Registered Dietitian Nutritionists Dalina Soto and Melissa Landry interview Sam Abbott MSEd, RDN, LDN to discuss how weight impacts PCOS and your hormones.
In today’s episode we answer YOUR listener questions:
- What is PCOS, or, polycystic ovarian syndrome
- Why is it important to get a PCOS diagnosis?
- Why is it important to get treatment?
- Did my weight cause my PCOS? Does weight loss cure it?
- Does Intuitive Eating work for women with PCOS who have hormonal urges to eat all day? Won’t they lose control?
- Does a gluten and dairy-free diet work for PCOS?
Episode Resources:
- Subscribe to Break the Diet Cycle podcast on Apple, Spotify, or wherever you listen to pods!
- Follow Sam Abbot on Instagram: @pcos.nutritionist
- Join the Break the Diet Cycle Podcast Community: @break.the.diet.pod
- Connect with Melissa on Instagram: @no.more.guilt
- Connect with Dalina on Instagram: @your.latina.nutritionist
This episode was sponsored by No More Guilt with Melissa Landry
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Episode Transcript:
Melissa Landry:
Hi there everyone. We are back for a new episode of Break the Diet Cycle with Sam Abbott, also known as the PCOS nutritionist. We’re going to talk today a little bit about what PCOS, is how it relates to your food freedom journey, and talk a bit more about hormone health. Sam, we are so excited to have you here. Welcome to the podcast.
Sam Abbott:
Thank you for having me. I’m so excited to be here.
Melissa Landry:
Once again, I know we’re always bragging about our Instagram friendships. This is another one. We love, love that we found you on that platform. Why don’t you tell us a little bit about yourself and what brought you to your work as the PCOS nutritionist?
Sam Abbott:
Well, my name is Sam. I have a nutrition practice called G & G Nutrition Company, and I specialize in helping people with PCOS balance their hormones and improve insulin resistance without dieting. My practice actually started as a brick and mortar practice in Charlotte, North Carolina. And it really evolved into specializing in PCOS because I was just getting so many clients who had PCOS and they really felt lost, like they had no answers in terms of improving hormone balance, improving some of the symptoms that come along with PCOS and really trying to regulate their period or get their period back naturally in hopes to try to conceive sometime in the future.
Sam Abbott:
So it was kind of a natural evolution to specialize in PCOS. And my sister also has PCOS. So I was somewhat familiar with the condition prior to offering nutrition coaching for it. But it’s definitely an area that I’m really passionate about. I find that my clients really need a lot of support and advocacy to get the type of care that they really need to improve their quality of life. And my business has really evolved and then I decided to change my Instagram handle, and I’m just chatting all about PCOS all the time.
Melissa Landry:
That’s amazing. I love your posts. I love the way you make it much more clear how people can pursue food freedom when they have PCOS. Because as we’ll talk about through some of our audience questions today, there’s a lot of information out there. And I think like what you’re saying, the gap at the doctor’s office, where there’s sort of these blanket statements or even dismissal, and then all this information on the internet, it’s kind of like all the info and none of the info. And then what do I do in the middle? So I’m hoping we can get to that today.
Sam Abbott:
Yeah, it can be really overwhelming and PCOS is so individualized as well. It’s a syndrome and it looks different in different people. So, I really try to give, put the information out there, but give people the flexibility to be able to take what is relevant to them and apply it to their own lives.
Melissa Landry:
Beautiful. Well, is it all right to dive in on some of our audience questions today?
Sam Abbott:
Yeah, definitely.
Melissa Landry:
So first, before we go into the audience questions, let’s just define what PCOS is in case maybe someone’s listening and then through this, they go, “I think I have some of these symptoms.” What is PCOS?
