Last month, I published a research deep dive essay on why people with PMOS experience painful fatigue. Here’s the link to catch you up:

This essay is part 2 breaking down my top 8 tips to help recover from PMOS fatigue, gain energy, and set the foundation to get better sleep.

DISCLAIMER: This essay is for educational and informational purposes only. Please speak to your physician and other in person healthcare providers about the information written here. I may be a registered dietitian, but I am not your registered dietitian. I am just a registered dietitian writing on the internet.

Hi 👋🏼 you are seeing this message because we are about to hit the essay section for paid subscribers. I so appreciate you reading so far! My deep dive research essays take many hours of work for me so they are for paid subscribers only. Writing is my only source of income and paid subscribers help me make a living.

September begins PMOS Awareness Month and my paid Substack will be 25% off yearly subscriptions You can start the celebration now and grab that FOREVER discount:

25% off paid subscriptions upgrade

If you are wondering whether you’d like to join the paid tier, here’s what you get:

✨ Access to all of my monthly paid essays. Full research deep dive essay list here. They include topics like:

✨ My complete yearly PMOS lab list I recommend to bring to your doctor. Because an A1c is undoubtably not enough!

✨ Access to my discount supplement dispensary.

✨ Access to all Substack Live recordings.

Whether you are a paid or free subscriber, I am so glad you are here. It means so much that you support my work.

25% off paid subscriptions upgrade

What actually helps the painful PMOS fatigue?

I combed the research and combined it with my 25+ years helping people with PMOS feel energized again. Let’s get to it.

Read more

Hey friend,

August has been a whirlwind and I am dusting off the chaos. How about you?

I successfully dropped off my first born at college and I am so proud of her! She is studying to become a special ed teacher. Here’s a snapshot after move in—

My youngest kid started 8th grade today and I am grateful routine is coming back. But, I will miss having humans at home with me. While I love the flexibility of WFH, I am too extroverted to be home all day without another person to chat with. Thankfully, my dog Doug amuses me when I try and hold conversations with him. Did you know I am learning Spanish? I use my Doug conversations to practice because he won’t tease my pronunciation. It’s amazing to see him come running to me when I say: “Tengo la correa!”

This email is to catch us up—what I am working on for the end of August, notables I found to share, and what’s next for September. Let’s get to it!

August Deep Dive PMOS Essay

Next Tuesday expect my deep dive on my top 8 tips to alleviate PMOS fatigue. It’s a continuation of July’s essay on the causes of PMOS fatigue. Did you miss that essay?

Last call for PMOS book

In case you missed the announcement, I am knee deep writing my next book, PMOS Power Moves. I am set to give birth to this book January 2028 and I want to make this book what you need it to be—informative, supportive, and inclusive. I would love your insight to make it good.

What do you think needs to be in this book? Who should I interview?

Here’s a link to a 5 question survey. You can add as much or little feedback as you like.

I will only have the survey up for a few more days so if you haven’t filled out the survey yet, please do so. THANK YOU!

September is PMOS Awareness Month

I am still contemplating what to do for my September PMOS deep dive essay but I am excited to share a special free essay for all subscribers early in the month. It’s not quite ready yet but here’s the gist: many people with PMOS experience food cravings or food noise (or both!) While we have medications like GLP-1s intervening, I want to add something to the conversation that is missing. More soon!

During September, I always run a special on whatever I am selling to celebrate PMOS awareness. This year, my paid Substack will be 25% off yearly subscriptions and you can start the celebration now a few days early and grab that FOREVER discount:

25% off paid subscriptions upgrade

Do you live with Endometriosis?

My friend has been generous sharing her lived experience with endo. I know many people with PMOS also have endo—do you?

I have already learned so much from Lindsay yet she recently was interviewed by another friend of mine—Jennifer McGurk—where Lindsay unpacked even more. She talks about surgeries, SIBO, FODMAP, and what actually helps. I thought you may want to listen to the interview too:

Be a part of the first ever Disordered Eating Awareness Week!

from Nope, That’s Not Normal Podcast asked me to be a part of Disordered Eating Awareness Week—and I quickly said yes! Disordered eating is sadly common for people with PMOS because dieting is the only advice you get! My mission is to help you move away from that food chaos and find sustainable ways to promote health with PMOS.

Disordered Eating Awareness Week is here to support the individuals impacted while also examining systems that keep us believing we have to choose these disordered ways of being.

In doing so, we can challenge what we believe, recognize the disordered habits, and rediscover joy through healing. Expect:

• Live panel discussions

• Social media advocacy

• On-demand video sessions

I get to be a part of a live panel discussion on navigating diet culture in healthcare spaces. Grab all the info and reserve your spot here.

If you are looking for a deeper dive on PMOS and disordered eating, check out my interview with Jessica:

That’s all for now!

Thank you for reading and catching up. I appreciate you and I hope you know that.

Do you want me to write about a particular topic related to PMOS? Let me know in comments or reply to this email.

Take care,

Julie

25% off paid subscriptions upgrade

Hey there,

Have you ever connected with a random person also living with PMOS? Maybe in the doctor waiting room or standing in line at the grocery store. One of you brings PMOS up then in the 3 minutes you have together you:

• compare provider notes—give warnings about who is awful and recommend the diamond in the rough

• swap supplements that actually moved the needle

• commiserate on how shameful PMOS feels

• reassure each other that PMOS is not your fault

If this has never happened, I hope this scenario occurs soon because I believe these connections are magic. Unfortunately, PMOS healthcare is too underfunded and misogyny-induced shame keeps many from discussing anything impacting people with uteruses.

I believe PMOS’s healthcare and our current culture prevents people with PMOS from gathering in community.

We desperately need to change this.

PMOS community is the most important tool. I see it helping more than any supplement, medication, or intervention. Here’s why.

1️⃣ Community increases access to good PMOS healthcare

Healthcare providers know and researchers substantiate healthcare continuity that is high quality and safe promotes health long term. And, I appreciate going to the doctor or dietitian is easier said than done.

We all know providers obsess over weight using fear based or body shame inducing tactics. Other providers dismiss common PMOS complaints like fatigue especially in midlife. People have confided in me about how they have not seen a doctor in years. Admitting the gap in healthcare often brought shame yet as clients peeled back the layers as to why they avoided providers, clarity emerged.

PMOS healthcare can be traumatic.

If you too have avoided going to the doctor, I hope you appreciate how the problems lies with the provider not you. And this is where I see PMOS community making the biggest impact.

When in community, I witness people with PMOS share the providers helping without harm and the ones to avoid. Over time, this allows for people to have access to that gold standard: healthcare continuity. This also creates another positive: providers giving non-stigmatizing and up-to-date care get more referrals. Crappy ones get less. While not everyone gets to choose providers, community connections help people with PMOS ask better questions to providers and release shame (hopefully!) that doesn’t belong to the patient.

