Statistics say, a diagnosis of infertility is as stressful as a diagnosis of HIV or terminal cancer. So I'm always on the lookout for ways to help keep that stress from interfering with your hormone balance.
Recently, I've been researching L-theanine, a compound found in green tea, which is also used in supplement form. It's got some interesting benefits, including reduced blood pressure, reduced heart rate, antitumor activity, increased serotonin and dopamine levels in the hippocampus, hypothalamus, and striatum, neuroprotection, weight loss, stroke protection, improved learning and memory, reduced neuron excitability, reduced insulin concentration, suppressed food intake
Of course, the caffeine and polyphenols in green tea have enough benefit themselves that for the most part, I'd prefer to see green tea consumed whole instead of parsed into its separate parts. However, given the fact that this anxiety we see with our audience can stretch into the extreme zone, there may be benefit to L-theanine in addition to whole green tea in your daily program. I am also intrigued by the beneficial effects on learning and memory, given the number of you reporting the problems you're having in that department.
I'm running a little theanine experiment here with myself as the subject. Not that it's all that scientific, but I do like to test things I'm writing about, when I can, so I've got a personal as well as an evidence-based perspective. Stay tuned for some followup reports on how my study is coming along!
Yokogoshi H, Kato Y, Sagesaka YM, Takihara-Matsuura T, Kakuda T, Takeuchi N. Reduction effect of theanine on blood pressure and brain 5-hydroxyindoles in spontaneously hypertensive rats. Biosci Biotechnol Biochem. 1995 Apr;59(4):615-8.
Sadzuka Y, Sugiyama T, Miyagishima A, Nozawa Y, Hirota S. The effects of theanine, as a novel biochemical modulator, on the antitumor activity of adriamycin. Cancer Lett. 1996 Aug 2;105(2):203-9. Yokozawa T, Dong E. Influence of green tea and its three major components upon low-density lipoprotein oxidation. Exp Toxicol Pathol. 1997 Dec;49(5):329-35.
Yokogoshi H, Kobayashi M, Mochizuki M, Terashima T. Effect of theanine, r-glutamylethylamide, on brain monoamines and striatal dopamine release in conscious rats. Neurochem Res. 1998 May;23(5):667-73.
Terashima T, Takido J, Yokogoshi H. Time-dependent changes of amino acids in the serum, liver, brain and urine of rats administered with theanine. Biosci Biotechnol Biochem. 1999 Apr;63(4):615-8.
Kakuda T, Nozawa A, Unno T, Okamura N, Okai O. Inhibiting effects of theanine on caffeine stimulation evaluated by EEG in the rat. Biosci Biotechnol Biochem. 2000 Feb;64(2):287-93.
Kakuda T. Neuroprotective effects of the green tea components theanine and catechins. Biol Pharm Bull. 2002 Dec;25(12):1513-8.
Zheng G, Sayama K, Okubo T, Juneja LR, Oguni I. Anti-obesity effects of three major components of green tea, catechins, caffeine and theanine, in mice. In Vivo. 2004 Jan-Feb;18(1):55-62.
Egashira N, Hayakawa K, Mishima K, Kimura H, Iwasaki K, Fujiwara M. Neuroprotective effect of gamma-glutamylethylamide (theanine) on cerebral infarction in mice. Neurosci Lett. 2004 Jun 3;363(1):58-61.
Kimura K, Ozeki M, Juneja LR, Ohira H. L-Theanine reduces psychological and physiological stress responses. Biol Psychol. 2007 Jan;74(1):39-45. Epub 2006 Aug 22.
Yamada T, Nishimura Y, Sakurai T, Terashima T, Okubo T, Juneja LR, Yokogoshi H. Administration of theanine, a unique amino acid in tea leaves, changed feeding-relating components in serum and feeding behavior in rats. Biosci Biotechnol Biochem. 2008 May;72(5):1352-5. Epub 2008 May 7.
Long ago, I had a client who needed me to help her stay on course in the grocery store. Most of the time she did well, but one day, as we were wrapping up the trip, she accidentally zeroed out her calculator (which was her indicator she was staying within budget), just as she had three items left to put in her cart. The next series of behaviors humbled me as her dietitian, because I saw just how useless it is for anyone helping someone with an eating disorder to assume that there is any kind of logical/rational thinking when a person encounters a stress.
My client broke out into a profuse sweat. She removed all of the planned menu items from her shopping list and proceeded to the frozen food section, where she loaded up on ice cream, pizza, chicken wings, you name it. She was in such a zone that I couldn't get her attention.