Sam Abbott:
Yeah, this is a great question because 50% of people who have PCOS don’t even know that they have it. They’ve been undiagnosed. But PCOS is a metabolic disorder that affects the endocrine system and the reproductive system. So when we’re saying the endocrine system, we’re talking about our hormones. The diagnostic criteria, there’s actually three pieces. One would be irregular or a missing period or ovulation. One would be elevated androgen levels. Those are male sex hormones that, women have them in smaller amounts. It’s normal for us to have them, but not in the elevated levels that we see in PCOS. And then the third guide or master criteria is an ultrasound that shows polycystic ovaries. They really present looking like a string of pearls. They’re enlarged follicles, just along your ovary. So, from a diagnostic perspective, you technically only need to have two of the three criteria, so-
Dalina Soto:
Because some women don’t have cysts, right? Or they’re not visible?
Sam Abbott:
Right, right. Yes, exactly. And with androgen levels, those can be difficult to test when you’re getting labs drawn. So part of the diagnostic criteria could be labs or just physical symptoms. So some symptoms of elevated androgens, maybe acne or something called hirsutism, which is excessive hair growth either on the face or the chest or the stomach. Oily skin, receding hairline, or male pattern balding. Hair thinning is another one as well. So just because somebody’s had normal labs that may not mean that they don’t have elevated androgen levels. So the symptoms are used as well.
Melissa Landry:
Yeah.
Dalina Soto:
So my question, Sam, is what does someone do? I hear a lot of my clients not have a diagnosis. But yet have a lot of these symptoms. So what can someone who feels or thinks that they are exhibiting these symptoms, how can they be an advocate for themselves at the doctor’s office if they’re not getting definite answers?
Sam Abbott:
Right. Well, I think it could be really helpful for them to learn a little bit more about PCOS so that they can have a dialogue with their provider, which I hate saying that because the burden shouldn’t be on the patient to initiate that conversation. But part of the reason that PCOS is undiagnosed in so many people is because one of the first symptoms may be an irregular period, which in adolescents, having an irregular period initially is pretty normal. But if it persists, usually birth control is just prescribed. So it’s kind of masking one of the symptoms. When we’re taking birth control, you’re not getting a true period. It’s just a monthly bleed, which is important for overall health. If you’re going too long, without a period that actually puts you at risk for endometrial cancer, which is why birth control is prescribed for PCOS.
Sam Abbott:
But I think it’s really important to understand if you think that you have PCOS, that this is truly a metabolic condition that affects overall health. It’s not just about reproduction. So, asking your provider, coming in with your list of symptoms and asking your provider if you can be appropriately screened with labs and a trans vaginal ultrasound and really explaining your symptoms. One important thing to note is that a diagnosis of PCOS, it’s really a diagnosis of exclusion. Meaning there are actually other things that can cause irregular or missing periods.
Sam Abbott:
So the process of being diagnosed with PCOS is actually ruling out other causes first. I actually had a really interesting experience recently where I felt like I was meeting a lot of the symptoms of PCOS and my sister has PCOS so I went to the doctor and requested to be evaluated. And actually, I ended up having a really large dermoid cyst on my ovary that had been there for over five years. So you can have other issues going on, whether it’s a different type of ovarian cyst or a thyroid problem, or a problem with your adrenal going on. So I think this is where it’s really beneficial to have a good relationship with a provider that you know, like and trust so you can have these open conversations.
Melissa Landry:
Totally agree. So important. Yeah. That’s a great question, Dalina. And one of the questions from our audience links and piggybacks on this, which is why is it important to actually get that diagnosis? And then once you have it, why is it important to seek treatment?
Sam Abbott:
Well, I think it is really important to have a diagnosis because PCOS can be the cause of other health issues. And it may connect the dots for some of the symptoms that you’re experiencing. One of the root causes for many people that have PCOS is insulin resistance. And insulin resistance can really make you feel hungry and crave carbohydrates all the time. And not just a small carb craving. I’m talking about truly eating a meal and then feeling hungry afterwards. So understanding that that could be coming from your PCOS, your fatigue, problems with sleeping. There’s a link between PCOS and anxiety and depression. Recently on Instagram, I was just sharing responses or doing a Q and A and somebody mentioned that they had had so many problems breastfeeding and they had no idea that it was because of PCOS.
