If you’ve been diagnosed with polycystic ovarian syndrome (PCOS), you’re not alone. PCOS is the most common endocrine disorder in reproductive-aged women. In fact, it occurs in 6-12% of women – a sizable chunk of the female population! What you may not know, is that 1 in 3 women with PCOS also suffer from binge eating disorder (BED).
Sir Francis Bacon (I know, what a last name) once said, “knowledge itself is power”. So let’s power up! We’ll focus on what BED is and six reasons someone with PCOS may be likely to binge eat. Then, you’ll learn how to control binge eating with my free guide “The 3 Step Guide to Navigating Binge Eating”. With these tools in your arsenal, you’ll be that much more prepared in the battle toward overcoming binge eating.
What is Binge Eating Disorder?
What qualifies as binge eating?
To understand BED, it’s first important to differentiate BED from overeating – they’re not the same thing. For a lot of us, the urge to overeat is a normal one. Having an extra serving of food when you’re already full, eating more than usual at a party or event. These can be common occurrences. But, while grabbing an extra donut hole at a birthday party may qualify as overeating, it does not mean you have BED.
BED is a more serious condition. It is a diagnosable eating disorder (ED) and it is, the most common eating disorder in the United States. It involves consistently overeating, with a marked focus on lack of control. The National Eating Disorder Association (NEDA) defines an episode of binge eating with two main factors:
1. The consumption of a large amount of food (more than what a typical person would consume) within a set amount of time (typically within a 2-hour window).
2. The feeling that one simply cannot stop themselves from eating and has lost control.
What’s the difference between binge eating and binge eating disorder?
Now that we’re a bit clearer on what exactly a binge eating episode is, let’s look at a few additional diagnostic criteria used to diagnose BED:
1. BED is marked by frequent, recurring episodes of binge eating (with the average episode occurring at least once a week), for up to 3 months.
2. Episodes themselves often feature 3 of more of these factors:
- Eating way faster than normal
- Eating until you feel unpleasantly full or sick
- Eating large amounts of food even when not hungry
- Eating alone to avoid embarrassment stemming from how much you’re eating.
- Feeling ashamed, disgusted, depressed, or guilty after eating.
3. Unlike other eating disorders, people with BED don’t try to “undo” their binge eating with extreme measures (such as trying to throw up or rigorously over-exercising).
If a few of these criteria hit home for you, it could mean that you have BED. At the same time, it doesn’t necessarily: a substantial amount of women with PCOS have reported disordered-eating symptoms that don’t quite meet the requirements to receive an ED diagnosis. Regardless of where you land on the spectrum, read on to learn how PCOS and binge eating are interconnected, and some tactics you may find helpful if you find yourself struggling.
6 Reasons PCOS & Binge Eating are Connected
Many women with PCOS report strong, urgent food cravings, often revolving around sweets. These cravings can lead to a binge eating episode, but why do they happen to begin with? Let’s zero in on some factors that contribute to binge eating and PCOS:
1. Insulin Resistance
Still feeling “hangry” 30 minutes after eating? The culprit is likely insulin resistance – something common in 50-90% of people with PCOS. Think of insulin as the key required to access the “door” of a cell. After you eat, food is broken down into glucose in the blood. Insulin’s job is unlocking the cell door to deposit this glucose from the bloodstream into the cell, where it’s stored for energy for later use.
Insulin resistance, however, means the “key” has a difficult time unlocking the cell door to let the glucose in. This results in high levels of excess glucose in the blood, which signals the pancreas to secrete more insulin to help get the glucose into the cells. This results in heightened insulin levels.
Insulin, a growth hormone, increases appetite. Here’s how:
When the insulin finally manages to unlock the door, all the glucose floods into the cells all at once, which drops your blood sugar. Your body notices your drastically reduced glucose levels, and signals for you to eat more (to restore glucose to normal levels). These resultant cravings often find us feeling hungry for, you guessed it, sugar. And as we all know, finding ourselves in dire need of a sugar fix can lead to binge eating episodes.
2. Leptin Resistance
Adipose tissue (body fat) produces a hormone called leptin. Leptin helps your body sustain its set-point weight long-term, by working to suppress appetite and by increasing the body’s use of energy. The concentration of leptin in someone’s blood is directly proportional to how much body fat they have. Leptin levels increase as a person’s fat mass increases (and vice versa).
When leptin levels rise, this can result in what’s known as “Hyperleptinemia”. Leptin levels of this magnitude can lead to “Leptin Resistance”, where your body builds a tolerance, and requires higher-than-normal levels of leptin to feel full. This leads someone to eat more, because their body may not have sent the signal that they’re already full.
3. Restrictive Diets
You, like many of us, have likely tried several restrictive diets in the hopes of managing PCOS symptoms. Doubly so if you’ve ever received the oversimplified advice “just lose weight” or “go low-carb” as a supposed catch-all solution. And, like many, what you have likely learned is that none of them seem to work how they’re supposed to. Many leave you feeling even more obsessed with food than before. Overly-restricting anything leads to feeling trapped, which often leads us to fixate on our impending freedom (“cheat days”, and anything that seemingly grants us a reprieve.)