I learned from this, that waiting until you're stressed out, to implement stress management behaviors, doesn't work. By that time, too many hormones and too much momentum are headed in the wrong direction for there to be much of a chance to think your way out of the problem. The same thing happens with anxiety and sleep medications. If you're taking them on an"as needed" basis, by the time you realize you need them, you've got far more momentum to overcome than you would if you implemented proactive stress management behaviors.
One of my favorite proactive remedies is lavender. It's an herb whose essential oil has repeatedly been observed to have powerful anti-anxiety, antidepressive, sleep-enhancing qualities. I was reminded of lavender this morning when I ran across a new study suggesting that lavender essential oil has the potential to be as potent as lorazepam (Ativan) for anxiety management, without thhe addictive potential. The beauty of this essential oil is that you can apply it throughout the day on your wrists, helping to keep anxiety at bay before it becomes overwhelming. Lavender sprays and pot pourris can be helpful as well. Of course, they will be more useful when used regularly and proactively than if you wait until you're completely freaked out (when you may not remember to use it, anyway).
Lavender is also an herb that can be used in cooking! Here's a link with some interesting recipes, including lavender scrambled eggs and lavender oatmeal.
I think Mother Nature is the most incredible pharmacist. I hope this is an option with potential for at least some of you with anxiety, depression, and sleep disorders that intensify your PCOS.
Kritsidima M, Newton T, Asimakopoulou K. The effects of lavender scent on dental patient anxiety levels: a cluster randomised-controlled trial. Community Dent Oral Epidemiol. 2010 Feb;38(1):83-7. Epub 2009 Nov 23.
Woelk H, Schläfke S. A multi-center, double-blind, randomised study of the Lavender oil preparation Silexan in comparison to Lorazepam for generalized anxiety disorder. Phytomedicine. 2010 Feb;17(2):94-9. Epub 2009 Dec 3.
Scientists have reported that myo-inositol can be a safe supplement to use to promote ovulation and fertility.
I have known about inositol for years, as it is also a supplement that can be helpful in the treatment of anxiety, obsessive-compulsive disorder, and panic disorder.
Since 80% of the women with PCOS coming to my website are reporting some kind of anxiety, depression, and/or mood swings, it seems that using inositol as part of your overall health and fertility program may not be a bad idea. Even if you don't have a DIAGNOSIS of anxiety, it's so easy to feel stressed out when all you want is to conceive!
The supplement can be a bit expensive…but it's far cheaper than in vitro fertilization. And it's simply a form of a water-soluble B vitamin. If it can't hurt, and it might help, at least one issue you are looking for help with…why not give it a shot?
Papaleo E, Unfer V, et al. A novel method for ovulation induction," Gynecol Endocrinol, 2007; 23(12): 700-3.
Harvey BH, Brink CB, Seedat S, Stein DJ. Defining the neuromolecular action of myo-inositol: application to obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2002 Jan;26(1):21-32.
Palatnik A, Frolov K, Fux M, Benjamin J. Double-blind, controlled, crossover trial of inositol versus fluvoxamine for the treatment of panic disorder. J Clin Psychopharmacol. 2001 Jun;21(3):335-9.
So let's say you've landed on this website because you were doing a Google search at 3:30 in the morning.
Or because you're home from work and can't slow your head down enough to relax and enjoy a leisure activity…so you're surfing the Internet to distract yourself.
What's going on?
It could be a lot of things.
1. If your hormones are out of balance, as with PCOS, you may have excess levels of stress hormones such as cortisol that rise more easily than average, and take longer to normalize after a stressful day.
2. If you didn't sleep well last night and used caffeine and sugar to get through your day, you may be experiencing the aftermath of that.
3. If you over-exercised too late in the day, because it's only large amounts of exercise that help to calm your mind, it may have stressed you more than it relaxed you.
4. You may have a mood disorder (anxiety, bipolar disorder, attention-deficit hyperactivity disorder, obsessive-compulsive disorder).
How to know which is which? If you've made major changes in your lifestyle, corrected nutrition choices, worked to prioritize sleep, etc., and your head simply won't slow down, that's a huge red flag that something important lies beneath those behaviors. In fact, the imbalances you adopted, from eating sugar to drinking alcohol to relax, to marathon exercise sessions, may have helped you to"medicate" something more important going on in your nervous system.
Mood disorders are important not to ignore. They can be degenerative, which means, left unchecked, they can prematurely age the brain and nervous system. Your new lifestyle choices are incredibly important in slowing that process down, but you may find that additional help, such as a medication, can be tremendously useful as far as finally bringing you back into balance.
If you feel as though I'm describing you, you may be interested in another blog I write, about nutritional aspects of psychotropic medications. It goes into more detail about this specific topic, and I do post a lot of information about nutrition for brain and nervous system health.