Sam Abbott:
And I was getting messages from people who said that they suffer from severe postpartum depression over their difficulty with breastfeeding and they had no idea that that could be associated with PCOS. And had they had known, then they wouldn’t have been so hard on themselves. But to get back to answering the question, why is it important to get a diagnosis? If you have this festering insulin resistance, that can eventually develop into prediabetes or type two diabetes, and that can lead to other health issues like fatty liver disease, we’re seeing a tie between PCOS and sleep apnea. So there are other health… cardiovascular disease. There are other health issues that you just want to have awareness about these issues. And then you also want to get appropriate treatment so that you can just feel better every day.
Sam Abbott:
One of the top complaints that I hear from clients is just having poor energy and difficulty sleeping. And those two things affect your quality of life from day to day. So that would be why I would say it’s important to get a diagnosis and to also seek treatment is to just improve your quality of life.
Melissa Landry:
So important. I think that just that phrase, quality of life.
Dalina Soto:
Yeah.
Melissa Landry:
[crosstalk 00:11:08] That’s what jumps out to me. There’s the right now needs that you have around sleep and feeling well and you’re not feeling out of control around food. If you are, they’re saying maybe having that experience be more positive for you and your baby, and then long-term setting the stage for your metabolic health so that you can work with your unique genetics the best way possible. And that’s what all of us are doing. We all have this genetic code and all of us are individualizing and optimizing. What works for me might not work for Dalina. It might not work for Sam. And so the tailoring is kind of key. It’s not wrong that you might carry PCOS as a diagnosis, it’s how are you going to work with it? That’s really the question.
Dalina Soto:
I always think of like Maslow’s hierarchy of needs. And you have to meet all those, that bottom part of the triangle to be able to have that quality of life and what you’re discussing here, what you’re describing is those basic needs that every human needs to meet before they can actually have a good quality of life and thrive.
Sam Abbott:
Yeah, exactly. And I think that’s why there is such a big conversation around the poor quality of care that many people with PCOS receive in the medical community, because this is kind of outdated, but PCOS was previously more associated with just being a reproductive disorder. So a lot of times when people go to the doctor and they’re trying to get answers and feel better, they’re told, “well, come back when you’re trying to get pregnant,” or “just work on losing weight,” or things like that. And I think that is a big reason of why so many people with PCOS do suffer from anxiety or depression because you’re literally living each day with no energy and not feeling well and not sleeping well and not understanding why.
Dalina Soto:
Right. We can make babies and we do a good job at that, but that’s not all of our health-
Melissa Landry:
Our sole purpose.
Dalina Soto:
-all of our identity. It’s incredible how the medical narrative sometimes is really, and even we drive it sometimes, right? We don’t ask for more than reproductive health when we’re at the doctor. I don’t think we’re trained and educated to think like that, that I want to be thriving. I want to feel well to do what I want in my life.
Sam Abbott:
Right. Yeah. And I think another problem with PCOS specifically is that right now it’s categorized with the NIH as a reproductive disorder. And that categoration, is that a word?
Melissa Landry:
It is now. [crosstalk 00:13:46].
Sam Abbott:
The way the category determines how much research funding it gets.
Melissa Landry:
I see.
Dalina Soto:
Oh, women rights.
Sam Abbott:
Yeah, it does really go back to, we could get into a big conversation about reproductive-
Dalina Soto:
Part two.
Sam Abbott:
[crosstalk 00:14:04] and stuff like that. But basically there’s a big advocacy push right now to get that classification changed to a metabolic disorder.
Dalina Soto:
You’re saying.
Sam Abbott:
Yeah. If you look at the funding that something like diabetes or cardiovascular disease gets, PCOS is getting just a tiny, tiny portion of the funding that it truly needs. 10 to 15% of women or people born with ovaries and a uterus, they may not identify as a woman now, that’s a huge, huge amount of our population that’s suffering from PCOS. And if you don’t have that research funding, it’s really hard to get that information out to the medical community and learn new things that could really help a lot of people.
