Take Control of Sugar & Carb Cravings [Podcast with Dr. Erica Armstrong] - PCOS Diva
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Take Control of Sugar & Carb Cravings [Podcast with Dr. Erica Armstrong]

PCOS Podcast #143 - Take Control of Sugar & Carb Cravings “You can’t out-willpower your physiology, but there is still hope and you can reverse insulin resistance. Think of it in a holistic way. It doesn’t have to be a super-restrictive diet, and you don’t have to focus on losing weight to do that.” – Dr. Erica Armstrong

Dr. Erica Armstrong, Md, IFMCP has a realistic, holistic approach to managing cravings and insulin resistance. We agree that willpower is no match for what is physiologically going on in our PCOS bodies. Overcoming destructive cravings must be centered on balancing hormones and blood sugar to prevent cravings from taking over. Listen in (or read the transcript) as we discuss why women with PCOS seem to struggle more than our non-PCOS peers with sugar and carb cravings and tips about how to manage them.

  • Why the focus should not be weight loss when working on lowering insulin
  • Tips on how to eat to balance blood sugar and manage cravings
  • Snack ideas
  • Supplements that help manage cravings
  • Pitfalls of sugar substitutes

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Mentioned in This Podcast:

PCOS seasonal meal plans

Complete Transcript:

Amy:

Many women with PCOS deal with sugar and carb cravings. And I know I was one of them and I continue to be. I remember being faced with a bag of Tootsie Rolls and not being able to stop eating them and not really understanding why. I’ve always felt that I was this woman that really had control over most areas of her life, but sugar and carb cravings was not one of them. And over time, I learned that willpower is no match to what is physiologically going on in our PCOS bodies.

And I brought one of my favorite PCOS experts, Dr. Erica Armstrong. She is an MD and an IFM, which is The Institute of Functional Medicine, certified functional medicine doctor and founder and CEO of Root Functional Medicine to chat with us about why women with PCOS have sugar and carb cravings and what we can do about them. So, welcome Dr. Erica Armstrong to the PCOS Diva Podcast.

Dr. Erica Armstrong:

Thank you for having me, Amy.

Amy:

Why don’t we frame, first of all, why women with PCOS seem to struggle more so than our non-PCOS peers with these crazy sugar and carb cravings?

Dr. Erica Armstrong:

Yes. So, we know that most women with PCOS do have insulin resistance, but you can also have PCOS without insulin resistance and blood sugar balance is still important. So, why women with PCOS have more severe carb cravings, it’s not only the high insulin levels which drives those cravings, but also the hormonal imbalance that is also contributing to that.

Amy:

So, specifically what hormonal imbalance? As women with PCOS, we struggle with elevated androgens and estrogen dominance or maybe dominance isn’t the right word, but just the ratio between estrogen and progesterone is off. We deal with insulin, we have higher cortisol levels. How does that all contribute to or what part of those hormonal imbalances contribute to these sugar cravings?

Dr. Erica Armstrong:

Yeah. To break it down like you said, women with PCOS tend to have more estrogen than progesterone because as you know, progesterone is mostly made after ovulation. And if women with PCOS are not ovulating, they will have relatively more estrogen than progesterone. But the other thing that happens that drives the imbalance is that insulin resistance can actually cause women to have more testosterone released as well, and it’s a cycle. So, the increased testosterone contributes to the insulin resistance, but the high insulin contributes to more testosterone. And then as you said, the cortisol. Cortisol is a protective hormone that our body needs to survive. One of the protective functions that it does is it raises our blood sugar. So if we’re in a dangerous, low blood sugar situation, cortisol will be pumped out to raise blood sugar. So, women who are chronically stressed because of PCOS, because of hormone imbalance, or because of external stressors, they will have higher cortisol, which is increasing their blood sugar. And blood sugar balancing is one of the key things that we focus on when we are trying to treat the adrenal glands, which secrete the cortisol.

Amy:

So, that’s really helpful information. So, the blood sugar balancing helps with healing our adrenals, in a sense.

Dr. Erica Armstrong:

Yeah. If your blood sugar is going up and down all day, you’re going to have a lot of cortisol released in response to get that blood sugar back up. When your blood sugar starts dipping, suddenly the signal comes from the brain, oh no, this is dangerous. The brain needs sugar, so cortisol, do your job. Let’s go and get that blood sugar back up. And so, if that’s constantly being stimulated because you’re going up and down all day as we sometimes see with insulin resistance, then that is taxing on the adrenal glands. And then, that signal starts to get dysfunctional from the brain to the adrenals. That’s what we call HPA axis dysfunction.