Awhile ago I made an informal (that is, never scientifically tested) questionnaire. It's not intended to diagnose, but rather to get you thinking about what kinds of thinking patterns may be underlying how often and how intensely you experience stress. You may be blaming your racing head on your stress, but it may be that your racing head attracts you to situations and relationships that are stressful.
There is no right or wrong way to answer these questions. But do consider, the more"yes" responses you give yourself, and the less your answers change in response to reasonable changes in diet, activity, sleep, and stress management, the more important it is to consider that you may have a mood disorder.
Are You A High energy Thinker? (Copyright 2000, www.afterthediet.com)
1. I am easily flustered.
2. I am easily drawn into a conflict.
3. I am very organized, and when my routine is disrupted, it can ruin my day.
4. I have a hard time with change, I would rather control thngs than let them take their natural course.
5. I can become so attached to a person, idea, or situation that I lose sight of the"big picture" perspective.
6. Staying focused on a task is a challenge; I am easily distracted/bored.
7. I can become obsessed with an activity. I ccan lose track of time because I get so absorbed.
8. People tell me I overanalyze things.
9. Peole tell me I am an adrenaline junkie.
10. I am a perfectionist.
11. I am very sensitive to criticism.
12. I worry a lot.
13. I procrastinate/can't finish projects I start.
14. I feel like I sabotage myself.
15. I have a way of saying or doing impulsive things that undermine relationships or which hurt my credibility.
16. I toss and turn a lot before falling asleep.
17. I can do a lot of things at once; in fact, it's easier thann doing one thing at a time.
18. I feel driven by some sort of internal machine.
There's a brand new study just out by one of PCOS' premier experts strengthening the correlation between anxiety and PCOS.
However, rather than this study confirming that yes, you are anxious because you have PCOS, it suggests that you may have PCOS because you have a tendency to be anxious.
This is a meta-analysis, meaning that 613 studies and 9 with similar methods were collectively analyzed for their common findings. Meaning the findings are significant.
Anxiety was present in about 20% of women with PCOS, compared to about 4% in controls. That is about 5 times higher.
We at inCYST believe that it is a combination of a tendency to be anxious, in combination with unhealthy coping behaviors such as over/undereating, over/underexercising, compulsions, and self-destructive behavior, that launches the complex web you all call PCOS. Bottom line is that since a large part of the problem is the choices that you make to manage the symptoms, the true cure for PCOS isn't anything we can hand you. It's about how you decide to manage the symptoms.
If you're having trouble changing behaviors that you use to self-soothe, even though you know they aren't working, I strongly suggest that you become a fan of Dr. Gretchen's Mental Health Monday series. Perhaps even schedule a Skype session with her if you do not live in Los Angeles.
It could make the difference between your controlling your PCOS, or the other way around.
Dokras A, Clifton S, Futterweit W, Wild R. Increased prevalence of anxiety symptoms in women with polycystic ovary syndrome: systematic review and meta-analysis. Fertil Steril. 2012 Jan;97(1):225-230.e2. Epub 2011 Nov 27.
It’s normal to have some anxiety from time to time. Everyone experiences anxiety as a normal reaction to threatening, dangerous, uncertain, or important situations. When you’re taking a test, going on a trip, or meeting your prospective in-laws for the first time, you’re going to have anxiety. Psychologists classify anxiety as normal or pathological. Normal anxiety can enhance your function, motivation, and productivity, such as the person who works well under pressure.
But there’s a larger problem called Generalized Anxiety Disorder (GAD), and it affects an estimated five to seven million Americans. People with GAD experience pathological anxiety, which is excessive, chronic, and typically interferes with their ability to function in normal daily activities. GAD patients are about 60%women/40% men, and women with PCOS are affected by anxiety disorders more often than other people, just as we’re more affected by depressive disorders.
There are biological and environmental risk factors for GAD, which include the following:
• Genetics (Research has shown a 20% risk for GAD in blood relatives of people with the disorder and a 10% risk among relatives of people with depression.)
• Sleep deprivation, sleep inconsistency
Stress in the following areas can intensify symptoms:
• Financial concerns
• Health
• Relationships
• School problems
• Work problems
Symptoms include trembling, general nervousness or tension, shortness of breath, diarrhea, hot flashes, feeling worried or agitated, trouble falling asleep, poor concentration, tingling, sweating, rapid heartbeat, frequent urination, and dizziness. A panic attack, which is an extreme manifestation of anxiety, may feel like a heart attack, and sends many patients to the emergency room. If you’re having these types of symptoms, you should definitely make sure you’ve seen a physician to rule out medical conditions.
