Episode 66: PCOS and the Anti-Fat Bias with Julie Duffy Dillon, RDN

On this week’s episode, Alyssa sits down with Julie Duffy Dillon, a weight inclusive Registered Dietitian, to talk about PCOS. Tune in for a discussion on how PCOS has become enmeshed in diet culture, anti-fat bias, and why this hormonal disorder may be linked to trauma. You might be surprised to learn that there is more to PCOS than what mainstream culture has led us to believe.

Julie's website

 

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Transcript:

Alyssa Scolari [00:23]:

Hello, my beautiful friends. Welcome back to another episode of the Light After Trauma podcast. I am your host, Alyssa Scolari. And I am super excited about today's guest. I was on Julie's podcast, the Love Food Podcast, about a month or two ago and that was an awesome episode. It was truly one of my favorite podcasts to do. Her podcast is phenomenal, so I highly recommend it. If you want to hear the episode, head over to my website, which is a lightaftertrauma.com. And you can check that out in guest appearances. That was a really fun episode.

And Julie and I really connected, and she is an amazing human being. So she is on my podcast today to talk about all of the good things and really talk about something that couldn't be more perfect timing, especially given a lot of the health issues that I'm having in my life right now. So let me give a formal introduction. So after sobbing in her boss's office, Julie Duffy Dillon, a registered dietitian and PCOS expert, never taught another diet. It was then that she appreciated the harm of the anti-fat bias and could not unsee it.

She now helps people with PCOS burn their diet books, regain the energy to live their life, and reclaim their power. Together, we will change PCOS health and care. So, for all of these reasons, obviously, from her bio, you can already tell the reasons why I have connected so well with Julie. So let's welcome her. Hi, Julie.

Julie Duffy Dillon [02:27]:

Hey, Alyssa. Thank you for inviting me on your show. I am so glad to be here, such an honor. Excited to talk.

Alyssa Scolari [02:36]:

I am nothing short of stoked. I was just telling the listeners that I was on your incredible podcast, the Love Food Podcast. And I mean, we just connected, right? We just connected right away.

Julie Duffy Dillon [02:51]:

Yes, totally.

Alyssa Scolari [02:52]:

And there are certain people that you meet in the podcasting world and you just hit it off right away. And we met in a rather unconventional way, because I showed up to Julie's podcast completely unprepared.

Julie Duffy Dillon [03:09]:

You're okay. It's okay.

Alyssa Scolari [03:12]:

So not my best first impression. But Julie is just a powerhouse in this field. So I am really honored to have you here. And so, we're talking about PCOS, which I just want to make sure, that stands for polycystic ovarian syndrome. Is that correct?

Julie Duffy Dillon [03:37]:

That is correct.

Alyssa Scolari [03:38]:

Alright. Alright. So can you give a little bit of a rundown on what that entails? I guess maybe what culture and diet culture will tell you that it is and society will tell you it is, versus what it really is. Because a lot of this is tied into diet culture and fat phobia and fat bias. Would you be able to give us a rundown of that?

Julie Duffy Dillon [04:10]:

Yes, I'm almost picturing an Instagram graphic that has two sides like, what society says PCOS is, with like a pie chart and ...

Alyssa Scolari [04:17]:

Versus what it actually is.

Julie Duffy Dillon [04:18]:

I'm like, oh, maybe I'll make that after in Canva.

Alyssa Scolari [04:20]:

Yeah, some content for you.

Julie Duffy Dillon [04:22]:

I spend a little too much time in Canva, so much fun in there, but ...

Alyssa Scolari [04:25]:

Canva is the best.

Julie Duffy Dillon [04:27]:

It is. What people are told when they're diagnosed with PCOS, what people assume PCOS is, diagnosis that has to do with reproduction, that has caused by a person's behavior, that a person has gained weight or eaten the wrong things and has caused these cysts on their ovaries and going to cause fertility issues. And society believes, and people who are diagnosed with PCOS are told like, take birth control so then you will then have a cycle. And when you want to have children, not if, when you want to have children ...

Alyssa Scolari [05:11]:

Yeah, there's never an if, right? Women aren't allowed ...

Julie Duffy Dillon [05:14]:

Yeah, because ...