Connecting in community will literally help you access the right medications, track symptoms, and address diseases over time. All of this promotes health and quality of life!

2️⃣ Community increases PMOS awareness

When people feel ashamed of their PMOS and hide it, less people know about PMOS and how impactful the condition can be. When I first started specializing in PMOS, my clients were shocked a dietitian would even specialize in PMOS. I think people were shocked to know a dietitian specialized in PMOS back in the early 2000s because there was little education on how PMOS impacted the whole body. This was pre-Facebook and Instagram, so PMOS conversations happened mostly behind closed doors. I noticed conversations were between healthcare providers then just orders directed to PMOS patients.

I was so shocked by this shock that I wrote a 2007 blog post called “PCOS is a not pamphlet condition” and updated it in 2012. Check out this vintage Julie writing here. Thankfully, since I wrote that blog post, social media has helped PMOS community form. We gained PCOS Challenge and PCOS Awareness Association—two US based community groups. I am grateful more understand that PMOS is not just about your ovaries. Instead it impacts just about every cell of your body and is lifelong.

With the renaming of PMOS better describing the condition, I hope a more holistic view emerges as the standard. But in order for better understanding we all need to keep talking about PMOS. I see PMOS chatter helping with:

• Doctors, dietitians, and other healthcare providers at least having PMOS on their radar. I know many of you go to a healthcare provider and you end up teaching them about the condition. The more we normalize talking about PMOS, the more healthcare providers will have a better PMOS foundation. It’s up to them to seek more info though.

• Researchers will want to study PMOS and funding sources will want to pay people to learn more about which interventions actually help people with PMOS.

• Patients will recognize the PMOS symptoms sooner and seek—hopefully—non-stigmatizing healthcare to get diagnosed with PMOS sooner.

3️⃣ Community de-stigmatizes PMOS

Are you the first person in your family to name you live with PMOS? I hope you know PMOS is still most related to genetics with environmental components. I write about this in the book I am currently writing—PMOS Power Moves—which is set to be released January 2028.

You may not know anyone in your family with PMOS because:

• No one else was diagnosed even though they experienced classic PMOS symptoms like infertility, intense cravings, mood concerns, sleep issues, and high blood sugar.

• No one felt they should discuss something related to periods, fertility, femininity, or weight gain. How long have we had to watch blue coloring to show period products working instead of red—because our actual body functions were too gross for those without uteruses? Showing actual red instead of blue hopefully signifies understanding how bodies work is more important than making cis-men comfortable.

Your aunt on your dad’s side who was always super maternal yet never had kids?? She may have had PMOS too yet didn’t tell anyone or never knew. Let’s change this moving forward!

⁉️ But why is PMOS community hard to find?

Have you looked to connect in real life or virtually and found little opportunity? Or, notice communities pop up yet don’t seem to last?

Me too.

I have been a part of running a few communities that are no longer. We may have even met that way—shout out to all of you that I met within the PCOS and Food Peace course, PMOS Power Membership, and/or PCOS Body Liberation Community! These communities in all their different forms were amazing and the connections were powerful. Unfortunately, they could not gain enough membership to make them financially sustainably (I blame capitalism for this, not anyone with PMOS).

One of the biggest roadblocks folks told me about maintaining community was the stigma of living with PMOS. I switched to a more asynchronous was of connecting through this Substack yet community has been coming up again in our Substack lives and the emails you send me.

Substack has a few different mechanisms for us—the chat feature is one. What do you think about adding community somehow? Reply to this email or place in comments what you think about adding PMOS community.

While on the subject of expanding access and community, I want to let you know about a new PMOS related platform hoping to expand high quality accessible PMOS healthcare. I don’t live with PMOS so can’t speak from personal experience yet still hope to pass this along. Recently, on Linkedin, founder of Emmi Health posted this:

I asked Jenny if it is ok to pass this survey along to you and she would love your input! Here is the link.

What’s next?

Be on the look out for my next monthly research deep dive essay on Why PMOS is so f*cking exhausting Part 2. Did you miss part 1? Here you go—

That’s all for now. Enjoy the rest of your week!!

Warmly,

Julie

Hey there,

Quick note for something fun. Raise your hand if you were all about Tiger Beat’s quiz sections like me.

I loved my teen magazine quizzes!

From What Your Mix Tape Selections Mean About Who You Will Marry to Which NKOTB Member Is Most Like You (Joe of course!), I spent hours filling them out.

Unfortunately, the magazine quizzes seem to be a Gen X or elder Millennial relic but we can make do with present day’s technology. I have gotten to know hundreds of people with PMOS over the years and while many have things in common, there are differences too.

I gathered this data into a fun quiz--its the PMOS Pearl Quiz. Want to try it out?

Put on some Debbie Gibson or Britney Spears and take the quiz here.

After you complete the quiz, let me know your result:

That’s all for now! I hope the rest of your week goes well.

Take care,

Julie

p.s. ICYMI, here are recent PMOS research deep dive essays:

If we went by what google tells us, the worst thing about PMOS (PCOS) is the infertility. As someone without PMOS who experienced primary and secondary infertility, not being able to conceive sucks. At the same time, you and I are not just baby factories. Healthcare’s focus solely on PMOS’s infertility misses a big issue.

In case we are newly acquainted—My name is Julie and I am a registered dietitian, eating disorder specialist, and have a graduate degree in mental health counseling. If food behavior change and maintaining positive body image were a Venn diagram, I am waving to you in the middle shouting to you about PMOS.

I spent two decades sitting across from people like you and one of the first questions I asked each new client:

“What is the worst part of living with PMOS?”

Rarely the answer was infertility.

The most common complaint?

Exhaustion.

Not just tired rather painful fatigue no matter how many hours rested.

I asked you, my Substack readers, this same question recently and you agreed:

This essay aims to explore the current research on PMOS fatigue including:

✨ Is fatigue even a PMOS issue? Here’s what the research says.

✨ What causes PMOS-related fatigue? I have 6 reasons from the research and my practice based evidence

✨ I explore how PMOS physiology changes from these reasons

DISCLAIMER: This essay is for educational and informational purposes only. Please speak to your physician and other in person healthcare providers about the information written here. I may be a registered dietitian, but I am not your registered dietitian. I am just a registered dietitian writing on the internet.

Hi 👋🏼 you are seeing this message because we are about to hit the paywall. I so appreciate you reading so far! My deep dive research essays take many hours of work for me so they are for paid subscribers only. Writing is my only source of income and paid subscribers help me make a living.