This type of anxiety is obviously more severe than normal anxiety, and can even be quite disabling. There might be a tendency to expect the worst without clear evidence, with particular worries about health, finances, job, and family. Individuals often can’t relax, sleep or concentrate on the task at hand. This disorder affects the quality of work and home life. You may know that your worry is excessive, but don’t feel like you can do anything about it. There are also some cultural issues — many people in the United States who are diagnosed with GAD claim to have been nervous or anxious their whole lives. Eastern societies, on the other hand, perceive and treat anxiety differently, as something associated with pain. So anxiety may be seen as normal in one setting, and pathological in another setting.
GAD is associated with irregular levels of neurotransmitters in the brain. Neurotransmitters are chemicals that carry signals across nerve endings. Neurotransmitters that seem to involve anxiety include norepinephrine, GABA (gamma-aminobutyric acid), and serotonin. Anxiety may result in part from defects in serotonin neurotransmission, and drugs that augment this activity may be useful in the treatment of anxiety disorders. However, many therapists believe that GAD is a behavioral condition and should not be treated with medication. Further, some believe GAD is more closely related to depression than to anxiety. I tend to believe that there’s a spectrum, and usually, if you’ve got depression, you’ve got some anxiety, and vice versa. There also seems to be a correlation between GAD and other psychiatric disorders, including depression, phobia disorder, and panic disorder. Anxiety is a risk factor for sleep disorders such as insomnia.
If you have numerous symptoms of anxiety, it’s important to be evaluated by a mental health professional who can help you identify the causes of your anxiety, and teach you ways to manage your anxiety. Many forms of therapy are effective, and I see great results in my anxiety clients who practice yoga or meditation (or both!). If that’s not enough, you can be evaluated by a psychiatrist and try some of the highly effective anxiety-reduction medications.
Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She has completed the inCYST training. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.
If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at AskDrHouseMD@gmail.com. You can also follow her on Twitter @askdrhousemd.
From inCYSTER Karen Siegel…contact information for her Houston clinic is listed below.
"Yes. Another reason to keep encouraging the fish oil supplementation."
Public release date: 16-Dec-2009
Contact: Public Affairs Office public.affairs@apa.org 202-336-5700 202-336-5700 American Psychological Association
New study links DHA type of omega-3 to better nervous-system function Deficiencies may factor into mental illnesses WASHINGTON — The omega-3 essential fatty acids commonly found in fatty fish and algae help animals avoid sensory overload, according to research published by the American Psychological Association. The finding connects low omega-3s to the information-processing problems found in people with schizophrenia; bipolar, obsessive-compulsive, and attention-deficit hyperactivity disorders; Huntington's disease; and other afflictions of the nervous system.
The study, reported in the journal Behavioral Neuroscience, provides more evidence that fish is brain food. The key finding was that two omega-3 fatty acids – docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) – appear to be most useful in the nervous system, maybe by maintaining nerve-cell membranes.
"It is an uphill battle now to reverse the message that 'fats are bad,' and to increase omega-3 fats in our diet," said Norman Salem Jr., PhD, who led this study at the Laboratory of Membrane Biochemistry and Biophysics at the National Institute on Alcohol Abuse and Alcoholism.
The body cannot make these essential nutrients from scratch. It gets them by metabolizing their precursor, α-linolenic acid (LNA), or from foods or dietary supplements with DHA and EPA in a readily usable form."Humans can convert less than one percent of the precursor into DHA, making DHA an essential nutrient in the human diet," added Irina Fedorova, PhD, one of the paper's co-authors. EPA is already known for its anti-inflammatory and cardiovascular effects, but DHA makes up more than 90 percent of the omega-3s in the brain (which has no EPA), retina and nervous system in general.
In the study, the researchers fed four different diets with no or varying types and amounts of omega-3s to four groups of pregnant mice and then their offspring. They measured how the offspring, once grown, responded to a classic test of nervous-system function in which healthy animals are exposed to a sudden loud noise. Normally, animals flinch. However, when they hear a softer tone in advance, they flinch much less. It appears that normal nervous systems use that gentle warning to prepare instinctively for future stimuli, an adaptive process called sensorimotor gating.
Only the mice raised on DHA and EPA, but not their precursor of LNA, showed normal, adaptive sensorimotor gating by responding in a significantly calmer way to the loud noises that followed soft tones. The mice in all other groups, when warned, were startled nearly as much by the loud sound. When DHA was deficient, the nervous system most obviously did not downshift. That resulted in an abnormal state that could leave animals perpetually startled and easily overwhelmed by sensory stimuli.
The authors concluded that not enough DHA in the diet may reduce the ability to handle sensory input."It only takes a small decrement in brain DHA to produce losses in brain function," said Salem.