Alyssa Scolari [05:14]:

... the choice, God forbid, we have a choice.

Julie Duffy Dillon [05:16]:

No, because that's what your point for, right?

Alyssa Scolari [05:20]:

Yeah, of course.

Julie Duffy Dillon [05:21]:

The misogyny is like, it's just obscene in PCOS, but anyway.

Alyssa Scolari [05:26]:

Suck it in.

Julie Duffy Dillon [05:28]:

So like a person is given, here's birth control, come back when you are trying to get pregnant and lose weight. So it's a diagnosis that people are told either directly or directly that they caused and that they have control over to get rid of. And those are all totally false. Totally false. And even the name is incorrect. There are no cysts involved in PCOS.

Alyssa Scolari [05:54]:

Oh.

Julie Duffy Dillon [05:56]:

I know. It's like, wait, what the hell?

Alyssa Scolari [05:57]:

What the hell.

Julie Duffy Dillon [06:01]:

So, can we give the actual what we know so far scientifically what PCOSOs is, because I can't say all that crap and not put what we actually know?

Alyssa Scolari [06:10]:

Yeah, absolutely. What do we know? Because I don't know anything. I'm excited to learn.

Julie Duffy Dillon [06:16]:

Well, good. I'm glad you're excited because this is something I love talking about. So ...

Alyssa Scolari [06:20]:

Yeah, let me get my glittery gel pen and take notes.

Julie Duffy Dillon [06:23]:

I'm so glad you found the pen. PCOS, what we know about it is that's an endocrine disorder that starts in the brain, not the ovaries. And the ovaries are basically an organ that gets affected by this endocrine disorder. And this endocrine disorder results in this hormonal imbalance that makes us set of symptoms. And it's also a diagnosis of exclusion. So in order for someone to get diagnosed with it, they have to exclude all these other things.

And it's a quite ambiguous question mark because it's relying on, again, this set of symptoms, instead of like, at this point, a blood test to find out yes or no. If you go in with a sore throat, you get a strep test. Oh, yeah, you have strep throat. There's lots of conditions where we can find out, for sure. And with PCOS, there is no exact test currently there are being. There's research right now on certain labs to potentially be used to help diagnose PCOS. But what we know about PCOS is that it is not something that person causes. It is a condition that is passed down through families.

It's not something that someone causes. They didn't gain too much weight. They didn't eat the wrong thing. It's not someone's fault. And because it's something that's passed down through families and a person didn't cause it through weight gain, pushing weight loss and dieting and losing weight is not going to cure it either. And it's unfortunately a condition that, especially on Instagram, it has this set of false truths that like, oh, I could cure it if I just eat the right thing. And unfortunately, it is a chronic condition. We don't have a cure for it.

So it's a lifelong experience. And so, learning ways to live with it and even if someone "ate perfectly" or did all the things that we know to do to help manage the symptoms with PCOS, it's still going to get worse, just because it is a chronic condition. That's just a part of chronic conditions and diseases. One last thing is I want to mention because I said like, hey, there's not even any cysts involved with PCOS, which I think is a great trivial pursuit question, if they declared it, so polycystic ovarian syndrome.

The reason why that was picked as a name is because when they ... It was like I think over almost 100 years ago, when on ultrasound, they were able to see these string of pearls on the ovaries and for people who had this set of symptoms, and they called them cysts at the time. But now what researchers and clinicians have been able to determine is that these are actually just immature follicles and not cysts, and so that's really important because people with ovaries will often get cysts and ruptured cysts and things like that, really painful. I've had them myself. I don't have PCOS. I should have mentioned that. But that's not something that is with PCOS, even though it's in the name. So it's confusing, right?

Alyssa Scolari [09:42]:

Yeah. Now, what are some things that show up in your everyday life that would cause someone to even be like, oh, maybe I should go get tested for this?

Julie Duffy Dillon [09:57]:

That's a great question. So, one way to capture that for you, the listener, is that, currently, there are three different criteria that can be used to help diagnose PCOS. And a person needs two out of the three criteria. So I'll share with you those things. And then there's also some hints, but they're not part of the diagnostic criteria. The three parts of the diagnostic criteria are either irregular or no periods. So if you have ovaries and you're supposed to be menstruating and you're not menstruating or they're super irregular, that could be one sign of PCOS.