Amy:

So, when we’re stressed, I mean, that is definitely a trigger, I think for cravings. And I think you just laid out what is happening when we’re stressed and why we’re craving sugar.

Dr. Erica Armstrong:

Yeah. So, stress definitely can cause carb cravings, and it’s on multiple levels, why that happens. Stress also deplete some of our key vitamins that help with insulin sensitivity, like magnesium. It can interfere with our blood sugar balance and cause more or less insulin to be released or metabolized. So, on many different physiological and emotional levels, stress causes more carb cravings.

Amy:

So, we have cortisol and stress related cravings. Cravings caused by the dysfunction of our insulin and insulin resistance. Can you tell us more about that and break that down?

Dr. Erica Armstrong:

Yeah. So, let’s talk about what insulin resistance is. Insulin resistance basically means that insulin isn’t doing its job well anymore. And so, insulin’s job is to take sugar out of the blood and drive it into the cells that need it for energy. And so, when insulin isn’t taking that sugar out of the blood and putting into the cells, more and more insulin is needed to do the job. So, we start seeing higher and higher insulin levels to get that sugar into the cell. High insulin levels cause weight gain and carb cravings. And so, what we want to do is to give our insulin a rest. So, you don’t want to have high insulin for most of the day. So, how do you get your insulin levels to drop? This is the tricky part where we start talking about tips. Are we… Is this where we want to go to?

Amy:

Yeah. Yeah. You know what, you can throw in tips anytime you want.

Dr. Erica Armstrong:

Okay. So, in our practice, we do not focus on weight when we talk about lowering insulin resistance, because we hear from so many people who get just either bad advice or no advice around what insulin resistance is. And they’re told just lose weight, but it’s harder to lose weight when you have insulin resistance. And then, people can have insulin resistance. So it’s not necessarily tied to weight. You can improve your insulin resistance without losing weight or it being the focus. And so I like to say, it’s not lose weight and you’ll feel better. It’s feel better, and then the weight comes off.

Amy:

Yeah. I mean, I really think about weight loss is a by-product of getting your body back into balance.

Dr. Erica Armstrong:

Absolutely. The weight comes off when we… Or reaches a healthy homeostatic level when we fix root causes. So, let’s just go back to that, fixing those high insulin levels. Insulin is secreted mostly when you eat carbs, also when you eat protein and not when you eat healthy fat. So, if we just break it down into a plate that would cause not so much of a high insulin spike after eating it, we could start there. So, when we draw a plate for our clients, we draw a line down the middle and half is non-starchy vegetables. So, your greens. A quarter or less of the plate is some starchy carbs because that’s going to prevent those carb cravings later, if we allow ourselves to have some of those. And then, we’re going to have a quarter of protein and then one to two tablespoons of healthy fats.

And when you eat this way, you will prevent that insulin spike that could happen say, as opposed if you just ate a plate full of pasta and carbs with no healthy fat or protein on it. That will cause a huge insulin spike. But if you eat a plate like I originally described with half veggies, quarter protein, quarter starchy carbs, and healthy fats, you’re not going to have that huge insulin spike that when it happens repeatedly and repeatedly, that’s when the cells start to ignore that insulin, like insulin you’re around all the time. It’s not going to work this time. You got to come in stronger with it.

So, we need to prevent that constant insulin release by just breaking it down to a balanced plate. And notice I didn’t restrict anything. In fact, I added things to your plate and that’s a key too for preventing carb cravings is that it’s not restrictive, it’s just a different way of looking at your plate. And so, if every plate and every snack is balanced, that is one of the first steps in both reducing your insulin levels to fix the insulin resistance. And that also to lower your carb cravings.

Amy:

Yeah. I call it my diva dinner plate and I think it’s really a great way to look at managing your blood sugar because the other thing that is really time consuming and burdensome is counting macros, counting calories. And then, I think it just puts too much focus on the minutiae rather than the really nutrient rich things that you put on your plate. I don’t know. I like your approach. So, what are some other tips for like… so, you’re having an acute craving, like what I described with my bag of Tootsie Rolls and not feeling like I’m any match for them, what do you suggest?