If you are wondering whether you’d like to join the paid tier, here’s what you get:

• Access to all of my monthly paid essays. They include topics like:

  • GLP-1s and PMOS: more than weight loss, can it improve health?

  • Trauma impacts your PMOS. Here’s how.

  • My top 4 tips for PMOS and liver disease

  • Should everyone with PMOS be fibermaxxing?

  • Full research deep dive essay list here.

• My complete yearly PMOS lab list I recommend to bring to your doctor. Because an A1c is undoubtably not enough!

• Access to my discount supplement dispensary.

• Access to all Substack Live recordings.

Whether you are a paid or free subscriber, I am so glad you are here. It means so much that you support my work.

Is fatigue even a PMOS issue? Here’s what the research says.

Pretty much everyone I know says they are tired. Is your PMOS fatigue actually worse? I spent years talking to hundreds of clients about their energy levels so exhaustion came up often. But there was always something different about PMOS-related tiredness. The only way I could appreciate it—as someone without PMOS—was that this exhaustion sounded painful.

Does your fatigue feel painful too?

Reading through research I found insight on whether PMOS fatigue was a unique experience. Bajpai et al. (2025) recently published a cross sectional pilot study on

Read more

Hey there,

I hope this note finds you well. I did a recent interview I want to share with you. It was with Stephanie Dodier on her show, It’s Beyond the Food. I have known Stephanie for years since we share common values and work in the same spaces. She sent me a Linkedin DM a few months ago wondering if I would be willing to chat about PMOS and GLP-1s.

Of course I said, “Hell YES.”

You can get to the episode here

Here are the timestamps courtesy of Stephanie to help you to get to the good parts:

[00:01:09] — Julie’s back. PCOS/PMOS expert, returning guest from episode 425.
[00:02:01] — The new book. A PCOS/PMOS guide releasing January 2028.
[00:04:04] — Why PCOS became PMOS, straight from someone who’s lived the research.
[00:21:58] — The insulin numbers behind PCOS. 75 to 95 percent.
[00:27:55] — What the GLP-1 research actually shows, lab by lab.
[00:36:34] — The insurance problem. Why the low dose isn’t covered.
[00:49:03] — What changes in your chart the moment you start a GLP-1.

If you want more nuanced conversation about GLP-1s, check out Stephanie’s full series called Beyond GLP-1. I also wrote in depth about GLP-1s and PMOS in this research deep dive.

What’s next.

✨ I am traveling a lot in July and weaving in writing as much as I can. This month’s research deep dive essay working title is What makes PMOS so f*cking exhausting. I am reading research on why exhaustion is a major PMOS pain point and what can be done about it. Look for it by the end of July!

✨ I hung out with my college friends last week and ran a tequila tasting for them. I don’t think I have mentioned it here, but tequila is the only alcohol that doesn’t trigger a migraine for me. I am also not a big drinker so when I do drink alcohol I want to enjoy it yet not get drunk. Tequila, like wine, can be appreciated slowly and has complexity that I find intriguing. I have been studying tequila and its history for a few years now. I tell you all of this because my friends learned so much they convinced me to get back on Instagram to talk about tequila. I have been off all Meta since 2022 y’all! I have not started posting yet in case you want to follow along, here’s my handle: https://www.instagram.com/morethanmargaritas.

✨ Do you have a PMOS topic you want me to write more about? LMK in comments or hit reply and let’s make it happen.

That’s all for now! Thank you for being a part of my writing and supporting my work.

Warmly,

Julie

Hey there!

I had a blast connecting with many of you during Thursday’s Substack live. It was a fly-by-the-seat-of-my-pants type live (my favorite!) that ended up being almost an hour.

I had so much fun and I hope you did too. I want to make these AMAs more regular and trying to see how I can make that work. I am in a time of transition, again, with a kid moving to college in August. I will probably set a regular Live AMA time sometime after that. Stay tuned!

The questions:

1️⃣ Intuitive eating requires that we honor our hunger & fullness, but what happens when your hunger and fullness cues are significantly impacted because of insulin resistance? Does the principle of gentle nutrition apply in this situation? If so, what does that look like in practice?

2️⃣ I’ve been working on IE for years but still don’t feel I quite have it. With my fatigue I find it difficult to cook for myself on a regular basis and get the healthier foods in (like yummy veggies and such). What are your best tips for continuing forward, making simple and balanced meals, and not letting the shake voice get in when not being as consistent as I’d like?

3️⃣ Talk to me about creatine - it is useful and helpful for women with PCOS, especially those of us in our 40s in perimenopause? Thanks!

4️⃣ (From a clinician) Can you provide some ideas on how to counsel on intuitive eating with PMOS patients? I'm curious if there are any questions you like to ask patients to jumpstart this conversation or keep it going.

5️⃣ I've started strength training and my inflammation and fatigue has gotten worse. I work with an intuitive eating dietitian and know I am eating enough. Am on metformin and the supplements etc but this makes me think my heart rate is too high when I am doing strength training. Do you have any advice on target heart rate or movement if the exercise is causing terrible fatigue?

6️⃣ The myo-inositol and d-chiro-inositol supplement caused me to get a period for the first time in a long time after taking it but it's only happened once. Is this typical for it to not happen again?

My absolute favorite part of the live is when folks in the chat connected forming a mini-PMOS community. Without a doubt, adding community will do more to help your long-term PMOS management than any other tool. I feel inspired to create more community space here and brainstorming how to make that happen.

What’s next?

🥁 The next PMOS deep dive essay is on that painful PMOS fatigue. I will include research behind the cause, what makes it worse, and my top tips to make you feel less exhausted. Paid subscribers will expect it in your email inbox by the end of July.

👩🏽‍💻 There’s still time to fill out the PMOS book survey! In case you missed the announcement, I am knee deep writing my next book, PMOS Power Moves. I want to make this book what you need it to be—informative, supportive, and inclusive. What do you think needs to be in this book? Who should I interview? Here’s a link to a 5 question survey. You can add as much or little feedback as you like.

That’s all for now. Thank you for being here and helping to build more tools to make living with PMOS sustainable while promoting healing.

Warmly,

Julie

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Hey there,

I hope July has started nicely for you. I am currently in the home stretch getting my first kid off to college—just one more month to go! We are having a good time picking out dorm essentials and still in shock that college is happening. Did I tell you my oldest wants to be a teacher and majoring in education? I couldn’t be more proud.

This note is to get us caught up and connected before my AMA live this Thursday!

Submit your questions!

It has been too long since I did an AMA so I am excited to connect and answer your questions. Substack can be funky with who actually sees my live so I am concerned I won’t have anyone there to ask a question. Submit your question here—they can be anything related to PMOS and trying to apply intuitive eating. Free and paid subscribers can join the live; paid subscribers get access to the replay.