The other is some signs of high androgens. So androgens are testosterone, or another one called DHEA. Those are hormones that can end up being higher in people with PCOS. And everybody with ovaries and/or uterus, it's going to have testosterone and other androgens. But people with PCOS oftentimes will have more androgens, and this will cause some symptoms like excess facial hair on the ... What's that? Excess facial hair on the face, yes. Excess facial hair, androgenic alopecia, which is the losing hair on the head. It also can cause really painful acne.

Sometimes it's called cystic acne that can almost look like boils and it can be on the back or the chest. And so, that's another sign of higher androgens. And sometimes doctors will test to someone's blood to see if they have high testosterone or DHEA. But if you have lots of extra facial hair or hair loss in your head or these really painful acne, that sometimes is all the doctor needs. You don't even need to worry about spending the extra amount of money on lab work if you don't want to. Some doctors, that's like the clinical observation is enough.

So then the last of the three is, if you get an ultrasound and they see those "cysts" or the multiple image of follicles on the ovaries. And remember, you only need two out of the three of those. So someone could have PCOS and not even have those multiple follicles. And for a lot of people, what happens is that they will have really heavy and really irregular periods. This is like the hints that you may have PCOS and also experiences with changes in mood, especially as you started menstruating or the time of when you thought you would start menstruating the first time.

A mood disorder oftentimes is the first sign and symptom of PCOS when people look back. And again, it's because PCOS is an endocrine disorder that starts in the brain, in the hypothalamus. And, Alyssa, I know you know the hypothalamus more than me as a therapist. That's where all the mood juices, right?

Alyssa Scolari [13:02]:

I love that you call it that, the mood juice.

Julie Duffy Dillon [13:04]:

I don't know. I don't think I've ever called it before. And now I'm frightened that I just did.

Alyssa Scolari [13:08]:

Oh my god, that was amazing. I will forever be using that, that's the mood juice.

Julie Duffy Dillon [13:13]:

It's all yours. But anyway, so that's one thing. And then there's also, because of the hormonal imbalance, this is not only to be diagnosed with PCOS. But for about 75% to 95% of people with PCOS, they also have high circulating insulin. And so, when someone has really high insulin levels, they will feel really tired and not sleep well, which is like, I'm so tired, but I can't sleep, that like exhaustion that comes with that. And then also, and this is where as a dietitian, I found myself a lot, these really intense carb cravings.

And I was just talking to some people within my course community yesterday about these cravings, and one person was like, "The word craving, that just doesn't describe it well enough because craving just sounds too subtle. It was like every part of my body needed these carbs, like I was going to die without them." And I've often used the word primal, and I'm appreciating, especially because I don't have PCOS, I haven't forgot a way to capture yet.

But if you have this just total pull to eat carbohydrates and maybe you have called yourself a food addict before or binge eat and feel like maybe you've used the phrase like I feel out of control with food and you also identify with some of the things I've said, you may have PCOS. That's a really common presentation, especially that I would see as a dietitian.

Alyssa Scolari [14:51]:

Wow. Okay. So this is a lot for my brain. This is like ...

Julie Duffy Dillon [14:57]:

I know. I dumped a lot.

Alyssa Scolari [14:59]:

Well, it's amazing because it actively is like, oh, this is what this actually is, versus like this is what society has made me think that this is. And I just wish ... It makes me sad for the folks out there who are not informed because ... So, I'm sure this diagnosis is going underreported in so many people. One of the reasons being fat phobia and fat bias and people just assuming that we have control over our weight and all aspects of our body. Now, I guess, bring it back a little bit because you have mentioned that you don't have PCOS. So, how did you get into this career path? Because I do not question at all your passion for this topic and I'm wondering like, what drives your passion for this, for all things, dietitian related, PCOS related? Where does that come from?

Julie Duffy Dillon [16:09]:

It's something that I didn't set out to really specialize in. I've always been a bit of an oddball. An awkward dietician is a phrase I've used before. A lot of my colleagues who I love dearly are really like detail-oriented colleagues of mine because we're trying to be scientists, and I just never identified me like that. And I'm probably wired more like a therapist and I probably should have studied that to begin with, but I did it. And so, when I finished my training to be a dietitian and then I have a Master's in Counseling. Once I finished that, I started to work with eating disorders.

