at a glance
Why Am I So Hungry With Polycystic Ovary Syndrome (PCOS)?
Do your hunger cues sometimes feel like that toxic friend you’ve been trying to cut out of your life for years but can’t seem to get rid of? If you relate to these feelings, you’re not alone. As much of a curse as it may seem, the feeling of hunger was designed to keep you alive. When you feel hungry, it’s a signal that you should eat. When you eat, the food is broken down into the building blocks needed to make hormones, heal wounds, grow your hair and nails, fuel your immune system, and even repair your DNA. However, sometimes the cues that make you feel hungry can get confused. When this happens, your body may start telling you to eat even when you don’t need energy or fuel.
The Different Types of Hunger Signals In Your Body
There are two types of hunger cues that you should know about. The first type is the hungry feeling you get in between meals. This type of cue tells us it’s dinner time, or that you need a little snack before lunch. The second type of hunger cue is more long term and is super invested in maintaining your body weight. If fat stores start to get a little low it kicks in and makes you feel super hungry. If fat stores stay pretty consistent, this cue will stay relatively quiet.
The day to day hunger cue is caused by a messenger in your body called cholecystokinin–but we’ll call it CCK for short. When CCK levels go up after a meal, you should feel satisfied and less hungry.
The second, more long-term signal is cued by a messenger known as Leptin. Leptin is made by fat cells which means the more fat an individual has the more leptin they’ll have floating around their body. Leptin is a hormone that simply should signal to your brain that you are full. It’s the satisfied hormone, unlike its counterpart ghrelin which will tell you that you are hungry.
Eating less, or restricting calories is one of the main ways to lose weight. Restricting calories can cause fat cells to shrink. Since leptin is made by fat cells, a decrease in fat mass will also reduce how much leptin is being pumped into your bloodstream. Remember that leptin’s job is to maintain your weight-so when we start to limit calories and lose weight, the control centers in our brain sound the alarm and make us feel super hungry. If you haven’t noticed yet, the brain is not our biggest cheerleader when it comes to weight loss. In fact, it is kind of working against that goal. For millennia eating too little meant it was time to find berries or kill a bison. That takes energy, so your body will help downregulate your metabolism to help so you can gather your next energy source using the smallest amount of energy possible.
In current times, most of us are fortunate to live with an abundance of food options. It doesn’t require killing the cattle to make a hamburger, you can just drive to the grocery store and buy it in a pre-portioned package. The double edge to this sword is that our hormones haven’t adapted to this incredibly fast shift in food availability.
A Closer Look At Which Hormones Dictate Hunger Levels
Meet your very own hunger managers. When it comes to hunger in PCOS there are three main players: CCK, leptin, and insulin.
CCK(cholecystokinin): The Facebook Friend
Both CCK and Leptin are influenced by PCOS metabolic abnormalities such as high testosterone. CCK has short-lived effects that help you feel full between meals. Testosterone squashes CCK production which makes the feelings of hunger more intense between eating times.
Wait…hunger and weight loss are about more than just restricting calories? Absolutely! Balancing your hormones (like testosterone) through exercise, adding ground flax seeds to your diet, drinking spearmint tea, and supplementing with natural androgen blockers like red reishi mushrooms, will help lower testosterone levels and consequently curb cravings.
CCK: How It Acts In a PCOS Body versus Someone Without PCOS
Leptin: The Ride or Die
Next, let’s chat a little about leptin. To put it plainly, leptin is a satiety hormone. As mentioned before, leptin is made by fat cells and is mainly interested in keeping you from losing weight. This is helpful for anyone living with food insecurity–but not so much for those of us living with overwhelming access to super-processed food. If you gain weight, leptin turns a blind eye and resets to maintaining the new number you see on the scale.
As soon as you start losing weight, your body will produce less of this hormone that signals to your brain that you are FULL and that you are SATISFIED. It’s hard to lose weight and restrict calories if you feel hungry all the time.
Research has shown that having PCOS makes it more likely that you have leptin resistance. Surprisingly this actually has nothing to do with your weight on the scale. This condition is similar to “insulin resistance” (read more about insulin resistance). Leptin resistance is when the leptin receptors in the brain get so used to leptins message that it tunes them out. Our bodies respond to leptin resistance by pumping out more leptin. It’s like a little kid that keeps yelling “mom”, louder and louder until she stops what she is doing to listen to them. The leptin receptors just get tired of the message.