Dr. Erica Armstrong:

Yeah. Like you said, it’s not a matter of willpower, this is physiology that that is driving this. And so, if you’re having an acute carb craving, first, we’ll go back to preventing that. So, having some healthy snack ideas planned for ahead of time or if someone who spend a little on Sundays with prepping, thinking about what snacks are going to be on hand can be really helpful.

Amy:

Before you go forward, can you give us some healthy snack ideas?

Dr. Erica Armstrong:

Oh, sure. Yeah. So when we’re talking about snacks, we don’t want to have this naked carbs or carbs without any protein or fat. And so, instead of just eating an apple, which can cause some carb cravings 45 minutes to an hour later, we want to have that apple and some almond butter with a healthy fat and protein. So, just making sure to match this up or including some hummus on your whole grain crackers. Those types of things, where it would be better to add the healthy fat and protein than not too. So again, we’re not calorie counting, we’re balancing things because weight is a complex hormonal issue and it’s not calorie related.

Dr. Erica Armstrong:

So, those would be some healthier snacks that you could eat. And so, I guess, one of the points I want to make is that if you’re having an acute carb craving, go ahead and have something just balance it, so that it doesn’t keep happening to you. So, if you’re going to have some dark chocolate, which is actually healthy. So, choosing some of those snacks that will satisfy those cravings, but are also… You can find some health benefit, would be a good idea to plan for. And then, have some… A handful of nuts with it. And so, you can feel good about eating that carb because we know that the more you binge and then restrict and do this cycle, I mean the worst off everything is.

Amy:

Yeah. I think there’s a lot of shame involved and guilt and bad feelings about yourself that end up just fueling the fire.

Dr. Erica Armstrong:

Exactly. Yeah. So, I think plan ahead, find some things that will satisfy that carb craving and go ahead and eat them and just balance them with healthy fat and fiber and then move on to the next. And don’t hold a guilt over yourself because it’s very a normal thing that’s going on that that women have carb cravings and especially women with hormonal imbalances and insulin resistance and we’ll plan and go ahead and have that carb and balance it and move on.

Amy:

So getting back to tips, have you found that there’s any specific supplements that had helped your PCOS patients manage cravings?

Dr. Erica Armstrong:

Yes, absolutely. Good point. Magnesium is one of our favorite supplements to use. Most of us need magnesium because our soil is more deficient in magnesium and can be helpful for sleep at bedtime. It helps with insulin resistance. It helps with hormone balance. So, I like to use… Go ahead, Amy.

Amy:

I was just going to ask you what form of magnesium do you like or what do you like to recommend?

Dr. Erica Armstrong:

Yeah. I prefer magnesium glycinate because it is helpful with relaxation and we know that a lot of women with PCOS have anxiety too or trouble sleeping. And so, they can take that at bedtime. If there are bowel issues like constipation, then I will either add some magnesium citrate or just use that instead. But magnesium glycinate is my preferred form.

Amy:

What do you think about the topical like magnesium oils and creams?

Dr. Erica Armstrong:

Yeah. I think that could be an option, especially if people are having some muscle aches. It’s like an Epsom salt bath, that can be helpful too.

Amy:

Okay. So, magnesium, what do you think about the inositols? Do you think that that helps with the sugar and carb cravings?

Dr. Erica Armstrong:

Yes. We see that being very helpful. That’s one of the primary interventions that we make too, is the inositols, which most women with PCOS are deficient in.

Amy:

Right. And what about beverages? Do you think that things like green tea could be helpful? Or if you’re having a craving, is there something else… I know for me, having some hot licorice tea seems to cut the craving.

Dr. Erica Armstrong:

Yeah. And that is a great point. And especially if you’re switching from a diet soda to that tea, because we know that those sugar substitutes, especially can drive insulin resistance because you’re eating something that’s still spiking your insulin levels or drinking something that is, but then there’s no sugar there. And so, the insulin is high without sugar and that’s going to cause some extreme carb cravings. So, if you’re switching from a diet soda or anything that has sucralose or aspartame in it, and taking that over to a healthy anti-inflammatory tea with other health benefits, you’re still getting that caffeine, but you’re also getting the benefits of the anti-inflammation. And you could even put a little squeeze of honey in that.