I loved food behavior and just really wanted to get into that. And any diagnosis that ... Any console that would come my way that had to do with any medical diagnosis, I would refer out. Because I was like, no, I just want to work in food behavior. But then people with PCOS had lots of eating disorders too. And so, I just kept having people with PCOS that were my clients. And I have these experiences of trying to just search and search and search for answers, like how do I help people with PCOS? People with PCOS deserve to feel like at home in their body too.

They deserve recovery. They deserve to be free from diet culture. They deserve food peace as well. And so, I had all these tools to help people, especially thin people with eating disorder recovery. But yet with PCOS, it just kept falling short. And I kept looking and looking outside of my area where I lived, and there was nothing. And this was in 2004, 2005. I mean, there was barely an internet. It was baby internet at this point. So, I finally found someone to take me under their wing.

And she was someone who wasn't, I guess you would say like 100% weight inclusive, but she was willing to not push dieting for PCOS. And so, she helped me just to learn some different tools. And what she always said, because I was always so grateful, her name was Monika Woolsey, and she died in 2017. But before she died, I remember telling her like, "I'm so grateful everything you taught me." And she's like, "Wait, yeah, but you took it and ran with it." But she helped me to learn a different foundation.

And so, I'm hoping by doing that work for years and years and honestly, sitting across from people in that space where I was just trying to experiment, I'm like throwing spaghetti at the wall to see what would stick, clients were also engaged in that process too of like, yeah, let's figure out what works. And so, I feel like a tremendous gratitude for clients who were willing to do that, who basically helped us gather this data of like, this is what helps a lot of people, this is what helped some people, and this is what helped a few without dieting.

And so, hopefully, we can pass the baton, and there are. There's so many more clinicians who are weight inclusive, helping people with PCOS. And that makes me feel ... I mean, I can feel my shoulders dropping off away from my ears even saying that. It makes me feel like such a sigh of relief because there was literally nothing before.

Alyssa Scolari [19:26]:

Nothing, nothing.

Julie Duffy Dillon [19:26]:

Nothing.

Alyssa Scolari [19:28]:

And it is, it is so heartwarming to see the changes. And the changes are so needed. In your experience, I guess, why is this a problem? Why is finding somebody who is weight inclusive so important when it comes to ... I mean, honestly, food, in general, but also particularly like getting this diagnosis?

Julie Duffy Dillon [20:01]:

So, from a perspective of someone who is trying to manage long term their PCOS, having someone on their side that is weight inclusive, there's so much to that.

Alyssa Scolari [20:15]:

I know. That's a loaded question.

Julie Duffy Dillon [20:18]:

Chevese Turner is a therapist out of Maryland who onetime said, I love that this quote, she said, she's like, "The medical community is just so married to the weight loss paradigm. They can't see outside of it." And that is something that I think a lot about for people with PCOS. When you are told that you need to be fixed, it's not getting you the tools that you need in order to help you to, again, feel at home in your body and to feel powerful enough to then look outside of yourself.

Because what I teach within my program, is that like, so much of PCOS management, and when I say management, I mean it's finding tools for you to live with this chronic condition. This is going to be lifelong. And here are some tools that we have. Let's sift through the things that are going to be helpful for you while also looking outside of yourself to realize that you're not the one that's broken, that this world, this diet culture world, rooted in White supremacy, that's what's broken.

And so, we need ... Here's this armor and let's bring together an army of people, so we can be stronger together to help change PCOS care. And that's the only way I can see moving forward, is this for us to all rally together, whether it's people with PCOS and also people like me who don't have it, but just help people with PCOS coming together to hopefully make it more normal. So when people are diagnosed, they're not just told like that, here's birth control, lose weight.

That people are told the truth of actually what this condition is, and also told that like especially that they didn't cause it and reminded of that over and over again. I worked with some people that are aligned with fat positive body liberation. That's been a part of their life for decades, and they'll say, "Julie, I still need to be reminded that I didn't cause my PCOS." That's how pervasive PCOS healthcare is with diet culture, how intertwined it is and how traumatic it is for them to just get their yearly appointment done with their endocrinologist or to seek reproductive medicine.