Melissa Landry:
So true. Now, following this train of thought, and I love how you’re making this more clear for us that this is a metabolic disorder that hinges on insulin resistance. One thing we often see as a treatment for this diagnosis is weight loss. So one of the questions was, does weight cause PCOS? I think you’re saying no, that weight is not the cause of PCOS. And then does weight loss cure PCOS? Because sometimes that message gets muddled when we’re told, “Hey, lose weight, it’ll get better.” What are your thoughts on the weight loss messaging around PCOS?
Sam Abbott:
Yeah, that’s a really big, that’s very problematic in my professional opinion. Just to back up for one second, many people with PCOS have insulin resistance, but not all. A lot of the root issue is coming from the elevated androgen levels and elevated androgen levels can cause elevated, it can cause insulin resistance and insulin resistance can actually cause our ovaries to produce more testosterone. So it’s pretty complex, but not everyone necessarily has insulin resistance with PCOS. So I just didn’t want to confuse people.
Sam Abbott:
But to answer your question about weight, this is actually something that I feel is so painful and traumatic is when somebody with PCOS is made to feel like because they gained weight that caused PCOS and that is the messaging that many people are receiving. We actually think that PCOS develops very early in life. That possibly when your mom is pregnant with you and she was exposed to some sort of environmental factor that that plays a role in the development of PCOS. Many people start showing symptoms during adolescence when they’re at a much lower weight and perhaps the insulin resistance and the elevated androgen levels actually leads to that weight gain.
Sam Abbott:
But maybe you don’t even know that you have PCOS until 10 years later. So a lot of my clients do have a very distinct memory of when they were younger, they all of a sudden just started gaining weight and they didn’t understand why. And maybe they were at a higher weight than their siblings, even though they were all eating the same things and living the same lifestyle. So your weight did not cause your PCOS. If you have experienced a weight gain and you’re not sure why, it could very well be because of elevated insulin levels. Because insulin is a growth hormone. Elevated levels do cause us to gain weight. In terms of the whole conversation about weight loss and improving PCOS, there’s so many layers to it. So I think we should lead the conversation by saying, and I’m sure that you guys speak to your audience about this all the time, we don’t have any study that shows that weight loss efforts are successful longterm.
Sam Abbott:
So when you are intentionally trying to lose weight, there is a very, very high chance that you will eventually regain that weight and then more weight. And that weight cycling actually makes insulin resistance worse. It increases your risk of cardiovascular disease, it’s linked to binge eating and anxiety and depression. So whether or not decreasing the adiposity on your body improves androgens or insulin resistance is truly a moot point if we don’t have anything that could successfully help you lose weight by focusing on weight loss.
Sam Abbott:
So what I like to focus on with clients is actually treating the root issue of what’s going on. So do you have insulin resistance? To what degree do you have insulin resistance? Are your androgens elevated in your labs? Which ones are elevated? Do you suffer from binge eating? Have you just kind of given up on your health because of this syndrome that’s greatly affecting your life? Do you have sleep apnea that’s driving your insulin resistance? So the conversation is so complex. I really just recommend focusing on actual behaviors and things that are within your control and really just viewing your weight more as an outcome.
Melissa Landry:
Beautiful. I don’t think I’ve heard anyone say that as crisp and clear as you just did. Yeah. And I think that’s where a lot of confusion lies. I love how you said it’s a moot point because we, and Dalina, you said, when we first met you, I’ve started doing this work because at the end of the day, we don’t have a solution for weight loss. Even if it were this magic silver bullet we’re told is-
Dalina Soto:
It’s a bandaid. It’s a bandaid. [inaudible 00:20:05] just for hot second a bandaid. Doctors just want to be, like “I told you so. It worked. Now you’re on your own. Bye.”
