You are Told to Cut Out Carbs. Now What?
I almost quit my job as a dietitian because I didn’t believe in dieting. I had only ever seen diets cause pain and harm to my patients. I recognized in my first few years of dietetics that higher weight clients were treated differently and blamed for high blood sugar, low energy, and weight gain. I did not want to replicate this harm.
I felt powerless and thought my only option was to quit and become a therapist. As I was heading out on what I thought was my last day as a registered dietitian, a colleague wrote “Intuitive Eating” on a post-it note. She added: read this before you quit. Half-way through graduate school, I read Intuitive Eating and the book led to a 180° pivot in my professional approach.
My first job after completing my master’s program was helping people in recovery from eating disorders move towards intuitive eating. I loved this work and no longer wanted to specialize in any other health condition. I loved stepping off the diet pedestal and unconditionally making space for all foods. I cheered when clients ate donuts for the first time in years, or ordered off a menu without the calories listed. This work suited me and felt easeful until I met Sarah*.
Sarah, a 25-year-old college student, went to her gynecologist because she experienced irregular menstrual cycles and was constantly exhausted. She had avoided the doctor since beginning college because she was always told to eat less and move more, regardless of the reason she’d made an appointment. What her doctor didn’t know was that Sarah was already severely restricting food and overexercising. Whenever she tried to explain her current diet or exercise regimen, Sarah knew they didn’t believe her.
I met Sarah a year after she received her PCOS diagnosis at the gynecologist. Her doctor told her to begin taking birth control pills, cut out carbs and sugar, lose weight, and come back when she was trying to get pregnant. She left the appointment feeling confused — ”Did she really have PCOS?” — and dismissed. What about the fatigue? How could she even eat less?
When I met Sarah it was easy to understand that she was in the throes of an eating disorder. She silently cried acknowledging how her doctor wanted her to keep dieting yet she didn’t think she could continue restricting. She was exhausted and hopeless.
Unfortunately, Sarah had been suffering in silence with anorexia nervosa for years because she was in a higher weight body. No one believed she was actually eating that little amount.
Even worse, Sarah was led to believe that she alone could fix her PCOS symptoms through the very instructions making her eating disorder worse: diet and exercise.
Looking at Sarah sitting on my green therapy room sofa, I knew I needed to help her eat enough and recover. Unfortunately, I only knew how to teach restrictions for PCOS management.
My nutrition training provided very little help on how to treat PCOS and other insulin-related conditions. I still remember pulling out my heavy nutrition textbook while sitting across from Sarah and scrambling for answers. Could I help Sarah with intuitive eating too? Or did PCOS mean she couldn’t eat what she wanted?
As I fumbled with the massive text, still annotated with my college handwriting, I found the section on PCOS nutrition therapy. It was a very small paragraph letting me know I needed to treat PCOS like diabetes and help her lose weight.
When I met Sarah, I knew in every cell of my body that diets didn’t work, but my education had taught me to prescribe a diet to someone with PCOS.
What about their high insulin levels? Her risk for diabetes? Heart disease? Could I trust intuitive eating even then?
I closed the textbook slowly and turned back to Sarah. At that moment, I knew I was on my own. Before, I had relied on evidence-based practice written by my senior colleagues to direct my clinical practice. But this was when I realized that they had failed me. Instead of relying on just scholarly journal articles, I needed to rely on Sarah’s lived experience.
I told her I had come to appreciate how diets harm most people and Sarah’s experiences were more the norm than the exception. Sadly, eating less and focusing on weight loss were the only nutrition interventions studied to help PCOS. We literally had nothing else to go on.
But we could still try something different.
I was frank about my novice non-diet skills and interest in finding another way with her to live with her chronic condition. Did Sarah want to try intuitive eating instead?
I am grateful she said yes.
Because of Sarah 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 cut carbs to lower insulin, balance blood sugar, and promote health.
If you have tried to recover from an eating disorder, it may have felt impossible, especially if you live with diabetes, PCOS, or another chronic condition. We are brought up to believe that each bite can either kill us or cure us. What an impossible wedge for you! To have all that power and yet feel powerless when each diet ends in failure — you must be exhausted.
If you too have been told to cut out carbs and sugar, consider these alternatives. Speak with your medical provider to see if these recommendations can be an asset in managing your health condition.
Be Sure You are Truly Eating Enough
A quick Google search on food and blood sugar will show you millions of opinions on what not to eat. People with PCOS and diabetes get inundated with rigid food rules upon diagnosis (even though no research confirms any diet exists that helps most people long-term). No wonder people with PCOS and diabetes are more likely to live with an eating disorder compared to people without these conditions.