In humans, weak sensorimotor gating is a hallmark of many nervous-system disorders such as schizophrenia or ADHD. Given mounting evidence of the role omega-3s play in the nervous system, there is intense interest in their therapeutic potential, perhaps as a supplement to medicines. For example, people with schizophrenia have lower levels of essential fatty acids, possibly from a genetic variation that results in poor metabolism of these nutrients.
More broadly, the typical American diet is much lower in all types of omega-3 than in omega-6 essential fatty acids, according to Salem. High intake of omega-6, or linoleic acid, reduces the body's ability to incorporate omega-3s. As a result,"we have the double whammy of low omega-3 intake and high omega-6 intake," he said.
### Article:"Deficit in Prepulse Inhibition in Mice Caused by Dietary n-3 Fatty Acid Deficiency"; Irina Fedorova, PhD, Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health; Anita R. Alvheim, PhD candidate, Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, and National Institute of Nutrition and Seafood Research, Bergen, Norway; and Nahed Hussein, PhD and Norman Salem Jr., PhD, Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health; Behavioral Neuroscience, Vol. 123, No. 6.
(Full text of the article is available from the APA Public Affairs Office)
Norman Salem Jr. can be reached at nsalem@martek.com or at (443) 542-2370 (443) 542-2370. He was with the National Institutes of Health until 2008, when he became the chief scientific officer and vice president of Martek Biosciences Corp. in Columbia, Md., an ingredient supplier of DHA. He states that he and his co-authors conducted this research while with the NIH.
The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States and is the world's largest association of psychologists. APA's membership includes more than 150,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting health, education and human welfare. -- Karen Siegel, MPH, MS, RD, LD, LAc Acupuncture & Nutrition Clinic 9660 Hillcroft, Suite 202 Houston, TX 77096 713/721-7755 713/721-7755 www.AcupunctureandNutritionClinic.com or www.Karensclinic.com
Knowing that PCOS often goes unrecognized, and that PCOS research often overlooks some of the most important issues cysters deal with, I'm trying to bring research to this blog you may not find if you're using"PCOS" as your search term but which may be entirely pertinent. In this case, I want to talk about antidepressants, which are very commonly prescribed in PCOS, whether it's officially diagnosed or unrecognized.
This study was conducted because of the number of women who use antidepressants. That increases the possibility that a woman may, intentionally or not, become pregnant while taking antidepressant medications. The researchers wanted to know if fetal exposure to antidepressants may influence brain and nervous system development. This particular study was done with mice, but it was previously determined that mice and humans demonstrate similar mother-fetal transfer with the medications being evaluated.
Fluvoxamine (Luvox) had a lower rate of transfer than did fluoxetine (Prozac). More offspring died in the group using fluoxetine, and most of these deaths were due to heart failure related to cardiac defects. The researchers reported no deaths related to fluvoxamine.
In addition, the part of the brain that distributes serotonin to the rest of the brain, the raphe nucleus, did not function properly in the brains of rat pups whose mothers had been exposed to fluoxetine. Behaviorally, these rats exhibited more anxiety- and depression-related behaviors as adults than rats who had not been exposed.
So it seems that babies of moms who have depression may be set up to have the same problems when they become adults. Some of that may be genetic, but some of it may be perpetuated by the way the mother's biochemistry is treated by her caregivers.
Bottom line, if you're using antidepressants, even if you're NOT trying to become pregnant but you MIGHT become pregnant because you're sexually active, you may want to be sure that you discuss this with your physician and determine which treatment option is most appropriate.
Don't forget diet and fish oil--they can eliminate the need in many cases to even have to make this kind of decision!
Noorlander CW, Ververs FF, Nikkels PG, van Echteld CJ, Visser GH, Smidt MP. Modulation of serotonin transporter function during fetal development causes dilated heart cardiomyopathy and lifelong behavioral abnormalities. PLoS ONE. 2008 Jul 23;3(7):e2782.
Dr. Gretchen Kubacky will be the featured expert this week on the PCOS Challenge Expert Webinar series.
Here is a description of her upcoming presentation:
Depression, anxiety, suicidal thoughts, infertility, and many other disorders are much more common in women with PCOS. In this PCOS Challenge Expert Series workshop, Dr. HOUSE will address the psychological issues and coping skills necessary for thriving with PCOS. Dr. HOUSE will also explain how to identify the most common conditions, suggest ways to find sources for help and support, and describe how to proactively manage your mental and physical health and relationships.
In this workshop, you will learn:
What a mood disorder is and what it looks like. Signs that you might be feeling suicidal. What every PCOS woman needs to know about infertility. Coping skills for relationships, medical treatments, and body image issues. How to be a proactive patient and get the help you need now.