Sam Abbott:
Right. Well, and I think short term intermittent fasting and keto are commonly recommended for PCOS. But if you cannot do that long term, then what is the point? If it’s affecting your mental or your emotional health, what is the point? And if we really look through history, Christy Harrison’s book, Anti Diet does a really good job of talking about the history of diet culture. And recently I was listening to something that Julie Duffy Dillon was teaching and she’s amazing, but she just said, “when you look through history, there have always been fat bodies. There are fat bodies now, and there will be fat bodies in the future. So why are we focusing on this as the way to treat PCOS?”
Melissa Landry:
Right. It’s working with who we are with our genetics and optimizing, enhancing our health. And that’s true of all diagnoses. PCOS is our topic today but if you carry other diagnoses, that’s always the question in anti dietician wants to know is how do we work with that? Get you from A to B where you want to be if you’re not there right now?
Melissa Landry:
What is the root cause? I think that that’s the primary thing we all work on, right? What is happening? Let’s fix that or help you at least feel better. And then really when you’re meeting your needs, when you feel better, everything else kind of falls into place.
Sam Abbott:
Exactly. And I think it’s so important and this is, I have been privileged. So I do not have the experience of living life at a higher weight and the types of experiences that many of my clients have had, which is many of which are very heartbreaking and upsetting. So it’s not my job to tell somebody that they should not hold the desire to lose weight. But something that I really like to do with clients is explore the reason why. Why would you like to lose weight? And what can we do now to support you in accomplishing those things and helping you live your best life and feel your best right now in your current body? If it’s, you want to fit into clothes, can we update your wardrobe and clothes that make you feel good right now? If it’s that you hate going to the doctor and being told you need to lose weight, then can we find you a more supportive care team that can respect where you are right now and focus on your actual behaviors? There are so many reasons why people want to lose weight and you can truly focus on those things and enriching your life now, at least to some extent.
Melissa Landry:
That’s beautiful and exactly the right framework for people to be thinking through. So I appreciate that you offer that. It’s amazing. So we’re going to wrap up here with, I think we have time for one more question. We are talking about mental and emotional health of women with PCOS quite a bit here. And I got this great question. Someone said, “when I’m not dieting and restricting, I eat junk food all day long. Can intuitive eating help women with PCOS who face this particular concern?” So what are your thoughts on the emotional eating or emotional coping aspects and intuitive eating?
Sam Abbott:
Yeah, I think that this is great, a great question. I think it’s important to remember that intuitive eating is a framework. It’s not actually medical nutrition therapy. So we really say it’s blending your food preferences and your thoughts and feelings and attitudes around food with whatever is going to promote your health at that given point in time. So, in terms of nutrition education for PCOS, if somebody’s not in a place mentally to receive any of that information, then that’s not appropriate. Whereas somebody who has a healthy relationship with food, maybe they can learn some of that information in a healthy and balanced way. One really important thing to remember with PCOS is that if you do have insulin resistance, you are probably going to feel hungrier and crave things more. So really addressing insulin resistance with either medication or supplements or adding some protein and fat to meals can really be beneficial.
Sam Abbott:
So that would be step number one for somebody that feels like the only way that they have some control is if they’re restricting. A lot of times, the insulin resistance plays a role in that. Another thing too is there, with that specific question, there’s a huge emotional layer of in addition to the insulin resistance, what’s really going on to where the only way that you feel like, I don’t even like using the word junk food or things like that, but why are you in this place of all or nothing? And what can we do to bring you back to the middle? And that usually takes a little bit of work. That’s not an overnight process.
Dalina Soto:
Yeah. I mean, at the end of the day, all folks following intuitive eating are teasing out how much of this is mental restriction? How much of this is biological hunger? And then how much of this is emotional? And sometimes it’s a little bit of all three. And so that’s where really dedicating three, six months of work with someone means that you can take your time unpacking each step of the way so that you walk away with true understanding of of this particular question.
Sam Abbott:
Yes, definitely. And I do think that with many people who have PCOS, there is a big biological hunger component, but it’s really making the emotional and mental aspect even worse.
Melissa Landry:
Yeah. And it’s ratcheted up because of the insulin resistance compared to someone who doesn’t really face that. So that’s such a great takeaway I think, for listeners that if your hunger feels maybe extreme or intense and you carry a PCOS diagnosis, you’re going to want that medical nutrition therapy element alongside the IE for sure.