Ever start a diet, feel like you’re sticking to it so well during the week, then the weekend rolls around and you decide “wellll….the weekend doesn’t quite count” and fall off the wagon a bit? Now you feel guilty for wrecking your progress, which is only a short leap to “screw it. This diet wasn’t working anyways. I’ll try again Monday”. Now you’ve given yourself a free pass to binge.
This is what we call “Last Supper Eating”. Letting your resolve slip from a minor setback and giving into full-on binge eating. You allow yourself to eat all the foods that were previously off-limits in an attempt to “get it out of your system”, before going back on the diet and restricting those foods again (in theory at least). This cycle increases the amount of insulin (responsible for “hangry attacks” and sugar cravings), testosterone (an androgen that causes symptoms like acne, hirsutism, and hair thinning/loss) and inflammation (which, in turn, increases your body’s insulin and testosterone all over again!).
As you can see, this is an all-too-tempting vicious cycle that not only leads to binge eating, but may also be worsening your PCOS symptoms.
4. Psychological Factors
Studies have shown that 27.3% of women with PCOS have reported struggling with depression (compared to 19% without). Additionally, 50% of women with PCOS also report anxiety symptoms (compared to 39.2% of women without). While researchers have various theories as to the root cause of this, one factor is fairly easy to understand:
Women with PCOS tend to struggle with unexplained weight gain and other body changes (acne, abnormal face and body hair growth, hair loss). These changes can understandably have a negative impact on our self-esteem. Low self-esteem can cause someone to wallow, and resign themselves to overeating. It can also cause one to become obsessed with over-correcting, leading them to engage in restrictive diets or over-exercising. In both cases, shame from overindulging (or from the fact that many restrictive diets fail, even when strictly adhered to) can result in even lower self-esteem.
If psychological factors seem to be creating a binge-oriented atmosphere in your life, check out this article on Emotional Hunger Vs Physical Hunger to help you learn to properly decipher what your body is telling you when it sends hunger cues. Too often, we turn towards food to self-soothe, without digging into what may be at the root of this desire.
5. Diagnosis-Related Stress
It’s no surprise that many women diagnosed with PCOS feel as though their diagnosis is yet another additional layer of stress perched precariously on top of their already stressful lives. That’s as good a reason as any to discuss stress and the multiple ways it can lead to binge eating.
Do remember, stress hormones were originally intended to get us away from danger (running from a saber-tooth tiger, for example). Urgent situations like these require your body to make a quick burst of energy to propel you to safety. As such, whenever your body senses stress, it signals your stress hormones to release glucose into your bloodstream (in case there’s any tigers you need escaping from). The excess glucose in the bloodstream, as we remember from earlier, increases the amount of insulin in your bloodstream, which we know causes sugar cravings and can subsequently lead to binge episodes.
Running from a saber-tooth tiger (or dinosaur, or volcano, choose your own adventure) is considered acute stress. In cases of acute stress, the hypothalamic-pituitary-adrenal (HPA) axis (which helps regulate food intake) attempts to replace the energy used. So, whatever your acutely-dangerous caveman-themed situation is, you will likely be starving shortly afterwards.
Now, acute stress differs from ongoing stress (which is more often how psychological stress, such as a new PCOS diagnosis, manifests). In ongoing stress, there is a constant elevation of glucocorticoids (the steroid hormones meant to treat inflammation, etc). This can cause changes in our eating behavior, leading to chronic eating and extreme weight gain. Moreover, when the body undergoes stress in general, the HPA axis increases cortisol production. Cortisol (the stress hormone) also increases hunger.
6. Sleep Issues
Do you suffer from poor sleep? Unable to fall or stay asleep? Unable to go back to sleep once woken up? Clinical researchers have categorized these as “sleep disturbances”, and there is a great deal of evidence indicating that women with PCOS are more likely to deal with sleep disturbances than women without it.
This is vital partially because a lack of sleep can lead to insulin resistance (and all the drawbacks stemming from that, discussed earlier), changes in our appetite, mood, and eating behavior. For instance, sleep deprivation has been found to trigger increased levels of ghrelin (a hormone produced by the stomach and primarily tasked with telling the brain when the stomach is empty), and decreased levels of leptin (the hormone produced by fat cells that regulates appetite and storage). Messing with these hormones can have drastic results and can easily lead to less mindful eating behavior. That is why when you’re experiencing energy crashes in the afternoon AND your body is signaling that it needs quick energy (AKA carbs), it can be exceedingly difficult to resist the oasis of a sugar-and-carb binge.
Binge eating can be quite difficult to overcome by yourself. That being said, it IS within your grasp to overcome it. Working with a dietitian specializing in binge eating and PCOS (like me!) can be a vital piece of the puzzle. Getting you the extra support, tools, and confidence, you need to help ditch the PCOS binge-eating episodes and to take control of your health.
If you are ready to take action, grab my free guide to Navigate Binge Eating. If you are looking for a more hands-on, tailored approach, book a 30-minute complementary call to discuss what working with me can look like. You can also check out the National Eating Disorder Association Helpline for additional resources and support if you think you are struggling with an eating disorder.