I've mentioned before that receiving any kind of medical diagnosis that can leave you backed into a corner, with no place to go, is one of life's most extreme stresses. If you're someone who is used to being in control, losing that control can throw you into a complete tailspin. That is when you are most likely to be susceptible to something called"magical thinking". This type of behavior is something you engage in to allow yourself to feel as if you you have more control over a situation than you actually have. Some examples in recent months that I've personally experienced:
-- A gentleman I really wanted to do business with because I liked his product, started to panic because sales of that product were not matching his projections. I started receiving e-mails from him about all kinds of interesting"effects" he was personally noticing that he attributed to the special powers of his product. I mentioned to him once that if his observations were true, science would validate them. He told me he didn't have time to wait for science. Can you hear the desperation and wishful thinking that was interfering with his overall long-term success? I felt sad, because his product was good, but he was gradually burning business bridges before he could get the sales he wanted and should have had.
--A young woman who had failed one IVF and was scheduled for another, afraid she'd lose that success too, wrote me asking to help her with a detox/cleanse, less than a week before her procedure. She wanted to rid her body of any negative influences that might work against her. We decided against the detox, and simply set up a very balanced eating/exercise/relaxation plan focusing on nurturing instead. (She's pregnant, BTW). I don't think she really wanted to detox, she really needed something constructive to do as an anxiety outlet, and to give her hope she wasn't going to fail again.
Supplements are the place where magical thinking really takes control. I watch women with PCOS throw the entire kitchen sink at a problem, without knowing exactly what kind of effect they're looking for, what dose, what brand, what kind of interactions their multiple supplements may have with each other…which ones duplicate the effects of others…all it seems to take is for one person out there to mention one supplement and the"wave" rolls across the PCOS blogs and Facebook pages. Because no one ever really took the time to figure out how to use the supplement in a scientific fashion, it doesn't work, women give up on it before it might have a chance to work, and they're off on a search for the next magical supplement.
We're starting to understand here at inCYST that there is more than one kind of PCOS. So if anyone is recommending any particular supplement, and it's a one-size-fits-all recommendation, they're either telling you what worked for them (which may not work for you), or they are throwing together a little bit of something from every study they could find, which makes their answer extremely expensive because half of what is in it, most women don't even need.
Just because you can buy supplements yourself over the counter, and dose them yourself, does not mean they're safe. If your physician is anti-supplement and you're not telling him/her about the supplements you're taking because you know s/he is against them, you could be negating the effects of both your medications and your supplements. There are ways to use both, but it's only going to work if whoever you are asking for help, is amenable to combining both approaches.
The supplement that currently seems to be the rage right now seems to be n-acetyl-cysteine, or NAC. I'm not sure where this wave got started. I'm not going into the nuts and bolts of the chemistry, you can find that elsewhere. But here are some things to consider.
1. NAC has also been shown to reduce the symptoms of bipolar disorder and schizophrenia. I'm guessing that the subpopulation of women with PCOS who also have one of these diagnoses (and that's a pretty significant percentage of the PCOS population BTW), are the ones most likely to benefit from NAC. But since mood regulating medications are powerful, it's super important, if this is you, to let the prescribing physician of any mood stabilizers know so that you don't experience a dangerous adverse reaction between medication and supplement. And by all means, DO NOT stop taking medication for schizophrenia or bipolar disorder because you read what I just wrote!!!
2. NAC is also being considered as a treatment for obsessive-compulsive disorder, something I know is also very common with PCOS. If you're going to use a supplement, I'm more comfortable with your using myoinositol for this purpose, which has also been shown to help improve fertility rates. Again, please let your caregiver know what you're doing. One of our fans recently shared that she took a blog post regarding inositol to her physician, who now recommends it to his PCOS patients. In talking to your doctors, you have to potential to teach them important things. (That's why I reference posts, so your doctors can read the research themselves and know my thoughts are evidence-based.)
2. There is some evidence that large doses of NAC can increase the risk of pulmonary hypertension, a very dangerous condition. I can't stop you from taking this supplement, but I can encourage you, if you decide you want to use it, to do so in conjunction with a knowledgeable health professional who can help you to properly dose it.
3. In the most recent study I found regarding NAC compared to metformin/clomiphene, metformin/clomiphene was found to be superior. But if you remember, I wrote pretty extensively not too long ago about the peer-reviewed finding that metformin increased ovulation and pregnancy rates but not live births (thus increasing the miscarriage rate). Perhaps you should think a little bit about whether or not this is the path you wish to embark on, using a supplement that has not been proven to be as"effective" as a medication that hasn't even been proven to be effective.