Unfortunately, to pump out more leptin we need more fat. To gain more fat, the body tells us to eat more food by making us constantly hungry. A super vicious cycle ending in more and more weight gain.
Insulin: The Two-Faced Bestie
Insulin resistance is also a problem for many people who are interested in maintaining a healthy weight (read more about insulin resistance). Long story short, insulin helps us manage blood sugar. When our blood sugar is stable we feel satisfied and calm. When our blood sugar is too high or too low, we feel hangry, shaky, crave carbs and yes, gain weight.
Insulin is a hormone that has two major jobs in the body.
Insulin Says “Take in Energy”
The first is just to bump up against cells and say “Hey cell. There is energy available, open up and use it”.
This happens after you eat. Your body takes the food, breaks it apart and puts the energy nutrients in the blood(blood sugar). When blood sugar levels go up, your pancreas pumps out extra insulin to tell all of your cells that they need to use that energy.
Insulin says “store fat”
Insulin is a growth hormone. It makes the body aware that energy is here. So it bumps up to the cell and says “Hey cell. There is energy available, store whatever you don’t need for later.”
Problems arise when we have too much of this hormone floating in our body. First of all, you get annoyed at the persistent hounding so you stop listening as well. After that, your body has to start making more to get that same message across.
How Insulin Resistance Affects PCOS Specifically
When we are insulin resistant, we have to make a lot more insulin to get the job done. This becomes a problem for PCOS patients because our ovaries are very sensitive to insulin. When insulin levels increase in our blood, the ovaries respond by making testosterone. Remember how testosterone squashes CCK and makes us feel more hungry?
PCOS Makes it Harder to Feel Full and Hormones Make It More Difficult for PCOS Patients to Feel Full – It Goes Both Ways
You can actually see how CCK, leptin, and insulin all have key interplays with hormone signaling in the body. PCOS on one hand, is making it more difficult to get the fullness signal (thanks CCK). Yet, all the hormones seem to make it more difficult for those of us with PCOS to feel full. It’s kind of a chicken-and-egg situation. Which one really came first?
How Do I Help My Body to Feel Full?
Diet
When focusing on connecting with hunger cues there are advantages of certain types of food to help your body feel full.
Fiber
Fiber comes from plant foods. It’s essentially a bulky part of the food that humans don’t have the ability to break apart and digest. Some fiber even absorbs water (this is called an soluble fiber). Fiber in general is bulky and can help you feel full. Most western cultures do not eat enough fiber. As you try to help your body feel full and satisfied after eating, choosing foods that help your stomach fill up will help you.
Could you eat 7 large raw carrots at one sitting? Probably not, why? Because it has fiber. Could you eat 3-4 slices of pizza? Yep, most of us have at some point in our lifetime. Why? It is a food highly lacking in fiber.
Protein
Your stomach does most of the work when it comes to digesting protein. When you eat a high-protein meal it takes longer for your stomach to pass the food into your small intestine. This can leave you feeling full and satisfied for a longer period of time in between meals.
Protein also decreases the hunger hormone: ghrelin. It works not only by causing physical feelings of fullness, but also impacting hormonal signaling that you no longer need to eat.
Fat
Fat is a macronutrient that is dense in calories. If you are anything like me, you grew up in a time when people were afraid of fat. My mom had every version of fat free foods in the house. Snackwell chocolate sandwich cookies anyone?
Just because fat shares a name with adipose tissue in our body, it doesn’t make you fat. Just ask someone eating keto. Fat does have the nice benefit of helping you feel full after a meal. So while a full-fat greek yogurt will pack more calories than the non-fat version. It will also help you feel full after eating.
We have been afraid of fat for far too long. Fat will help your stomach slowly empty food similar to protein and supports hormone signalling.
Savory Foods
Can you recall a time you had pancakes and syrup for breakfast? What happened about an hour later? No, I’m not talking about the nap you had to take. Yep! You were hungry. Sweet foods and starting your day with a super sugary breakfast can actually lead to blood sugar rollercoasters that send you craving food and feeling more hungry.
