Managing PCOS Without Dieting with Julie Duffy Dillon

I get asked about PCOS all the time. Specifically, I get a ton of questions on following a low carb diet to manage PCOS, since the condition is associated with insulin resistance.

To answer your questions, I’m talking with eating disorder specialist, food behaviour expert and PCOS authority Julie Duffy Dillon, also known as the Food Peace Dietitian.

In this podcast, we cover:

  • Julie’s professional history and why she stopped prescribing weight loss
  • What PCOS actually is
  • How PCOS affects insulin levels and carb cravings
  • The effectiveness of weight loss treatment for PCOS
  • What you can do to support your health if you have PCOS

Supporting Your Body When It Seems To Be Working Against You

Dealing with a chronic condition isn’t easy. It requires a lot of time, energy, and sacrifice to manage your health along with everything else in life. 

It comes down to this- whether you have PCOS or another health issue, be kind to yourself. 

The question should NOT be:

  • ‘How can I punish my body for this,’ or
  • ‘Why is this happening to me?’ 

Catch yourself having those thoughts, take a step back and ask instead:

  • ‘How can I support my body?’

Instead of criticizing your body, be there for it.

Even when it may feel like your body isn’t working with you, everything that it does serves a purpose to keep you alive. Work towards respecting your body, with the understanding that it’s trying to support you. If you support it in return, you will have a MUCH easier time trying to navigate your health.

This doesn’t mean you’re not going to be mad or upset; it’s still important to feel your feelings. You can be grateful for what you have, AND be in service to your body, AND be upset about it at the same time. You don’t need to pick one emotion- life isn’t just black or white.

PCOS & Intuitive Eating

Beginning her dietetics career in weight management, Julie worked mainly with children and their families. Over time, she started seeing similar a pattern- after talking to families about making healthier choices, they either:

  1. Wouldn’t come back, or
  2. They would come back and their weight was the same, if not higher.

Thinking this had something to do with her counseling style, she went back to school to get her Masters. After graduation, she worked 2 jobs: one at an eating disorder clinic and the other at a bariatric clinic, where she helped people lose weight for bariatric surgery with liquid diets.

Over time, she realized that while she was telling the two groups to do essentially the same thing, the means to doing it were different: one was freedom, and the other was torture. From that moment on, she knew she couldn’t prescribe diets anymore. Over the following year, she evolved her knowledge to learn about Health At Every Size and hasn’t looked back since.

After gaining experience in the eating disorder field, she came across a different pattern- many of her clients with disordered eating also had PCOS.

What is Polycystic Ovarian Syndrome (PCOS)?

PCOS is an endocrine disorder with metabolic and reproductive consequences. It’s associated with high circulating testosterone, which causes:

  • Facial hair
  • Hair loss
  • Cystic acne
  • Weight gain
  • Periods that are heavy, too long, or irregular in some way

PCOS is the number 1 cause of ovulatory infertility, and it affects about 1 in 5 of those who are assigned female at birth.

The treatment for PCOS is traditionally the same for diabetes, and often focuses on weight loss. But if diets don’t work for the general population, why would they work for people with PCOS?

Insulin, Carb Cravings and PCOS

The available PCOS research is lacking. However, we know that about 75-95% of people with PCOS have high circulating insulin levels- even higher than in diabetes.

For many, this causes intense, primal cravings for carbs.

Aside from carb cravings, having high insulin levels can cause weight gain, which may be rapid in some cases. Although focusing on weight loss doesn’t cure or even treat PCOS, people are told to diet to control their weight.

When weight loss doesn’t work, people continue to cut back more and more until they’re living a life of anorexia- even though the way they look may not reflect that. This commonly turns into a binge and restrict cycle, which is extremely hard on the body and makes PCOS symptoms even worse.

While cutting out carbs or gluten may seem to be beneficial in ‘long-term’ research studies, it doesn’t actually help in the real-life long term. 

Especially since high insulin triggers a primal instinct to eat carbs, restricting them will only make that experience worse. Essentially, using weight loss and carb restriction to treat PCOS is setting people up to experience binge eating.

PCOS, Inflammation and Weight Loss

Research shows that there is a chronic pro-inflammatory state associated with PCOS. This means that the normal process of oxidation and inflammation is exaggerated, so the body constantly has to do a ton of repair work.

Despite the knowledge that:

  1. Among the general population, dieting makes inflammation worse, and
  2. There is a lack of research on long-term effects of pursuing weight loss with PCOS,

Weight loss is still the main treatment for PCOS.

To promote health in PCOS without dieting, the first thing to do is make sure you’re eating enough. You might be surprised at how much you need to eat in order to be well- it’s probably more than you think.

Getting people with PCOS diagnosed and off the diet rollercoaster is one of the most health promoting things they can do to make insulin levels and inflammation go down without having to torture their bodies.

Instead of focusing on the scale (because high insulin and testosterone make the scale look higher), it’s important to look inwards. Once you make sure you’re eating enough, your body will let you know if your PCOS is being managed effectively.

Body Respect & Moving Away From Diets

As I mentioned in the appetizer, something else you can do to manage your PCOS (and any other health condition) is support your body through respect.

When moving away from diets, especially with a hormonal condition, something that frequently comes up is weight gain. With PCOS, weight changes are common, and it has nothing to do with calories in versus calories out. Sometimes, weight change is just an indicator that something is going on with your PCOS- you can use it as a tool rather than a measure to judge your body against.

People get so uncomfortable with weight gain that talking about body respect and body acceptance becomes so important.

Instead of jumping feet first into trying to love your body, a good first step is to simply not pursue weight loss- it does not serve you or your health. Acknowledge that right now, you might not love your body, but you can respect it enough to find a different tool to help manage your life and food.

So What Can You Do?

Just by moving away from dieting, your health markers will improve in PCOS. Not only this, but it will also help you reclaim your life and have energy again. After making sure you’re eating enough, there are 3 things you can experiment with:

  1. Looking into supplementing with Anocetol: a B-vitamin that has been found to be lacking in people with PCOS
  2. Getting Omega-3’s through a supplement: to help with inflammation and damage from dieting
  3. Adding in more protein strategically: having 10-20 grams in the morning with whatever you want to have it with, and an hour or 2 before you go to bed. Don’t take the carbs away- add the protein to it! This helps with managing insulin levels, fatigue, and brain fogginess.

People with PCOS are told over and over again that they ‘just need to try harder.’ They’re told that once they comply with their treatment, they’ll feel better, they’ll be able to get pregnant, they’ll get prescribed new medication they need, and more. The issue is, when we focus on diets, the burden gets placed on the individual instead of on the faulty tool. This can make ‘complying with treatment’ and managing this condition extremely frustrating.

If you have PCOS or have hit diet rock bottom, know that you didn’t do anything wrong- diets are the problem. Moving away from diets and respecting your body will allow you to find peace with food, minimize the chaos in your life, and promote health at the same time.

About Julie Duffy Dillon

Julie Duffy Dillon is a Registered Dietitian, Eating Disorder Specialist, and Food Behavior Expert partnering with people on their Food Peace journey. She is trained as a mental health counselor and supervises dietitians and other health professionals to use weight inclusive and attuned eating strategies. She owns central North Carolina’s group nutrition private practice and premier source of eating disorder treatment and prevention, BirdHouse Nutrition Therapy. Julie also produces and hosts the weekly podcast, Love Food and has an online course to help those affected by PCOS. Learn more at 

Instagram @FoodPeaceDietitian

This post was transcribed and edited by Brittany Allison. You can find her on Instagram @brittybfit.

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