My clients with dual diagnoses of blood sugar imbalances and an eating disorder all had something in common: they were following their doctor’s orders to restrict carbs and sugar — but it had only led to chaos. Instead of lessening their symptoms long-term, these diets just made matters worse. Not only did physical health suffer, but their mental health tanked too.
I was taught in my dietitian training to treat insulin resistance with carbohydrate restriction and weight-loss interventions. I heard from my clients with PCOS that primal, intense carbohydrate cravings were the norm, yet they were just expected to omit or limit carbs. Even when my clients were able to restrict, as directed by their healthcare provider, the cravings only intensified. I remember Sarah describing cravings as if every cell in her body were screaming at her to eat something sweet or starchy or she would die. Eventually, clients with PCOS would eat carbohydrates and feel out of control, ashamed, and sluggish.
Eating enough total food, including carbohydrates, throughout the day is a health promoting sustainable option. Doing so will balance blood sugar. It lessens insulin surges and helps your brain fixate less on food.
So, what is “eating enough?” That varies and working with a registered dietitian can help you decide. Some basics to get your started:
Three meals a day with at least three or four food groups represented
Snacks between, as needed, with at least two or more food groups represented
Check in at least every two hours to look for hunger cues and eat when accessible
Addition Instead of Subtraction
When struggling with high insulin levels or trying to balance blood sugar, consider what you can eat more of instead of what to eat less of.
Adding protein, fat, or fiber has helped many of my clients lessen PCOS symptoms sustainably. This focus has also successfully demonstrated that restricting carbs and sugar is not necessary for most people.
When you eat more protein, fat, or fiber in combination with simple carbohydrates, your digestion slows down, blood sugar balances, and your body releases less insulin.
For example, if breakfast is normally a bowl of Cheerios, add something else you enjoy like:
Breakfast sausage (protein and fat)
Full fat Greek yogurt (protein and fat)
Berries and walnuts (fiber and fat)
You don’t need to take away the Cheerios or whatever carbs you are eating, just add the foods to help your body digest them. You’ll know these additions are helping if you feel full longer, more energized after the meal, and/or your blood sugar stays lower.
Consider Supplementing
Supplements are not a cure all and some are just gimmicks. A few supplements, however, have shown in both research and practice to help my clients with insulin and blood sugar levels. A few to consider:
Inositol: A B Vitamin that helps repair insulin receptors and can help people with insulin resistance
Omega 3: An essential fat that often gets depleted with stress, dieting, over exercise, and inflammation
N-Acetyl Cysteine or NAC: An antioxidant that helps lower inflammation and improve insulin levels
While supplements can be a tool to help lower insulin and balance blood sugar, more isn’t always better. Begin one at a time and evaluate if they are helping or not after three to six months. Avoid supplements that combine more than one ingredient unless you know all are necessary. Lastly, be sure to speak with your healthcare provider before starting any new supplement.
Prioritize Rest
My clients with PCOS, diabetes, or insulin resistance often complain of painful fatigue. One thing I know to be true: getting poor quality sleep and not enough breaks throughout the day will lead to higher circulating insulin levels. Clients who added additional rest periods found they more successfully balanced blood sugar long term than when they restricted carbs. Here are some ideas to help you add more rest:
Studies (TW: stigmatizing language) show that people with PCOS often have a co-occurring sleep disorder. I encourage anyone with insulin resistance to get a sleep study done every five years, if not more frequently.
Go to bed earlier or sleep in later. Even if you can only add 15 or 30 minutes, starting your bedtime routine earlier can help your body get more rest.
Add more breaks wherever you can while at work or home throughout the day. Even for one minute, pausing and asking yourself some grounding questions like, what am I feeling right now? Or what do I need right now? This helps your mind-body connection and heart rate.
During your waking hours, try to pause more frequently for fresh air. Can you open a window for a few minutes and feel the breeze? Or step outside and feel the grass on the ground? Practice grounding in an accessible way to bring in more calm.
Final Thoughts
Being told to cut out carbs may feel like the only path forward when managing conditions like PCOS or insulin resistance—but it’s not the only option, and often, it’s not the healthiest one. Make room for approaches that honor both physical and emotional well-being, and that move beyond restriction toward nourishment. Intuitive eating is not a quick fix for insulin-related issues, but a sustainable and compassionate alternative—one that doesn’t ignore science, but instead integrates it with lived experience. Sarah’s story, and the stories of so many others, show us that healing doesn’t come from depriving ourselves, but from trusting our bodies, feeding them adequately, and prioritizing rest and joy. If you’ve been told to cut carbs, consider that the most radical, health-promoting step you might take is learning to eat enough—and doing so without shame.
*Name changed for anonymity