4. One reason NAC is thought to be useful is that it protects against"glucose toxicity". Here's a thought — why not eat less glucose? Even if you choose myoinositol over NAC based on what you're reading, consider that your own inositol stores may have found themselves depleted in the first place from imbalanced eating. No way around it, supplements do not replace healthy choices. If you're going to experience the greatest benefit from a supplement, it needs to complement, not replace, better eating.
You're all grown women and you can make your own choices. I hate seeing you struggle with PCOS. But worse than that, I hate seeing you jump around from supplement to supplement without any kind of plan of action for how you're going to use it, how you're going to know if it's working, and how you're going to know if you need to not use it.
The people who benefit the most from magical thinking…are the ones who play on your anxiety and frustration and take your money, offering"solutions". Be a wise consumer. And remember, something you ALWAYS have control over…is healthier food choices, activity schedules, and stress management.
Berk M, Dean O, Cotton SM, Gama CS, Kapczinski F, Fernandes BS, Kohlmann K, Jeavons S, Hewitt K, Allwang C, Cobb H, Bush AI, Schapkaitz I, Dodd S, Malhi GS. The efficacy of N-acetylcysteine as an adjunctive treatment in bipolar depression: An open label trial. J Affect Disord. 2011 Jun 28. [Epub ahead of print]
Camfield DA, Sarris J, Berk M. Nutraceuticals in the treatment of obsessive compulsive disorder (OCD): a review of mechanistic and clinical evidence. Prog Neuropsychopharmacol Biol Psychiatry. 2011 Jun 1;35(4):887-95. Epub 2011 Feb 23. Abu Hashim H, Anwar K, El-Fatah RA. N-acetyl cysteine plus clomiphene citrate versus metformin and clomiphene citrate in treatment of clomiphene-resistant polycystic ovary syndrome: a randomized controlled trial. J Womens Health (Larchmt). 2010 Nov;19(11):2043-8. Epub 2010 Oct 12.
Kaneto, H. Kajimoto, Y. Miyagawa, J. Matsuoka, T. Fujitani, Y. Umayahara, Y. Hanafusa, T. Matsuzawa, Y. et al. (1999). Beneficial effects of antioxidants in diabetes: possible protection of pancreatic beta-cells against glucose toxicity. Diabetes 48 (12): 2398–406.
If you've been enjoying the PCOS Challenge Radio Show, you'll love Sasha's latest venture! Dr. Van Dyke, Ellen Goldfarb, Gretchen Kubacky, and myself will be presenting more in-depth seminars on our areas of specialty.
Topics to be covered include:
Nutrition Essentials for PCOS--Monika M. Woolsey, MS, RD Tuesday, October 20
Eating Disorders and PCOS--Ellen Reiss Goldfarb, RD Tuesday, October 27
Living Happier and Healthier with PCOS--Gretchen Kubacky, PsyD Tuesday, November 3
Hair Removal Solutions for Women With PCOS--Susan Van Dyke, MD Tuesday, November 10
The Natural Solution to Overcoming PCOS--Julie Walsh, ND Tuesday, November 17
All webinars will be held from 8:00 — 9:00 Eastern Time.
Space is limited for the live sessions, but if you can't make any of the live sessions, they will all be recorded and made available on CD.
Please join us! We've all been working hard on this project and it's all been especially for YOU!
It's a quiet day around here, and I am cleaning up papers. I found a chart I prepared several years ago, in which I listed the commonly recognized symptoms of PCOS, and did literature searches to see how often these symptoms appeared in other medical diagnoses. The diagnoses that occurred most often were epilepsy, bipolar disorder, and anxiety disorder.
I don't really know what this means, except that maybe we're not always looking at the right places when we try to understand the syndrome. Maybe we're not correctly connecting the dots.
I sent this to a PCOS researcher who didn't seem very excited about the information at the time. I am not a researcher, and I will never have the laboratory that can do this research. So I am posting the information hoping that someone who can…will pick up where I left off and do some creative work on behalf of the women with PCOS.
One comment I WILL make, is that I don't entirely believe PCOS is caused by insulin resistance. It is a very prevalent symptom, but correlation does not always equal causation. I don't think we would say that insulin resistance causes epilepsy or bipolar disorder. I do wonder what function insulin resistance plays in an imbalanced system, as the body wouldn't have that mechanism if it didn't have a need for it.
I know, I know, I'm stepping away from conventional wisdom on this one. I just think we need to think outside a much bigger box for the most profound answers to the PCOS mystery.
I wonder sometimes if insulin resistance isn't a way for the body to shuttle glucose to a brain and nervous system that are overstressed, since that system is so dependent on glucose for fuel.
The letters after each symptom denote which of (E) pilepsy, (B) ipolar disorder, and (A) nxiety disorder has been reported in peer-reviewed research to be associated with that particular symptom.