Start your day with something savory. Choose snacks that have a savory component. Use spices that highlight the other taste profiles than sweet. Find that umami. This is something that I have really seen in working one on one with clients.
If you want the fastest ticket to craving carbs and sugar all day, start your day with something sweet. If you want more balanced energy and hunger cues, switch to a savory breakfast.
Caffeine and Coffee
I remember sitting in my metabolism course and hearing that coffee was the perfect “food”. It suppressed your appetite and increased your metabolism. A nutrition student’s dream! A college student’s dream. Why am I bringing it up here? While it does have those effects it also can increase your anxiety which will more than likely lead to cravings and binge eating episodes. So consider your caffeine and coffee intake like many other things, moderation is key. Our individual tolerance for caffeine varies as well as our genetic ability to metabolize it.
Spices
Spices have many beneficial qualities. They can help lower insulin sensitivity, lower inflammation and help satisfy your appetite. Consider using the following spices in your meals:
cinnamon
ginger
turmeric
Exercise
Exercises that utilize big muscle groups–like wall sits, squats, and weight lifting–paired with a well-balanced diet can be very helpful. More important than anything is that you choose an exercise that you can be consistent with, enjoy, and that will not cause injury.
That exercise will also increase your metabolic burn and could give an unintended side effect of feeling more hungry for a period of time. Your body should adapt to this rather quickly though.
Supplements
You can also supplement intentionally with things like berberine, inositol, NAC, and magnesium. Most of these will help hunger cues by improving insulin resistance and the hormonal changes downstream that will happen on testosterone. Remember how testosterone stops CCK from doing it’s job? Many of these supplements also help with insulin resistance. There are supplements that have been used to suppress appetite, but generally speaking I do not recommend them for clients.
Medication
Many doctors will still prescribe medications that lower appetite to help treat PCOS. The intent is to lower appetite and help someone lose weight. Appetite suppression can assist in calorie restoration. Earlier we discussed how calorie restriction can actually make you feel more hungry. The purpose of the medication is to combat this effect and help aid weight loss efforts. As body weight decreases so will insulin resistance and leptin resistance making it easier to become in tune with true appetite signals.
Phentermine
One popular medication that is still used is called phentermine. This was popularly used in the 80s and 90s for weight loss. I have seen a recent resurgence of phentarmine in treating women with PCOS who have weight loss goals.
Wellbutrin
Wellbutrin is an anti-depressant that also has appetite-suppressant qualities and is an option to consider if you deal with depression, weight gain, strong hunger signals.
Contrave
Contrave is a weight loss drug that contains two active ingredients. One of those ingredients is wellbutrin.
Diabetic Medications Used In An Off Label Manner
Other medications that help with weight loss and improving insulin sensitivity are typically used for diabetes. Metformin is the most common to be prescribed to PCOS patients. In the last two years, I have also seen an uptick in prescriptions for Ozempic. This is a once-weekly injection and helps treat insulin resistance in a different way than metformin. Common side effects of the drug are feeling no appetite, nausea, and loose stool. You can see how all of this would help you eat less an potentially lose weight. This article is showing options and not endorsing any of these specifically. You should have a thorough conversation with your healthcare practitioners about the benefits of each of these items.
Mind-Body Connection
Many of the issues related with hunger and satiety are hormonally regulated. Creating a stronger mind-body connection, consistently focusing on calming the nervous system, and lowering stress can all help encourage this mind body connection.
Deep breathing, journaling, meditation, time in stillness can all help facilitate a more sensitive connection with your body and how it is feeling. These things are not valued as highly as they should be in modern society and become critical to helping our body feel safe and heal in all the ways it needs to.
There are so many ways to improve huger cues, satiety, insulin resistance and they are all main tenets of managing PCOS for the long run.
Can fasting help?
Many people that implement intermittent fasting describe their hunger going away completely. While I don’t think intermittent fasting is a great option for most of us with PCOS, there is something to having a sufficiently long enough overnight fast. One useful trick is choosing to extend the length of time of your overnight fast.
This looks like eating normally throughout the day, but after dinner trying to extend the period between eating dinner and breakfast to 10-12 hours. Yep, this means no middle of the night snacking, as an added perk you may notice that you sleep better! So this could look like having your last meal by 7 pm and not eating breakfast until about 7 am the next morning. Totally doable for most of us!