Again, I know that word trauma is a ... Excuse me, is a part of your podcast, but also used a lot these days. But it's something that I firmly believe in. People with PCOS period are experiencing so much trauma just seeking care, and that needs to change. And I think the only way that's going to change is for all this to come together to move the paradigm, like the one that Chevese was talking about.

Alyssa Scolari [23:19]:

Yes, absolutely. And you nailed it, the process itself of even getting treatment and getting help or even getting a diagnosis in the first place is in itself traumatic. Timing is such a fascinating thing to me because as we're having this conversation, I am less than 48 hours out from a doctor's appointment now. So I've had several doctor's appointments in the last couple of months. And I'm sure I've been keeping the listeners up to date and aware for the most part, so many of the listeners know.

So I have been having severe menstrual cramping, severe, severe, severe, and it has gotten worse every single month. And I have seen so many doctors that have thrown a mixture of Advil and the pill at me. And I have been told, even when I go for the period cramping, somehow I am always told that everything in my life would be better if I just lost weight and ...

Julie Duffy Dillon [24:35]:

Oh, that's such a bullshit.

Alyssa Scolari [24:37]:

Right. It is the biggest crock of shit I have ever heard in my life. But people who, myself included, even though I'm aware of this, it still didn't make it less traumatizing for me.

Julie Duffy Dillon [24:37]:

No, no.

Alyssa Scolari [24:54]:

To go to doctor after doctor and be told ... I went to an endocrinologist because I was also having issues with just rapid weight gain awhile back, and I was told, "Oh, well, you should try walking 20 minutes a day."

Julie Duffy Dillon [25:09]:

Shut up.

Alyssa Scolari [25:10]:

Yup. That is what this renowned ...

Julie Duffy Dillon [25:13]:

That's laughable. Oh my gosh.

Alyssa Scolari [25:15]:

... endocrinologist sent to me. And then I had a doctor's appointment several weeks ago and I went in and I was like, "Look, I'm at my wit's end here my period is coming every three weeks. I am having cramps so severely that I am vomiting and having these weird fluctuations in my weight. There is something going on that I believe is deeply rooted in my hormones, possible endometriosis. I need you to listen to me." And she said, "Well, your kidneys aren't going to like this, but you should load up on Advil the day before your period. That will probably help. And then also for everything else, have you ever considered prescription diet pills? I can refer you to our weight loss doctor."

Julie Duffy Dillon [26:05]:

Oh my gosh. Wow.

Alyssa Scolari [26:08]:

And I sobbed in that doctor's office because I was just written off as, I hear that you're in pain, but this is probably your fault because you're fat. And you won't lose weight or are telling me you can't lose weight, so we're going to put you on a pill. Because I think that as long as you're not fat, it'll solve your problems. Which is her projecting her own discomfort of my body onto me. So, this is just ...

Julie Duffy Dillon [26:46]:

That's so much. I'm so sorry, Alyssa. That's ...

Alyssa Scolari [26:48]:

Thank you. I mean, listen, I was really looking forward to talking to you about it because I knew you would feel like it was absolute bullshit and now I will ...

Julie Duffy Dillon [26:57]:

Yes, 100% bullshit.

Alyssa Scolari [26:58]:

Absolute bullshit. Now I will say this to the listeners, okay? Because not taking anyone else's shit has really paid off because I ended up making multiple doctor's appointments. And this past week, like I said, less than 48 hours ago, I met with a doctor who was not only deeply apologetic and frustrated for all everything I've been told, but finally explained to me exactly what endometriosis is and exactly what my next steps are in terms of surgery and being referred to a doctor who specializes in all of this. So, there are people out there who will listen. But sometimes it takes a lot of fighting to be able to find those people.

Julie Duffy Dillon [27:41]:

Yeah, yeah, yeah. And your experience getting dismissed by your doctor and also the assumptions that were made on your movement, that obviously you want to be smaller like, let me give you this medicine to make you small. Those are the assumptions that people with PCOS are experiencing every time they get healthcare, unless they're lucky enough to be able to connect with a weight inclusive provider. And I mean, there's very, very few. I have one hand raised, both the MDs that I know, not just near me, but total. And that's just not okay.