Vote for the next PMOS research deep dive essay

What should be next?? If you don’t like any option below, send me a message with your idea! I will announce July’s deep dive topic next week.

Did you miss my last PMOS deep dive essay on Intuitive Eating?

Help me write the PMOS book you want and need

In case you missed the announcement, I am knee deep writing my next book, PMOS Power Moves. I want to make this book what you need it to be—informative, supportive, and inclusive.

What do you think needs to be in this book? Who should I interview? And, yes, I would love to interview you!

Here’s a link to a 5 question survey. You can add as much or little feedback as you like.

Thank you in advance for helping me build this book!

That’s all for now. Thank you for reading and helping me create the content needed in the PMOS space.

Warmly,

Julie

p.s. Copy and past the AMA live link into your calendar: https://open.substack.com/live-stream/263837 Hope you can make it!

Can you not diet and still promote health with PMOS?

Have I told you about Matilda yet? She is someone I write about in my first book, Find Your Food Voice. When I met Matilda, she was a 20-year-old college student at a prestigious university near me. She had recently been diagnosed with polycystic ovary syndrome (PCOS…now PMOS) and had identified as plus size since middle school. I wrote about the first time I met her (FYFV, pages 10-11):

Fast forward to 20+ years later and I know non-diet tools like intuitive eating can promote health with PCOS. Because of Matilda and thousands of others, I have witnessed people moving away from diets and towards improving their physical and emotional health. Gathering their outcomes and tools that helped, I can firmly say you too do not have to diet.

But what does the research say?

This essay aims to explore the current research on PMOS and non-diet tools like intuitive eating.

This essay includes these topics:

✨ Do people with PMOS want another way outside of dieting?

✨ Why do people with PMOS want another way?

✨ Can intuitive eating lead to healthier eating for people with PMOS?

✨ Can people with PMOS experience health improvements outside of weight loss?

✨ Are you letting yourself go if you stop dieting with PMOS?

✨ 6 ways to make sense of intuitive eating for PMOS

DISCLAIMER: This essay is for educational and informational purposes only. Please speak to your physician and other in person healthcare providers about the information written here. I may be a registered dietitian, but I am not your registered dietitian. I am just a registered dietitian writing on the internet.

Do people with PMOS want another way outside of dieting?

At diagnosis and every doctor visit, you probably were told to diet to manage any PMOS symptom. I was not surprised to read 2026 research suggesting people with PMOS want another option just like Matilda. Herbert et al set out to study what people with PMOS are looking for in a sustainable intervention. The authors asked 267 people with PMOS which providers they want to work with and if a non-diet intervention could work for them. The majority of participants responded they want to mainly work with a dietitian (☺️) yet many also reported wanting to work with an interdisciplinary team. They also were strongly interested in learning more about adding intuitive eating yet concerned about letting food rules go (1).

Why do people with PMOS want another way?

1️⃣ Diets don’t work for most people so why would they work for PMOS? If you’ve ever felt like an anomaly because you failed another diet, please reconsider. Most weight loss or restrictive diet research studies have high drop out rates. Even with all the support these participants get, a big percentage does not stick around.

2️⃣ If you want to recover from an eating disorder, you cannot diet. Dieting, even just tip toeing into one, can be fatal for someone in eating disorder recovery. My career has been devoted to helping people recover from eating disorders. I taught intuitive eating as another way to recover from eating disorders and chronic dieting to improve heart health, balance blood sugar, and enjoy eating again. I did not want to specialize in PMOS at this time yet people with this condition kept calling to learn how to recover and still promote health.

3️⃣ Diets worsen health—physically and emotionally. For brevity, I am linking what I have already written about diets worsening health here and here plus 10 years of podcast episodes found here. If you want even more, my book Find Your Food Voice goes deeply into this topic.

4️⃣ Diet culture contributes to weight bias. Were you ever teased because of your weight? Or, do you know someone who gets treated differently at work because of their body size? Weight bias or weight stigma is something that we often see as bullying at school, harassment, violence, dehumanization, hostility, negative appearance commentary, pressures to lose weight, and many other weight-related micro-aggressions. Sometimes weight stigma is loud and obvious yet other times it is subtle. Big or small weight stigma hurts health. Weight stigma is related to high blood pressure, inflammation, high triglycerides, higher calorie intake, binge eating, other eating disorder behaviors, and depression.

Early on in my career, there were zero research studies on non-diet tools and PMOS. I knew dieting harmed most people so intuitive eating was a map for me to help guide my clients. As I have been researching PMOS Power Moves I found non-diet PMOS research (including the one cited above). Here’s what else I have found.

Hi 👋🏼 you are seeing this message because we are about to hit the essay section for paid subscribers. I so appreciate you reading so far! My deep dive research essays take many hours of work for me so they are for paid subscribers only. Writing is my only source of income and paid subscribers help me make a living.

If you are wondering whether you’d like to join the paid tier, here’s what you get:

✨ Access to all of my monthly paid essays. Full research deep dive essay list here. They include topics like:

✨ Access to my discount supplement dispensary.

✨ Access to all Substack Live recordings.

Whether you are a paid or free subscriber, I am so glad you are here. It means so much that you support my work. Onward with the ess

Can intuitive eating lead to healthier eating for people with PMOS?

Herbert and Woolf (2024) surveyed 342 people with PMOS between the ages of 18 and

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Hey there,

Happy Friday! I hope you were able to join my Thursday live but if not, I have the replay ready for you.

Like I mention in the video, I have always been curious as to why emotional health and stress were harder on people with PCOS.

Have you experienced this with your PCOS?

• Intense anxiety that was incredibly tough to treat, maybe even stumping your therapists or doctors?

• A mood disorder before your PCOS diagnosis, either right before or at the start of puberty?

• Intense flight or fright reactions for no apparent reason?

PCOS physiology is different and stress impacts your body more.

In this video I unpack how its different and how stress is harder on you than people without PCOS including:

• How one overactive part of the brain contributes to that constant flight or fright.

• The impact of trauma, especially chronic and/or childhood trauma on the development of PCOS and its symptoms. I write more about how trauma impacts PCOS here.

• Allostatic load compounds all of this to make stress harder on your body. This impacts PCOS in a way making things worse.

• Other hormones contributing to more depressed mood, stress, and fatigue.

• Inflammation and insulin contributing to mood changes. Knowing how much insulin and inflammation are impacting your symptoms can be a different way to manage PCOS symptoms without focusing on weight loss. I share which labs to check here. Like I mention in the video, an A1c is not the best way!

• If you want a deeper dive into the research behind what I talk about in this video check that out here.

Is there a way to make things easier without another rigid diet?

