PCOS, weight gain and eating disorders (ED): everything there is to know!

Polycystic ovary syndrome (PCOS) was first described in 1935. It is due to a hormonal imbalance of ovarian and pituitary origin (related to the pituitary gland in the brain). This endocrine disease is common in women of childbearing age. PCOS affects 5 to 10% of women, from adolescence to menopause.

PCOS is associated with an increased risk of developing other health problems, such as type 2 diabetes or high cholesterol.

Among the symptoms most frequently reported in people with polycystic ovary syndrome (PCOS), weight problems are a major concern.

What is the link between PCOS (polycystic ovary syndrome) and weight gain? 

Polycystic ovary syndrome (PCOS) can manifest itself differently in different women. Some are overweight or obese, while others are slim or even excessively slim. Some patients may never experience weight problems at all.

Nevertheless, in many cases of PCOS, weight gain is the predominant condition. Indeed, the hormonal variations associated with PCOS, and the insulin resistance it can imply, are aggravating factors when it comes to weight gain. They can also significantly hinder any attempts to lose weight.

PCOS is not only a hormonal syndrome, but also a metabolic one. It therefore influences metabolism, i.e. energy expenditure, the way the body uses and stores ingested calories, and so on.

PCOS is associated with insulin resistance. Around 70% of women with PCOS have insulin resistance. Insulin is a hormone secreted by the pancreas to deliver glucose to our cells for use as fuel for the body.

When we eat, our blood glucose levels rise, and the pancreas begins to secrete insulin, preventing glucose from stagnating in the blood and being properly delivered to our cells.

But when our cells become resistant to insulin, the pancreas secretes more and more of it, in order to get glucose into them. And insulin has the effect of blocking the breakdown of fats. Fat is then stored, leading to weight gain, often around the abdominal area.

In addition to this weight gain, overexposure to insulin increases testosterone secretion by the ovaries and, at the same time, increases general inflammation in the body. The result is worsening of PCOS symptoms.

What is the link between PCOS (polycystic ovary syndrome) and eating disorders (ED)? 

In women, it is hormones that partly regulate mood and morale throughout the menstrual cycle. In a context of hormonal imbalance, mood swings can be frequent.

In addition, the physical changes associated with PCOS, such as excess weight, acne or hirsutism, can be a source of anxiety and even depression for some patients.

Insulin resistance can lead to eating disorders (ED), since it causes weight gain, chronic fatigue and sugar cravings. Studies suggest that up to 11% of PCOS patients suffer from eating disorders.

The origins of EDs are multifactorial and poorly understood. An individual is considered to have vulnerability factors (genetic or biological background), precipitating factors (strict diet, puberty, hormonal changes, stressful life events) and factors that maintain the disorder (induced biological imbalances, psychological or relational benefits).

Anorexia 

Anorexia can be caused by a variety of organic diseases, such as cancer, a large number of bacterial or viral infections, metabolic disorders and so on.
It involves dietary restriction aimed at significant weight loss.

Bulimia

A bulimic attack corresponds to the compulsive or ritualized ingestion of a much larger-than-normal volume of food in a limited period of time, usually less than 2 hours.

Bulimic attacks are often accompanied by compensatory behaviors to neutralize the weight gain: vomiting, taking laxatives or diuretics, periods of fasting and excessive exercise.

Hyperphagia 

Hyperphagia takes the form of uncontrolled, recurrent binge eating without compensatory behavior. Generally, a certain degree of restraint is observed, which reinforces the urge to eat.

However, it is advisable to stabilise your weight as close as possible to your "healthy weight" to achieve better control of PCOS symptoms. In the case of excess weight, loss of around 10% of the initial weight reduces hyperandrogenism and shows a beneficial effect on amenorrhoea, with a potential benefit on fertility. In the longer term, this weight loss will have a positive impact on the risk of metabolic complications associated with PCOS. On the other hand, for women of normal weight, losing weight brings little or no benefit.

What foods can help reduce the symptoms of PCOS? 

Diet plays a crucial role in the management of polycystic ovary syndrome.

Indeed, numerous scientific studies have highlighted two main drivers of PCOS: chronic inflammation and insulin resistance. Both lead to the overproduction of androgens, the cause of PCOS. And both mechanisms are strongly linked to what we eat.

A balanced diet is the basis of all nutritional management. A balanced diet includes vegetables, starchy foods, proteins and fats (olive oil, for example).

A low-glycemic diet is recommended in the management of PCOS. In fact, when a carbohydrate-containing food is ingested, our blood sugar levels rise. To regulate this increase, the pancreas secretes insulin to lower blood sugar levels.

However, in PCOS, insulin resistance is present in many patients. It is therefore essential to keep blood sugar levels stable throughout the day.

Here are a few recommendations on how to achieve this:

• Eat vegetables at every meal. They're rich in fibre, which helps limit the blood sugar spike induced by the meal. 
  
• Eat protein at every meal. Proteins help boost metabolism, control appetite and improve blood sugar regulation. They also play an important role in the synthesis of hormones such as oestrogen, testosterone and insulin.
  
• Prefer wholegrain cereals and legumes, rich in fibre.
  
• Eat omega-3s. They limit insulin secretion and have an anti-inflammatory effect.
  
• Avoid consuming sugary foods and drinks alone. Drinking fruit juice alone will induce a blood sugar spike. However, if fruit is eaten with yoghurt (plain, for example), the proteins and fat it contains will help reduce this spike.
  
  

Don't hesitate to seek the help of a nutritionist specialised in PCOS, so that you can set up a personalised programme in line with your eating habits.