Amy:

Yeah. I often think too, that it’s like priming your taste buds for something sweet. It hits even if it’s an artificial sweetener, even some of these sweeteners, healthier sweeteners. I know monk fruit is something that is a hot sweetener right now, but even using some of those sweeteners, it’s still… I think, hits that reward center in your brain and still makes you want more. What do you think?

Dr. Erica Armstrong:

Yes. As you eat less sugar, your taste buds will change. And so, using something like monk fruit, which is a healthier sweetener in the meantime, can still satisfy the brain craving of it. So, I think that’s a great idea then, as you eat less and less sugar, you’ll start to find things like berries and even onions have sweet taste to them. And you won’t crave the actual sugars, the processed sugars as much.

Amy:

Yeah. That’s funny that you said about onions. I find that, just a side note, that women that don’t really love vegetables, and that are really addicted to sugar and that sweetness when you roast or even sometimes grill, can bring out those natural sugars in your vegetables and make them more palatable for people who have that sweet palette.

Dr. Erica Armstrong:

Yeah. That’s a great tip.

Amy:

So, we talked about changing the way that you eat and the structure of your meals and snacks, and possibly adding some supplements like magnesium, inositols, even like cinnamon can help with blood sugars insulin control. So, do you have some other tips up your sleeve for us?

Dr. Erica Armstrong:

Yeah. And so, important to know that insulin resistance isn’t necessarily because someone is overweight, there are other causes, especially if you’re having other symptoms like bloating or diarrhea or constipation, joint pain, strange rashes, fatigue. A lot of those signs and symptoms are a sign that there’s something going on in the gut, which is often a source of inflammation. And it’s the inflammation that is actually driving insulin resistance. And so, one of the ways that makes our practice unique in functional medicine is that we look for root causes of PCOS. And especially when women are having these other gut symptoms, we focus on gut health. And so, looking to see if maybe there is something else going on in your gut, working with a functional medicine doctor can help resolve root causes that are driving some insulin resistance.

Amy:

So, when you’re looking at the gut health, do you do like a GI-MAP type stool test? Or how do you identify the gut issues?

Dr. Erica Armstrong:

Yeah. It’s a combination of the person’s story and then testing. We use GI-MAP or GI effects and that can really guide things like looking for, is there a parasite there? Is there a yeast overgrowth? We want to talk about too. Or is there a bacterial overgrowth? Is there a lack of bacteria, good bacteria there? Are you having trouble digesting and absorbing healthy fats. These are all things that can be affecting your insulin resistance.

Amy:

And this is just to point out listeners that this is what makes functional medicine doctors unique. I think because they are really trained to look at these root factors and really get to the bottom of issues. And that’s why I love doctors like you, Dr. Armstrong. So, why don’t we talk a little bit about maybe some other reasons that you may have sugar cravings?

Dr. Erica Armstrong:

So, sugar cravings could be a stress coping mechanism too. Especially if that was brought on from an early age that in stressful times, you eat dessert or ice cream. It’s like those TV shows when you have a bad day and you get out the gallon of ice cream, if that’s something that’s been ingrained over the years, that could be just part of the stress response that needs to be rewired, I guess.

Amy:

Yeah. That’s a great point. It’s just your comfort coping mechanism, but I guess I was just getting back to that gut health and maybe some things that are going on in… You mentioned yeast, so why don’t you tell us about how that could be contributing?

Dr. Erica Armstrong:

Yeah. So, when we were talking about that higher estrogen levels, that women with PCOS have sometimes as a setup for candida or yeast overgrowth in the microbiome. And so, yeast overgrowth, because of the gut brain access, yeast actually can send signals to the brain to cause us to crave sugars, because yeast love to eat sugars. And so, we know that the bacteria and yeast, our microbiome, actually does communicate to the brain through neuro-transmitters. And so, that’s how having a hormone imbalance that leads to yeast overgrowth can lead to carb cravings and eating more carbs and then insulin resistance.

Amy:

Yeah. It’s really a vicious cycle, because then the more sugar you eat, the more you’re feeding that yeast. And it just goes on and on. So, if you suspect, maybe you could give us some other symptoms of yeast overgrowth and how can we determine that that might be something that we’re dealing with?