Yes. I mention a few ideas in this video and talk more about that here, here, and here.

Tuesday I will publish my next research deep dive essay on PCOS and Intuitive Eating. Be sure you are subscribed to get it when it drops!

Have you filled out the PCOS book survey?

In case you haven’t heard, my next book PMOS Power Moves comes out January 2028. I want to be sure the book is more helpful than your last doctor visit—where you had to teach him about PCOS. Again. Or worse, he mansplained how to cut out all white foods to fix your symptoms 🙄 Here’s a quick survey so you can tell me what you want to see me include. Thank you in advance!

That’s all for now.

Have a great weekend!

Warmly,

Julie

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Hey there,

I hope you are having a good day so far. Quick message to let you know I will be jumping on Substack live this week to talk about an important topic—PMOS Stress.

I think know stress makes PMOS worse

Sitting across from folks with PMOS for years, it was easy to see how mood impacts health and quality of life. Even more, I noticed how mood shifts and disorders were harder to lessen. I already wrote about how trauma impacts PMOS but what about stress in the moment?

Why is it harder to find relief when things are stressful?

I have always wondered why mood disorders were tougher to treat when someone had PMOS. As I am writing the PMOS Power Moves book, I am sifting through newer research. Poof—I think I am connecting dots that is making me appreciate why stress hits different with PMOS.

Join me live to talk about PMOS stress

Cut and paste this into your calendar so we can chat live: https://open.substack.com/live-stream/247891

Free and paid subscribers can join the live video.

The replay will be sent out to paid subscribers—getting video replays are one of the perks to join my paid tier. Want to know more about joining as a paid subscriber? Here’s the run down.

That’s all for now. Thank you for being a subscriber and supporting my work. Please share this essay in your circles or with someone you know with PCOS. I really appreciate it!

Warmly,

Julie

Hey there and happy early solstice!

Summer is in full swing at the Duffy Dillon house. We can wake up a bit later and feel less rushed. I love that about summer and so does my nervous system!

In case you missed the announcement, I am knee deep writing my next book, PMOS Power Moves. I am set to give birth to this book January 2028 which seems ages away but in book timeline reality it is not.

I want to make this book what you need it to be—informative, supportive, and inclusive. I have a lot to do and here’s my working plan:

1️⃣ Write all the didactic bits and bobs—research analysis, practice based evidence, and teaching points. I hope to have this done by September.

2️⃣ Interview people with lived experience and clinicians who help people with PMOS. Bonus if the clinician has PMOS too. I plan to start the interviews in August/September.

3️⃣ Weave in case studies throughout the book to better explain teaching points. Goal to begin this in January or February.

4️⃣ Beg and plead folks to review this unedited manuscript. I hope to start querying folks in January/February and send before April.

5️⃣ Manuscript is due to my publisher June 2027 😱

Here’s where I need your insight.

Countless people over the past 20 years asked me to write a book about PMOS. I don’t want to mess this up! Not to get all perfectionistic, yet I want to write a useful book that can be handed to someone at diagnosis or whenever someone needs a new PMOS strategy. A book that feels empowering without stigma and shame.

What do you think needs to be in this book? Who should I interview? And, yes, I would love to interview you!

Here’s a link to a 5 question survey. You can add as much or little feedback as you like.

Thank you in advance for helping me build this book!

Warmly,

Julie

p.s. Survey link here.

Hello there!

I hope I am connecting with you during a nice mid-week scroll. This message is to catch us up—on fun stuff as well as surprises I have uncovered.

🎉 Help me celebrate

I announced on Substack notes a little celebration I am planning—I am officially in menopause. If we’ve been connected for awhile, you know that I have been suffering with chronic migraine and one of the triggers has been shifting hormones. I have been looking forward to the day I stopped cycling and it is officially here. Confirmed with lab work, my womb has retired.

A big round of 👏🏼 applause 👏🏼 for my uterus and reproductive system that have:

⚡️ been available for temporary apartment dwelling for 38 years

⚡️ cycled approximately 508 times—subtracting pregnancies and adding the rapid cycles of 40s. Yes, I pulled out a calculator for this one.

⚡️ temporarily homed 4 developing dwellers including one persistent survivor who was the lone human to finish completion in my apparently hostile uterus. And she graduates from high school tomorrow!

⚡️ underwent 5 rounds of clomid, 6 rounds of letrozole, one hysteroscopy, countless HSG injections, and one round of injectables to try and make it less hostile

⚡️ completed a few surgeries including one salpingectomy for an ectopic pregnancy

Well done womb.

I asked folks on notes to help me figure out ways to celebrate. Some ideas included:

• cake

• doing things I couldn’t do during perimenopause

• solo weekend in cottage with a hot tub and fab scenery

• retirement party…for my reproductive system

What do you think? How can I celebrate? From silly to serious, let me know in comments.

Leave a comment

🤢 PMOS Diet Research Is….Awful

I am knee deep writing PMOS Power Moves and currently on Chapter 4. This chapter explores all the diet recommendations you’ve received as the way to manage symptoms or even cure it. From working with thousands of people with PMOS, I saw diets not working. As I dug through research, I see why. Whether its low calorie (👀 WW 👀), low carb, keto, intermittent fasting, etc I found these problems:

• smaaaaall sample sizes. You should not be trusting your relationship with food with the few people with PMOS diets have been tested on.

• short duration. Six hours to six weeks was the typical length of time PMOS diets were tested. Sure, some were “long term” going 3 to 6 months but is that really long term? NONE go past a year.

  

I almost done writing this chapter where I tie together crappy diet recommendations with new ways forward to improve your relationship with food and promote health. No rigid diet necessary.

Be on the lookout for a survey soon on what you want me to include in the PMOS Power Moves book.

🥁 The next PMOS Research Deep Dive is on…..

I asked in my last PMOS research deep dive which topic you want for June. You overwhelmingly picked PMOS and Intuitive Eating. I can’t wait for you to read through what I discover as I hunt for these studies on Google Scholar. Expect it in your email inbox by the end of June.

Have you missed my PMOS research deep dives? Paid subscribers get access to the whole essay. Catch up here:

Now we are caught up!

Thank you for reading this essay and connecting with me. I appreciate you!

Warmly,

Julie

Author note: As I am writing about mental health, there is mention of suicide and self-harm. Please take care of yourself while reading this essay and seek help when things are tough. If you are struggling, one place to start is the 988 Lifeline.

I am so glad you are here.

PCOS has metabolic, reproductive, and psychological alterations stemming from imbalanced hormones. Unfortunately, I found in my clinical practice most treatment emphasized physical health.

Mood disorders and other mental health concerns were often dismissed, overlooked, or glossed over.

This doesn’t make sense to me because everyone I know with PCOS tells me how hard it is to live with this condition.

