell maybe broken in PCOS and usually when the doorbell of the cell is broken, the body sends a signal and these secondary messengers, you know if you can picture these little messengers coming down to fix it. People without PCOS, it fixes the doorbell and then the insulin can work. Well there’s these secondary messengers are either defective or deficient or there’s something going on in that system and so then the body just all it knows to do is just send more insulin to like, help open the door more so there’s lots more blood sugar shifting around and there’s a lot more insulin and I think a lot of providers think of this insulin conversation just like how we talk about with diabetes and you know there’s some similarities because there’s talk about insulin but the hyperinsulinemia with PCOS is so much higher and that leads to some symptoms that are different and it leads to also like the insulin levels need to be treated before you do anything else. And especially, you know I know diets don’t work and if we lived in a place where society where someone invented one that actually did, like I’m not going to hold my breath on that but, if they, if there was one that was invented it wouldn’t work because the insulin levels are just so high and insulin is a growth hormone. It would just make the body like keep going through this process until insulin went down. And so there are no diets that work anyway so it’s kind of a moot point. But when someone tells someone with PCOS, well you need to lose weight. Well, no, you need to help her lower her insulin levels. That’s what the first thing you need to help her do, whether it’s through medication or through supplements and that’s where I always go first with people. It’s like, let’s talk to your doctor about medication or supplements and help your

Paige: Because it doesn’t matter how great your eating and sleeping and taking care of yourself.

Julie: Nuh-uh. It doesn’t matter

Paige: If your insulin levels are elevated, you are not going to be feeling well, functioning well. Right?

Julie: Well and you can search online, there’s people who do it but it’s like, there are people who like are able to lose weight but they’re not the typical, like you can’t use that as the outcome for everyone and also like there’s anorexia. Yeah there’s people who are good at that stuff and that’s called anorexia. You know, and I think one of the big parts of PCOS that is really frustrating to me is that basically women with PCOS are told to torture their body and practice anorexia. You know, we would call it in anorexia in a woman with a smaller body for sure. But women in a larger body with PCOS, they’re made to do it. And I just, I think there’s like this disconnect on why is it ok for them.

Paige: Ohh, totally.

Julie: Why do they have to torture themselves and we call it pathological in someone else.

Paige: That is a big problem.

Julie: And it’s not the same. It’s a really big problem and it’s weight stigma. You know?

Paige: Yeah.

Julie: You gotta get rid of it however you can but yeah so if there’s, [if] anyone’s a provider for people with PCOS understanding how the hyperinsulinemia is so much different and so much more biologically involved and it literally will drain the woman’s body so if a woman is told she needs to be more active with PCOS because being more active, you know, as humans I think we’re just meant to move and I don’t think we should do like no pain, no gain stuff but like joyful stuff, things that feel good and I would love for women to find something that was pleasurable for them and to move their body. But a woman with PCOS that has untreated insulin levels it’s like carrying around a bag of rocks, you know, they just can’t, it’s not the same you know. So somebody was like, it just feels like dead weight that I’m moving and I’m trying to move my body and so that’s why I’m like, just help them lower their insulin levels and I unfortunately hear a lot of providers who like, won’t provide fertility treatment or even help them treat insulin levels until they lose weight and that is like disgusting to me. I mean I’m like that’s super discriminatory, you know, and just knowing all this physiology, I hope that convinces some people to just do it a little differently.

Paige: I love it. So to continue on with the idea of painting the picture of Paige: I love it. So to continue on with the idea of kind of painting the picture, one thing we alluded to but didn’t say outright is that there are immense and very intense cravings associated with PCOS. I mean, you, you actually did say that. You said that outright. So she might go throughout her day feeling just compelled on just a cellular level toward the sugary simple carbohydrate type of food or just maybe food in general. And then on a mental health level what that does to a person.

Julie: Yeah

Paige: Is it makes them feel like, gosh, what is wrong with me? Like why am I such a loser.

Julie: Exactly.

Paige: I mean they might say these things, I’m not calling these people losers.

Julie: No.

Paige: But that might be going through your head like, gosh, I just have no willpower, I clearly need to make more rules, I continue to fail. You know, you know you go down that shame spiral pretty intensely.

Julie: Totally.

Paige: Meanwhile they’re making more rules. Saying, ok tomorrow I’m recommitting, I’m not gonna do that. And you can see how this can be a recipe for an eating disorder. Right?

Julie: Oh yeah. It totally.

Paige: Where, I feel like a failure, I keep failing and I keep making more rules and I keep failing and then I just give up and binge on all the foods and you know, and then I recommit and say ok, I’m gonna be good, you know. And that…

Julie: Isn’t that so exhausting to think about?

Paige: So exhausting! Yeah.

Julie: So exhausting there’s so much shame and blame cuz again so many people think they caused this condition because of their weight and then they have these cravings and so when they give in, because they’re really just doing what their body is telling them to do. There’s like immediately a level of shame and oh geez, how did I mess it all up? And so, what I end up hearing from people that I talk to is that they feel like they’re constantly bouncing between dieting and not dieting or restricting and binging and it’s exhausting in itself but then that’s just on the outside. But inside their body, they’re feeling so