Dr. Erica Armstrong:

Yeah. That’s a great point. So, the carb cravings are one sign. You could have other intestinal permeability signs, like the joint pains or bloating. Some people will get an overgrowth of yeast in the small intestine, and it causes a lot of bloating, especially after eating sugary foods. Sore breasts, sign of estrogen imbalance or ovulation pain. Heavier periods, those are signs that estrogen might be high, which might also cause candida to be a-

Amy:

What about vaginal yeast infections

Dr. Erica Armstrong:

Oh, yes. That’s a great point. Yes. Or thrush, which is a yeast infection of the mouth.

Amy:

So, you have a coating on your tongue.

Dr. Erica Armstrong:

Right.

Amy:

Yeah. Okay. So, if you suspect that you might have… I say, candida Is it candida?

Dr. Erica ARMSTRONG:

I’ve heard it both way.

Amy:

Oh, okay. What can you do there? How do you break that cycle? Probiotics or?-

Dr. Erica Armstrong:

Yeah. Probiotics can be very helpful. I like a certain strains of probiotics. There’s Saccharomyces boulardii is a strain that I like to use. And it’s often in combo with other strains, like bifidobacteria or lactobacillus.

Amy:

There’s a supplement that I really like that’s helped me in the past. It’s called Syntol. And it has some enzymes, I think, as well, it’s helped break down. Is it breaking down the byproducts of the yeast or the outer coding? I’m not quite sure how it works, but it seems to… I don’t mean to put you on the spot.

Dr. Erica Armstrong:

It’s okay. I haven’t used that supplement before, so I was going to see what the active ingredients are.

Amy:

Oh yeah, yeah. S-Y-N-T-O-L, but it seems to really work well and take care of the yeast overgrowth fairly quickly without like die-off side effects.

Dr. Erica ARMSTRONG:

Yeah. That’s good to know. Caprylic acid is another one too. That comes from coconut.

Amy:

Yeah. So, that’s a great point about the candida. The other thing is that I think women with PCOS tend to have mood related disorders, I think because of excess hormones, depression, anxiety, and we tend to have higher rates of disordered eating patterns. Something that I have found that helps is to have… I call it a sweet stuff list, to find ways that add sweetness to your life in non-food ways. So that when you are feeling anxious or you’re feeling blue, and you might reach for that pint of ice cream to comfort yourself, you can reach for something else on that sweet stuff list. Maybe it’s going for a walk with your kids or taking a bubble bath or something like that. Do you have any thoughts around sweets… Like what’s on your sweet stuff list?

Dr. Erica Armstrong:

It would definitely be time with my kids. Yeah. Just watching them play is a mindfulness activity. Can be really calming for me, especially when they’re outside in the backyard, but that would be my number one sweet stuff.

Amy:

Yeah. So, any other tips for PCOS divas around sugar and carb cravings?

Dr. Erica Armstrong:

Yeah. Just know that even though you can’t out-willpower your physiology, there is still hope and you can reverse insulin resistance, we see it all the time. And you can do that without having to feel restrictive. If you just focus on balancing your plate or the good things that you can add. And then, think of it in a holistic way. Amy, I love that sweet stuff idea. Incorporating those other things that will bring down your cortisol and satisfy the dopamine response that you get from carbs and other ways. I mean, that’s great. So, I guess I would just leave women with, there is hope. I’ve seen insulin resistance reverse all the time. And it doesn’t have to be a super restrictive diet and you don’t have to focus on losing weight to do that.

Amy:

That perfect. So, tell us more about your practice and how listeners can find out about you and Root Functional Medicine.

Dr. Erica Armstrong:

Yes. Thank you. So, at Root, we are in Grand Rapids, Michigan. We also do tele-health and we’re a team of doctors and dieticians, and we have a specific PCOS program that is run by our dieticians. And we work together in our Get to the Root Program where I get to do some of the additional testing and counseling around PCOS. And we usually work with women for three to six months. And that time period is on-purpose because that’s the time period where we see a lot of those great changes, like regaining periods and reversing insulin resistance, healing gut. So, you can check us out on Instagram @rootfunctionalmedicine or on our website, rootfunctionalmedicine.com.

Amy:

That’s great. And you’re so right, that there is so much hope for women with PCOS to heal and feel better and getting control of our sugar cravings is an important step. So, thank you so much for sharing your knowledge and wisdom with us.

Dr. Erica Armstrong:

Thank you.

Amy:

And thank you everyone for listening. I look forward to being with you again very soon. Bye, bye.

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