When working with clients, I noticed how mood disorders, especially anxiety, were tougher on folks with PCOS compared to people without the syndrome. Interventions that typically helped lessen anxiety with a therapist and medication, did not work.

I always wondered why—

Why do people with PCOS appear to experience more emotional distress?

Why are psychiatric illnesses often harder to treat when combined with PCOS?

This curiosity brings me to this month’s PCOS research review deep dive:

In this essay I explore the mental health burden of living with PCOS.

Topics covered in this essay:

• How PCOS’s physiology impacts brain health

  • Neuroendocrine changes

  • Gut microbiome differences

• Psychiatric disorders and what the research is saying about people with PCOS. I include:

  • Anxiety

  • Depression

  • OCD

  • ADHD

  • Bipolar disorder

  • Eating disorders

• Emotional burdens impacting quality of life while living with PCOS

• What every healthcare provider should be doing to help ease the burden

• Interventions to consider

DISCLAIMER: This essay is for educational and informational purposes only. Please speak to your physician and other in person healthcare providers about the information written here. I may be a registered dietitian, but I am not your registered dietitian. I am just a registered dietitian writing on the internet.

PCOS impacts brain health

As an endocrine disorder starting in your brain, PCOS impacts your brain health. Mood disorders, like anxiety and depression, start in the brain too. Both mood disorders and PCOS start in the hypothalamus where the body controls hormones.

If you were living in a lab with no outside stressors, the hormonal impact of living with PCOS already increases the risk of experiencing a diagnosable mood disorder.

But you don’t live in a bubble or a test tube. As a fellow human experiencing outside stressors, PCOS further impacts emotional well-being. Healthcare providers focus all the attention on physical health and weight—are they missing something that could drastically improve quality of life and health?

Many people I know with PCOS explain how isolating this condition is. Even more, people let me know the how the condition impacts their body shape, appearance, and energy level as a tremendous burden. Further, could the focus on physical health and weight loss place people with PCOS at higher risk for mood disorders?

Here’s what the research is saying.

How PCOS’s physiology impacts brain health

PCOS has metabolic and reproductive consequences stemming from imbalanced hormones. How does this end up impacting mood?

Hi 👋🏼 you are seeing this message because we are about to hit the essay section for paid subscribers. I so appreciate you reading so far! My deep dive research essays take many hours of work for me so they are for paid subscribers only. Writing is my only source of income and paid subscribers help me make a living.

If you are wondering whether you’d like to join the paid tier, here’s what you get:

✨ Access to all of my monthly paid essays. Full research deep dive essay list here. They include topics like:

✨ Access to my discount supplement dispensary.

✨ Access to all Substack Live recordings.

Whether you are a paid or free subscriber, I am so glad you are here. It means so much that you support my work. Onward with the essay!

Neuroendocrine

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Hey there,

Typing this I feel like I jumped back into the 21st century. I have been without internet all week and can finally watch the Summer House Reunion #TeamCiara, of course, because you don’t sleep with your friend’s ex-boyfriend. Ever.

No internet this past week unfortunately derailed my PCOS deep dive essay publishing schedule. My plan was to deliver The mental health burden of PCOS/PMOS: Why emotional health gets disrupted by PCOS and how its treated with ways to make things easier to you right now…but instead I am sending this email.

I have been typing relentlessly since my internet got fixed 3 hours ago hoping I could churn out the essay. I realized in the last few minutes I just don’t think the essay will be ready in a way that is satisfactory to me so it will be delivered to your email inbox on Tuesday instead.

Thank you in advance for understanding! Until then, here’s some bits and bobs to keep you caught up on what I have written or announced recently.

📚 I am writing a new book! PMOS Power Moves: Nutrition and Exercise Strategies to Balance Blood Sugar, Improve Fertility, and Repair Body Image From Diagnosis, Mid-life, and Beyond will be in your hands January 2028! I am honored to be working with Routledge—they published Sick Enough, A Women’s Guide to Menopause, Body Image, and Emotional Well-Being at Midlife, and Freeing Children and Young Adults from Shame, Scales, and Stigma. Probably a bunch of your textbooks too.

✨ I have a pop-up Substack sale! Get 25% off yearly PCOS Health with Intuitive Eating paid subscriptions forever between now and May 31st. Use this link to get to your discount: https://findyourfoodvoice.substack.com/BirthdayAndPPMBook. Paid subscribers get access to all of my monthly past and present research review deep dives, my discount supplement dispensary, my yearly PMOS Lab List, and video replays.

⚡️ PCOS is now PMOS. Did you catch my last live unpacking the pros and cons of the new name? Get to it here and let me know what you think!

4️⃣ My Top 4 Tips for PCOS and Liver Disease. Last month’s research deep dive explores metabolic dysfunction-associated steatotic liver disease (MDSLD) and PCOS and how to make sense of the recommendations without another rigid diet. Jump to it now here!

That’s all for now. Thank you for reading and supporting me. I will be back Tuesday with May’s PCOS research deep dive.

Have a great weekend!

Warmly,

Julie

p.s. Get 25% off yearly PCOS Health with Intuitive Eating paid subscriptions forever between now and May 31st. Use this link to get to your discount: https://findyourfoodvoice.substack.com/BirthdayAndPPMBook.

Happy birthday to meeeee! Hey there reader. I hope today is going well. I have 4 big life updates in this note that includes a special pop-up paid Substack sale. I have all the details at the end of the essay but here it is if you want to jump ahead.

Get 25% off forever here

Today I turn 5️⃣1️⃣ and as you are reading this I am probably at my oldest child’s high school senior awards ceremony 🥰

If you have been reading my work or listening to my podcast for a while, you know I am a mom of 2 kids. When I first started my podcast my oldest was 8 and just starting to get into musical theatre. Ten years later, she is graduating from a performing arts high school and on her way to college to become a teacher. I. Am. So. Proud.

I don’t know about you but I thought parenting teens would be much harder than toddlers. Parenting toddlers was tough for me and did not work well for my nervous system or rest requirements to function. I was worried things would get harder as my kids grew up.

But here’s the thing.

As my kids got older I had more time flexibility and chance to rest.

I could also explain things to a brain who could better understand. Yes, we argued but we could also repair. Yes, there were tough experiences that were more complicated than spilling the milk cup yet we learned grace.

Here’s what I want you to know if you are a mom of a baby or younger school age kid: you don’t have to be afraid of the teen years. They can be more fun and your connection with you kid can grow.

Unfortunately, as my kids were in their elementary and middle school years, I started to experience chronic pain.

You may have noticed pre-2020 I was online often—always on IG stories, doing the podcast circuit, speaking all over the country, and seeing clients. I appreciate right after the pandemic started I did the Homer Simpson meme fading into the bushes.