Sam Abbott:
Yes, definitely.
Melissa Landry:
Awesome. We had one last question. I said the last one was the last one, but can we do a quick hot take?
Sam Abbott:
Yeah, I’ll try to be brief, sorry, I know I go off on tangents. [crosstalk 00:26:46]
Melissa Landry:
No, you honestly, Sam, this is so, so helpful. Many of my clients have these questions and it just makes me feel hopeful that you’re out there spreading this message because people need to hear it. Okay, so here is our hot take quick question. This is deeper than just a quick reply, but we’re going to try. So gluten and dairy free for PCOS, there’s a lot of messaging out there that that is helpful. Quick take. Does that work? Should people be going gluten-free or dairy-free to treat their PCOS?
Sam Abbott:
Yes. So in a very brief explanation, I’ll make a couple points. One is that if gluten or dairy is upsetting your stomach, then yes, that can play a role in inflammation and making PCOS worse. So if you notice a difference in your symptoms or you’re getting an upset stomach or brain fog or whatever, then it may be beneficial for you to eliminate any food, not just gluten and dairy, that makes you feel that way. There are no studies specifically that support eliminating gluten from your diet for PCOS. I have no idea where that started, but no research there to support that. With dairy we do know that if somebody has PCOS, it is more beneficial to consume full fat dairy. That can help with androgen levels. Whereas we do see an increase in androgen levels with low fat and fat free dairy. There’s also an association between dairy and acne. So if you struggle with acne as one of your PCOS symptoms, then trialing full fat first to see if that helps and then doing a trial elimination of that could be beneficial.
Melissa Landry:
Hire Sam you guys. This sounds like a lot of work. I’m just saying. No, but it just really gives, I hope this again underscores [inaudible 00:28:41] You haven’t figured this out yet. Experts don’t have the clear answer for you either. It’s really about informed experimentation and finding guides that really you trust and are expert in this is incredibly valuable. So that’s my takeaway from listening to you say that that this is a process.
Sam Abbott:
And I think also PCOS is really, really individualized. What works for one person may not work for somebody else. And I would really, as a takeaway message, steer away from any type of influencer or provider that is just giving across the board advice without recognizing the gray area, without encouraging trialing things or experimenting and seeing how you feel. Because it is just so individualized and I’ve worked with hundreds of people with PCOS and it’s not just the same prescription for everyone.
Melissa Landry:
Oh, Sam. I want to hug you.
Dalina Soto:
Hug the screen ladies.
Melissa Landry:
Seriously.
Dalina Soto:
Hug the screen with out curly hair.
Melissa Landry:
Yes, curly hair hugs everybody. It’s so true. Well, that’s a good as takeaway as any that we could have asked for here, just to be able to have that permission to individualize, to give yourself time and space, to find what works for you. Each lesson you learn is one you can build on. And then you have that as a habit for a lifetime. Super inspiring. Sam, anything that you want to plug or share about you and your brand? What are you working on over at PCOS Nutritionist?
Sam Abbott:
Well, I run a group coaching program where I really walk you through some of the things that can really cause these PCOS symptoms to be worse and cause your period to be irregular. So I walk you through that from a non diet approach. So instead of focusing on weight loss, we really focus on getting you feeling better and living your best life. So I have my group coaching program, I love running that. It gives clients a sense of community. So that’s the main thing that I’m working on right now. And you can always come over and just hang out with me on Instagram. My handle is PCOS.nutritionist.
Melissa Landry:
Awesome. Everybody take out your phone now. Unless you’re driving, do it when you’re pulled over and follow Sam at PCOS nutritionist. Sam, thank you for your time and being here today.
Sam Abbott:
Oh, you’re welcome. It was so fun.
Dalina Soto:
Thank you so much.
Sam Abbott:
All right. Have a good one, ladies. Thanks.
Melissa Landry:
Thanks.