It's heartbreaking how that is just the norm. And also, there's something about ovaries and periods, and I think it's more normal now. But 10 years ago and earlier, people didn't talk about their periods. And so, so much of this was just something that people hidden shame about. And so, they just never talked about. Even though this is a really common condition, it's really common. So whenever people with PCOS get together and areas, it's really amazing to see how validating it can be to know that like, yeah, you're not the only one that's getting dismissed like this.

And also, it can be like infuriating. And a lot of us who are socialized as women, we can be like, what the hell do we do with all this anger? It is rocket fuel for a food peace. It's rocket fuel to come together to help us change PCOS care, so like, let's do it.

Alyssa Scolari [29:29]:

Exactly.

Julie Duffy Dillon [29:30]:

We need this anger in order to make the change that we need for people who haven't started this process yet.

Alyssa Scolari [29:39]:

Exactly, we need this anger. We need it and we need to be able to use this anger productively to get our needs met. Collectively, women as a whole, and I have found that that anger has really helped me. It's helped me in the work that I do with my clients, as I'm sure it's helped you in the work that you do with your clients. But it's also helped me in my doctor's appointments. Whereas I think, again, not to say that my experiences recently have been not traumatizing, but whereas I think I would have maybe come home and crawled into my little shame shell.

And I would have maybe turn to my eating disorder because of what that doctor said to me. Instead, I went home and got on the phone with four other doctors and refused to miss a meal because of what that doctor said to me.

Julie Duffy Dillon [30:36]:

Yeah, that's important. You're so right. Because so many people have said that like, if we're in recovery, for a lot of people, eating disorder recovery was something that they had been in for years and years, and then they were diagnosed with PCOS, and that was a trigger to relapse and immediate. Because that doctor is like, "Well, guess you now have to cut out carbs."

Alyssa Scolari [31:00]:

Ugh.

Julie Duffy Dillon [31:00]:

I know. I'm like, have you seen the thick medical record of eating disorder treatment? It doesn't matter, because that's where the anti-fat bias is like, well ...

Alyssa Scolari [31:00]:

Exactly.

Julie Duffy Dillon [31:13]:

... it's worth the risk, I think. And also because people are just like, well, we're not really sure what to do. So then it's something that is just thrown out there. But it's really unfortunate. So a lot of people are activated, then just start restricting, even a part of their brain "knows better," but so much of that is because the body responds. The body gets activated and it's just trying to survive, and survive the trauma.

Alyssa Scolari [31:41]:

Exactly. Exactly, exactly. Now, in your opinion, because I know there's no exact research on this, or at least not to my knowledge, but what are some theories ... Because I know that there are some, what are some theories about the link between perhaps trauma and PCOS? And not just in the sense that the process of getting diagnosed and the process of treating and managing or managing because there's no cure, but the process of managing that can be traumatic. But are there theories and potential links about the cause of PCOS? I mean, I know we know it's passed down through families, but is there any relation to trauma on the onset of PCOS?

Julie Duffy Dillon [32:29]:

Yeah, that is something that is so interesting to me. And we have evidence-based practice and practice-based evidence. And this is where I rely a lot on the latter, the practice-based evidence. But thinking about what has been researched already, it's been a while since I've gone on Google Scholar to really take a deep dive. But every year or so, I'll go and be like, so anybody published anything on this? But the thing that gets in the way with a lot of it is like for you and me, so we're talking about diet culture as a trauma.

And so much of PCOS research is like, hey, how is ... For example, and this is a stigmatizing word when I say it, so I just want to give that heads up, like sedentary lifestyle. How is that a predictor for PCOS? And so, maybe they'll weave trauma in that way. And so, I'm like, oh, what can I do with this research? It's loaded with fat bias. So how can this be helpful?

Alyssa Scolari [33:31]:

Exactly.

Julie Duffy Dillon [33:32]:

You already have to do a lot of sifting. But what I noticed or what I know about PCOS and physiology are two things to keep in mind. And if a researcher is out there that's like, I don't know, twiddling their thumbs and looking for some new research, hey, look into this. What we know [inaudible 00:33:48] ...

Alyssa Scolari [33:47]:

Please. Any researchers with idle hands, please.