I started experiencing chronic migraine. I had them as I went through puberty and as I started perimenopause, they came back. Many of the migraines were triggered by hormones yet also poor sleep, allergies, stress, and lots of unknown triggers.

It took years to really appreciate what was going on with my migraine and get to the right specialists. (One day I will fill you in on some of the diet advice I got along the way from random people and doctors. Some were bizarre!)

An update I am happy to share:

I just started a new trial migraine preventative medication that is really helping! Knock on wood I am having pain-free days in a row which hasn’t happened for a very long time. I am hopeful that I will continue to have more pain-free days so I can have more energy for my big announcement. I have been working the last few months quietly behind the scenes on this—

🥁 🥁 🥁 🥁

I am officially under contract to write a PCOS PMOS book 🎉

PMOS Power Moves: Nutrition and Exercise Strategies to Balance Blood Sugar, Improve Fertility, and Repair Body Image From Diagnosis, Mid-life, and Beyond will be in your hands January 2028! I am honored to be working with Routledge—they published Sick Enough, A Women’s Guide to Menopause, Body Image, and Emotional Well-Being at Midlife, and Freeing Children and Young Adults from Shame, Scales, and Stigma. Probably a bunch of your textbooks too.

I loved writing my first book, Find Your Food Voice. I loved the process of turning a concept in my head into a physical book. I loved the rhythm of writing a book and ability to rest when I had a migraine.

I can’t believe I get to do this book building thing again!

Here’s what I hope PMOS Power Moves gives you:

Stop cutting carbohydrates and sugar. Get off the PMOS diet roller coaster. Understanding which foods, supplements, and exercises to add helps PMOS more than any meal plan. Learn what your body needs to sustainably manage PMOS, balance blood sugar, and promote long term health. You don’t need more food rules. You need more truth behind what causes PMOS and how to manage PMOS to prevent infertility, diabetes, heart disease and cancer. You can do this without restricting foods and over-exercising. Learn the PMOS Power Moves and finally feel at ease in your body.

To celebrate my birthday, my first born graduating, more pain-free days, and the PMOS book—let’s have a pop-up Substack sale!

✨ Get 25% off yearly PCOS Health with Intuitive Eating paid subscriptions forever between now and May 31st.

✨ Use this link to get to your discount: https://findyourfoodvoice.substack.com/BirthdayAndPPMBook

✨ Paid subscribers get access to all of my monthly past and present research review deep dives, my discount supplement dispensary, my yearly PMOS Lab List, and video replays.

✨ Paid subscribers help me be able to support me and my family. While I am under a book contract, you probably know how little income most authors actually make (waaaay under minimum wage). Paid subscriptions subsidize my work so I can write.

Thank you for being here and supporting my work however you can.

I am grateful for you. I don’t take your trust lightly and look forward to sharing this next book creation. As I am writing, I would love your input. Keep your eyes out for a survey so I can write a book that can actually be helpful for you!

Thank you for reading and letting me share this good news with you.

Warmly,

Julie

Get 25% off forever here

I hope this weekend is giving you the rest or joy you need! Quick note to send my Substack live chat with Popik about the PCOS PMOS name change.

This past Tuesday, we learned PCOS will now be PMOS: Polyendocrine Metabolic Ovarian Syndrome. Of course I texted Rachel and Coleen to start unpacking what this name change means, if anything.

Seeing the name change announcement brought more people in the media interested in PCOS/PMOS which is always great! Did you see NY Times piece?

Here’s a breakdown of what Rachel and I chatted about:

1. Why did they change the name?

2. How did they change the name?

3. Breakdown of the new name

   1. Poly–many

   2. Endocrine–hormones

   3. Metabolic–insulin, diabetes, sleep apnea, cravings

   4. Ovarian–still impacts ovaries and reproductive consequences

   5. Syndrome

4. Cons to the name change. We have concerns!

5. Pros to the name change. We are hopeful!

One big concern of mine is with adding the word metabolic, you will be pushed to follow a rigid diet plan even more.

We know PCOS is not caused by weight gain and there are zero diets studied that help people with PCOS long term and promote health. I hope to continue to help you make sense of the research and connect with sustainable tools to help you feel better long term.

I will probably keep using PCOS for the next year.

The organization that changed the name stated PCOS and PMOS will be used interchangeably for two years then officially only PMOS starting in 2028.

What do you think of the name change?

I would love to read what you think about the changes. Let me know in comments.

Leave a comment

Before I run I went to give you a heads up:

Tuesday is my birthday (the big 5️⃣ 1️⃣ 🎉 ) and I have a special announcement you don’t want to miss!

Thank you to everyone who tuned into my live video! I will have another live video soon and will share time and date here.

Bye for now!

Warmly,

Julie

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Hot off the presses! PCOS name change has been announced.

The new name is……🥁

Polyendocrine Metabolic Ovarian Syndrome (PMOS).

PCOS ➡️ PMOS

What do you think of the name change? Like it? Love it? Couldn’t care less? Let me know in comments ⤵️

Leave a comment

Before the name change, I wrote the email below to recap Thursday’s live chat. It was on living with chronic conditions associated with PCOS.

Curious about what I talked about? Here’s the breakdown.

• PCOS as a chronic condition—what do you think? Since there is no cure and you are supposed to alone fix it? Many people I speak with feel sad about PCOS being a lifelong condition yet relieved to know its not their fault they haven’t cured it yet.

• Getting a PCOS diagnosis is usually not just PCOS. It also means current or future:

  • Infertility

  • Diabetes

  • Heart disease

  • Endo

  • Fatigue

  • Pain

• I dove into my top tips to manage liver disease with PCOS since 1 in 4 folks will get diagnosed with liver disease at some point in their life.

  • ED relapse point

  • Scary—but does fear actually promote lasting behavior change?

  • Why does liver disease happen with PCOS?

    • High insulin/IR

    • Those with high androgens and high insulin are at highest risk

• Most providers will direct folks to lose weight

  • Weight loss is not a behavior–let’s talk behaviors instead!

  • Weight gain isn’t the cause rather a data point from high insulin and high inflammation for some people

  • I share my 4 specific behavior tips to help improve liver health with PCOS

Want to watch the live?

All of my lives are free yet the replay is available to paid subscribers only. Wonder what other benefits paid subscribers get?

• Access to my discount supplement dispensary saving you hundreds of dollars every year. Get to it here.