It’s Good to Feel Hungry
Hunger is not the enemy. Eating is life-giving to our bodies, and enjoying food with friends and family creates community and connection. As we start to learn more about what our body needs, and how it works, we will discover effective strategies for managing our hunger cues.
Your body is beautifully and intricately designed. Like any relationship, it takes a little time to recognize our specific needs and learn how to respond to them in a healthy way. As always, we’re rooting for you.
References
Gruzdeva O, Borodkina D, Uchasova E, Dyleva Y, Barbarash O. Leptin resistance: underlying mechanisms and diagnosis. Diabetes Metab Syndr Obes. 2019 Jan 25;12:191-198. doi: 10.2147/DMSO.S182406. PMID: 30774404; PMCID: PMC6354688.
Crowe FL, Key TJ, Allen NE, Appleby PN, Roddam A, Overvad K, Grønbaek H, Tjønneland A, Halkjaer J, Dossus L, Boeing H, Kröger J, Trichopoulou A, Dilis V, Trichopoulos D, Boutron-Ruault MC, De Lauzon B, Clavel-Chapelon F, Palli D, Berrino F, Panico S, Tumino R, Sacerdote C, Bueno-de-Mesquita HB, Vrieling A, van Gils CH, Peeters PH, Gram IT, Skeie G, Lund E, Rodríguez L, Jakszyn P, Molina-Montes E, Tormo MJ, Barricarte A, Larrañaga N, Khaw KT, Bingham S, Rinaldi S, Slimani N, Norat T, Gallo V, Riboli E, Kaaks R. The association between diet and serum concentrations of IGF-I, IGFBP-1, IGFBP-2, and IGFBP-3 in the European Prospective Investigation into Cancer and Nutrition. Cancer Epidemiol Biomarkers Prev. 2009 May;18(5):1333-40. doi: 10.1158/1055-9965.EPI-08-0781. PMID: 19423514.
Galante L, Pundir S, Lagström H, Rautava S, Reynolds CM, Milan AM, Cameron-Smith D, Vickers MH. Growth Factor Concentrations in Human Milk Are Associated With Infant Weight and BMI From Birth to 5 Years. Front Nutr. 2020 Jul 29;7:110. doi: 10.3389/fnut.2020.00110. PMID: 32850934; PMCID: PMC7403458.
References
Gruzdeva O, Borodkina D, Uchasova E, Dyleva Y, Barbarash O. Leptin resistance: underlying mechanisms and diagnosis. Diabetes Metab Syndr Obes. 2019 Jan 25;12:191-198. doi: 10.2147/DMSO.S182406. PMID: 30774404; PMCID: PMC6354688.
Crowe FL, Key TJ, Allen NE, Appleby PN, Roddam A, Overvad K, Grønbaek H, Tjønneland A, Halkjaer J, Dossus L, Boeing H, Kröger J, Trichopoulou A, Dilis V, Trichopoulos D, Boutron-Ruault MC, De Lauzon B, Clavel-Chapelon F, Palli D, Berrino F, Panico S, Tumino R, Sacerdote C, Bueno-de-Mesquita HB, Vrieling A, van Gils CH, Peeters PH, Gram IT, Skeie G, Lund E, Rodríguez L, Jakszyn P, Molina-Montes E, Tormo MJ, Barricarte A, Larrañaga N, Khaw KT, Bingham S, Rinaldi S, Slimani N, Norat T, Gallo V, Riboli E, Kaaks R. The association between diet and serum concentrations of IGF-I, IGFBP-1, IGFBP-2, and IGFBP-3 in the European Prospective Investigation into Cancer and Nutrition. Cancer Epidemiol Biomarkers Prev. 2009 May;18(5):1333-40. doi: 10.1158/1055-9965.EPI-08-0781. PMID: 19423514.
Galante L, Pundir S, Lagström H, Rautava S, Reynolds CM, Milan AM, Cameron-Smith D, Vickers MH. Growth Factor Concentrations in Human Milk Are Associated With Infant Weight and BMI From Birth to 5 Years. Front Nutr. 2020 Jul 29;7:110. doi: 10.3389/fnut.2020.00110. PMID: 32850934; PMCID: PMC7403458.
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