Julie Duffy Dillon [33:52]:

Especially fat positive researchers.

Alyssa Scolari [33:52]:

Yes, exactly.

Julie Duffy Dillon [33:54]:

I know they're out there. But we know people with PCOS, like I said earlier, most will have high circulating insulin levels. And what we know about systemic oppression and trauma-related systemic oppression is it causes higher insulin levels as well. And so, that's really interesting to me. It could be the chicken or the egg thing. And this is where as a clinician versus a researcher, I'm more invested in where my clients are in the here and now. So thinking about systemic oppression like my clients who are living, experiencing racism right now, I know that's making their insulin levels higher now.

Alyssa Scolari [34:36]:

Exactly.

Julie Duffy Dillon [34:37]:

So like, how can we help remove racism so they will have less insulin levels? And then the other one is inflammation. And I should name too, inflammation and insulin are diet culture magnets. Diet culture loves those words.

Alyssa Scolari [34:54]:

Love it.

Julie Duffy Dillon [34:54]:

And I know it's out of the scope of the time of what we have today, but that's all bullshit too.

Alyssa Scolari [35:00]:

Ugh.

Julie Duffy Dillon [35:00]:

Because that's only short term research. But what we know with inflammation is in the long term, dieting, like chronic dieting, and the dieting can be consistently dieting for two years or it can be off and on dieting for two to five years, is something that has shown a causal link to more inflammation. And what that means is, basically, dieting has been shown to cause more inflammation. And why that's important is because we know that inflammation predicts disease or it has a link to more disease. And that's why everyone talks about inflammation as this "horrible thing," when in fact, really, my mind, I'm getting into the weeds here, but inflammation is something that ...

Alyssa Scolari [35:44]:

No, I love it.

Julie Duffy Dillon [35:45]:

Inflammation is something that we need in order to survive. Like if we get a cut on our finger and it's red and it's warm, that's inflammation healing the spot. And people with PCOS, because of the hormonal imbalance, there's this imbalance going on, so the body is having to do a lot more cleanup work. And so, there's just more of this inflammation. And it's just a sign that the body's having to work harder than somebody else. So whatever we can do to help that person not have to work as hard is going to help.

And again, what we know is systemic oppression, any of them, those are things that also are shown to cause inflammation. And that's where trauma can come into play as well. We know trauma. You probably have more depth in that area, but the things that I've read about trauma, how they interact with blood pressure, blood sugar, and insulin levels, and inflammation, it's similar. And so, I know less about how PCOS occurs or how it like, poof, becomes in a person's body. But it sure as hell makes it a lot worse to live with. And that's my practice-based evidence. And ...

Alyssa Scolari [37:00]:

I love that. I love what you said about practice-based evidence versus evidence-based practice.

Julie Duffy Dillon [37:07]:

Oh yeah. Well, in PCOS world, that's why I struggled for so long when I first started working with it, is there's so little research on PCOS. Why? Well, it's because it's for people with ovaries. Who's going to be spending research dollars on it? Well, now, there's more, but it's all with weight centric PCOS interventions. And so, I'm like, well, how much of that research am I going to use besides showing, oh yeah, thanks for the six-week long keto research on 26 people.

Alyssa Scolari [37:39]:

Ugh.

Julie Duffy Dillon [37:39]:

That really helps me.

Alyssa Scolari [37:40]:

Yeah. You're really changing the world with that.

Julie Duffy Dillon [37:45]:

Yeah, thanks for spending all that money on that, NIH.

Alyssa Scolari [37:50]:

Ugh, god. We just have so much more work to do. It's vicious cycle. Because it's like, what came first, the chicken or the egg? But we do know that there is a potential link. There can be a potential link.

Julie Duffy Dillon [38:07]:

Yeah. I think there's something to it. Especially I know, as therapists, y'all talk a lot about like intergenerational trauma. And as dieticians, we talk about epigenetics. And I think about how did slavery affect people experiencing PCOS.

Alyssa Scolari [38:25]:

Absolutely.

Julie Duffy Dillon [38:26]:

Yeah, just like that's just one example. How did different traumas that have been passed down through families, how does that affect people getting PCOS? I don't know the answers to these things, but I would imagine that that's a piece of the pie somehow.