• Monthly PCOS essays into research or tips to promote health. Check out them right now:

  • The PCOS Lab List I Recommend You Bring to Your Next Doctor’s Appointment Because an A1c Is Not Enough (September 2025)

  • GLP-1s and PCOS: More Than Weight Loss Can This Medicine Improve Your Health: Can It Lower Insulin, Prevent Heart Disease, and Improve Reproductive Health? (October 2025)

  • The Pros and Cons of Midlife PCOS: What to Expect As You Reach Menopause and Beyond (November 2025)

  • My top 5 interventions during perimenopause, menopause, and midlife+ PCOS. Food, exercise, and supplement recommendations tailored specifically for peri-menopause, menopause, and beyond (December 2025)

  • Trauma impacts your PCOS. Here’s how. Psychologically and physiologically, trauma experiences make an impact on your PCOS symptoms. (January 2026)

  • Should people with PCOS be fibermaxxing? Can fiber impact PCOS symptoms? Is more better or worse? (February 2026)

  • My Top 6 Tips for Improved Ovulation with PCOS: Gain clarity on what causes PCOS ovulation issues and ways to improve your reproductive health (March 2026)

  • My top 4 tips for PCOS and liver disease: Research deep dive into metabolic dysfunction-associated steatotic liver disease and PCOS and how to make sense of the recommendations without another rigid diet (April 2026)

  • 2026 Topics to Include—individual supplement deep dives, weight loss surgery, eating disorder recovery, and more as I keep flushing out ideas. Would love to know what you want me to cover—DM me or email at julie@juliedillonrd.com

• Comment and ask questions in posts.

I wish PCOS essays were free to create and I was subsidized by the government so I could make it free to give. A girl can dream.

By becoming a paid subscriber, you help me make writing my full time job, support my small yet mighty team, and keep my other content free.

What is the emotional burden living with PCOS?

I am working on my next PCOS essay on the Mental Health Burden of PCOS. While I have been helping people with PCOS for over 20 years, I don’t live with PCOS. What is the hardest part of living with PCOS for you? LMK in comments or hit reply to this email!

That’s all for now. Enjoy the rest of your day!

Warmly,

Julie

Randomness

Check out this live set of REM from 1987 and the picture shows the set list. Did you know that I love live music? And my prize treasures are the collections of ticket stubs and set lists from shows? https://archive.org/details/ajc02667_rem1987-11-04.aud

Get more from Julie Duffy Dillon in the Substack app

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Hello there! A quick note to say 👋🏻 Hiiiiiii and let you know I will be jumping on Substack live this week. I am way too extroverted to be writing all day with just my dog Doug. Would love to connect with you! Bring a cup of something yummy, a snack, and your questions to ask me live.

💫 Live chat on liver disease and other chronic conditions associated with PCOS

Last week I posted an essay full of research reviews and my top tips to help liver disease with PCOS. The full essay is available to paid subscribers yet free subscribers still get a lot from it. Check it out here:

Can we chat about what it means to experience all of these complicated chronic conditions with PCOS? So many people believe PCOS to be only a reproductive condition controlled by weight loss—but, wow, are they missing so much!

Free and paid subscribers can join live. Paid subscribers get the replay. In the live, I will teach more on my top tips for liver disease (a free way to access the material in my paid essays!) as well as unpack the complicated bits associated with chronic disease.

💫 Join me live on Thursday May 7 at 2 pm US ET

📆 Grab the link for your calendar here ⤵️

Link to live

That’s all for now. Looking forward to connecting Thursday!

Warmly,

Julie

💫 p.s. If you live with PCOS and crave more than another rigid diet, I write for you! Check out my monthly PCOS research deep dives and join me live so we can virtually meet.

💫 one more p.s. What’s your biggest PCOS pet peeve? Or something PCOS-related you feel confused about? I would love to research the topics that interest you! Let me know in comments.

Leave a comment

What is metabolic dysfunction-associated steatotic liver disease?

Name change alert! Non-alcoholic fatty liver disease is now called metabolic dysfunction-associated steatotic liver disease or MASLD for short. Liver experts changed the name to better reflect what the disease included instead of what it does not (1).

Forty years ago clinicians and researchers noted a type of liver disease that resembled the disease often seen in folks who were chronically using and abusing alcohol yet patients denied alcohol use. A few years later, researchers and clinicians described a metabolic syndrome often occurring with this non-alcoholic fatty liver. This metabolic syndrome includes high insulin (hyperinsulinemia), insulin resistance, and high triglycerides (2).

People who live with metabolic dysfunction-associated steatotic liver disease are at higher risk of cardiovascular disease. Forty to sixty percent of people with MASLD have hypertension (high blood pressure). Alcohol use with MASLD increases one’s risk of a cardiovascular event, like a heart attack or stroke. People with MASLD are also at risk for kidney disease and cancers. Both kidney disease and heart issues come from MASLD’s pro-inflammatory environment (2).

This essay aims to explore PCOS’s connection to MASLD and experiments with how to intervene without another rigid diet.

DISCLAIMER: This essay is for educational and informational purposes only. Please speak to your physician and other in person healthcare providers about the information written here. I may be a registered dietitian, but I am not your registered dietitian. I am just a registered dietitian writing on the internet.

What causes metabolic dysfunction-associated steatotic liver disease?

The new name, metabolic dysfunction-associated steatotic liver disease helps understand the role metabolic dysfunction plays in liver disease progression. Metabolic dysfunction-associated steatotic liver disease is the most common cause of liver disease and impacts many people worldwide. Thirty percent of the world population has MASLD and that number is expected to rise. Ten to twenty percent of children live with MASLD (3).

Metabolic dysfunction-associated steatotic liver disease has a bidirectional relationship with type 2 diabetes. This means that if type 2 diabetes goes up, so does the prevalence of MASLD (2).

Why does this happen?

Insulin resistance plays a key role in the development of MASLD. The development of this liver disease is complex and involves the pancreas, adipose tissues, muscles, and liver. As the disease develops, it creates a pro-inflammatory state in the body which in turn further promotes liver dysfunction and disease (2).

If a person has insulin resistance and type 2 diabetes, they have an 11-fold increase of MASLD. If the person has pre-diabetes, the risk is 3.4 to 4 fold higher compared to those without pre-diabetes (4).

Why do people with PCOS get metabolic dysfunction-associated steatotic liver disease?

Hi 👋🏼 you are seeing this message because we are about to hit the essay section for paid subscribers. I so appreciate you reading so far! My deep dive research essays take many hours of work for me so they are for paid subscribers only. Writing is my only source of income and paid subscribers help me make a living.

If you are wondering whether you’d like to join the paid tier, here’s what you get:

✨ Access to all of my monthly paid essays. Full research deep dive essay list here. They include topics like:

✨ Access to my discount supplement dispensary.

✨ Access to all Substack Live recordings.

Whether you are a paid or free subscriber, I am so glad you are here. It means so much that you support my work. Onward with the essay!

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