Alyssa Scolari [38:41]:

Absolutely. I think it would be almost foolish for us to even deny that, even though we try to as a society. But it's like, all you need to do is take one read through Bessel van der Kolk's The Body Keeps the Score to know that trauma is stored in the body. And when there's no release, it tends to just get passed down and passed down and passed down.

Julie Duffy Dillon [39:08]:

Right, right. Yeah, for sure. So much, yes, so much.

Alyssa Scolari [39:16]:

So much. Okay, so I feel like I learned so, so much. I just ... Ugh.

Julie Duffy Dillon [39:21]:

Good.

Alyssa Scolari [39:21]:

I love conversations with Julie. They're the best.

Julie Duffy Dillon [39:26]:

And so was I. You always make me feel so good about myself.

Alyssa Scolari [39:29]:

I mean, well, it's so hard to find people who understand this, but also have a passion for it. And I love it. I love all of it. I love your passion for it. I love the work that you're doing. I love that you are fighting for people to have a voice, and all of that is so important. I've mentioned your podcast. So if people, if the listeners out there would like to find you, which I'm telling you all, you need to go check out Julie's podcast. I said it in your introduction, the Love Food podcast, it's so good. It is such a ...

Julie Duffy Dillon [40:11]:

Thank you.

Alyssa Scolari [40:11]:

... wonderful and unique twist on podcasting. Ugh, it's great. It's great, people. It's great. You tell us, what are all the different ways people can find you, work with you, hear from you? I know you have lots of different irons in the fire, so to speak.

Julie Duffy Dillon [40:32]:

Well, yeah. I have less irons in the fire, I think, now than I used to . I'm taking some of those irons out because I'm like, y'all, I'm tired.

Alyssa Scolari [40:39]:

That's not a bad thing, wasn't it?

Julie Duffy Dillon [40:41]:

No. I think it's been good. But the best place for you, the listener, to find me is if you go to my website, juliedillonrd.com, I have a page. If you go to juliedillonrd.com/freebies, if you have PCOS, I have a PCOS roadmap, that's a really great place to start. And it's the top three things that I tell people if they're like, hey, where should I start if I'm thinking about moving away from diets with PCOS? Again, that's a great place to start and also to see like, hey, do I like how Julie talks about PCOS? It's a great way to get to know me.

But what you also will find on there are links to other free downloads I have. And you'll find my podcast. I have a PCOS course. I'm going to be actually launching a new program in the spring, so be on lookout for that. That should be super fun. I'm excited to get that out to the world. And I'm on Instagram. And I'm actually like turning down the dial on how much I'm on there. But if you are someone who loves me on Instagram, go to food peace dietitian. But mostly, if you want to connect by going and getting onto that freebie page, you'll automatically get entered into my email list and I will be emailing you every once in a while, and we can we can chat that way.

Alyssa Scolari [42:04]:

That is awesome. So I'm actually on the page right now. And also, Julie's website is just so beautiful.

Julie Duffy Dillon [42:12]:

Thank you.

Alyssa Scolari [42:13]:

The colors are so peaceful. It's just beautiful.

Julie Duffy Dillon [42:19]:

Thanks.

Alyssa Scolari [42:19]:

So, to the listeners out there, I will link Julie's website right to the freebies and, as she said, there you can find everything, the podcast, all the freebies that she has. And then I will also put her Instagram handle in the show notes for today. Julie, thank you. I have been looking forward to this for quite some time, and I'm so grateful that you really just came into my life in the wild and unconventional way [inaudible 00:42:53].

Julie Duffy Dillon [42:54]:

Yes, and I'm so glad that you introduced yourself to me. I feel like this is a new friendship. So thank you so much for connecting with me, and I look forward to chatting again in the future.

Alyssa Scolari [43:05]:

Yes, thank you. Thanks for listening, everyone. For more information, please head over to lightaftertrauma.com. Or you can also follow us on social media, on Instagram, we are @lightaftertrauma. And on Twitter, it is @lightafterpod. Lastly, please head over to patreon.com/lightaftertrauma to support our show. We are asking for $5 a month, which is the equivalent to a cup of coffee at Starbucks, so please head on over. Again, that's patreon.com/lightaftertrauma. Thank you, and we appreciate your support.