Acne E, B
Infertility E, B
Irregular periods E, B, A
Decreased sex drive E, B
Obesity/rapid weight gain/difficulty losing weight E, B, A
I've had two different clients share a similar observation in the last couple of weeks, and I thought I'd write about it since it's not uncommon to feel this way in early recovery.
First of all, I want to share with you an article on depression that was recently in the Boston Globe.
This article presents the argument that depression is not about a deficiency of neurotransmitters that need to be balanced with medication, but rather, a condition in which neurons are dying a slow death and gradually losing their function. I've had this premise for awhile; it is the basis of my treatment philosophy for PCOS. Fish oil is the best compound nature has for restoring life to neurons, and when you put it into your diet, the brain begins to function again.
My two clients have both observed that as they began taking fish oil, they felt more alert and their memory and concentration seemed to be better. Signs that Elvis is back in the building!
These two clients also observed, though, that they were feeling more emotional. Not all emotions, especially anger and sadness, are easy to feel. So when you begin to feel these emotions, it can feel like things are getting"worse", not better.
Keep in mind, when neurons are malnourished, that means ALL neurons stop functioning, not just the ones affecting memory. The ones affecting emotion, the ones affecting appetite, and the ones affecting hormones.
If you've had PCOS, your hormones have not been functioning as they should, perhaps for a very long time. And that means you've not had the experience other women have, of fluctuating energy, emotions, you name it. Those fluctuations are normal!
So I often get the question,"What can I do?" The most important advice I can give is, be patient with yourself. Become used to what it means to truly cycle. Get to know what a healthy body feels like. It means it is normal to feel bloated, even constipated, just before your period. Your weight might fluctuate. The cycle should be around 28 days when you're back on track, and every single day within that 28 days may feel different. There may be no such thing as getting on the scale and weighing the same thing every single day.
With regard to your emotions, perhaps as your brain becomes more aware, this is an opportunity to experience what emotions might be about. Emotions are messages from the brain, telling you how you are with regard to balance, and what you need to do to restore balance if it isn't there. Anger is often a clue that a boundary has been violated. Loneliness means you need to seek companionship of some sort. Fear suggests that you need to remove yourself from danger. If they didn't feel uncomfortable, you would not be motivated to engage in behaviors that keep you healthy and safe. So rather than running from emotions, embrace them! They're telling you that your health is returning and things are getting back to normal.
PCOS is so hormone driven that emotions end up on the back burner. Excesses of androgens and stress hormones put anxiety and anger in control. But if you find that these feelings are persistent and do not wane after time, or that they seem to be there even when nothing in your life can explain them, they may be signs of hormone excesses and not really environmentally or event-stimulated emotions. When your hormones have you constantly revved up, it can feel strange to not have that kind of energy rush.
I couldn't figure out why, when I first started recommending yoga to clients, they would come back after one class and tell me they hated it. I figured out eventually, that yoga slowed their bodies down but their heads were still spinning. And being pinned to the floor in a yoga pose while your head is thinking angry thoughts can be a very uncomfortable place to be. Those clients got the same advice I'm giving you. Give the new changes some time. Don't abandon your new lifestyle because it initially feels uncomfortable. It's been a long time since your body has felt normal. Be gentle with your self and get to know/understand that"normal" involves hourly, daily, weekly, and monthly cycles. There is no such thing as being the same weight, temperature, size, or temperament every single minute of every single day.
Our philosophy is a little different than what many physicians will have you do. We're not trying to control your hormones, your weight, or even your diet. We're not trying to force a cycle, a pregnancy, or a clothing size. We're guiding you toward healthy choices that allow your body to be in balance. Sometimes giving up control, and letting the body speak to you instead of the other way around, is the absolute best way to get there.
So if things seem a little chaotic and you feel like you're charting uncharted territory, welcome to the world of female physiology! Ask questions, observe, and embrace the wonderful lesson you're learning, that your body will heal if you let it. There is no such thing as being past the point of no return or"stuck" where you are.
The following is a guest post reprinted with permission from theblog of Karen Siegel, MPH, MS, RD, LD, LAc. Karen is a registered dietitian and licensed acupuncturist practicing in Houston, TX. If that's your neck of the woods, I highly recommend you take advantage of her knowledge, experience and talent.
Depression, Anxiety, Bi-Polar Disorder & Acupuncture Questions about acupuncture for mental health issues are one of the most common inquiries I receive after questions about pain.
I actually do quite a bit of “mental health” acupuncture. Because of my nutrition specialty of working with eating disorders (for over 25 years), I have developed a great network with some of the best mental health professionals in Houston.
Acupuncture can help with depression, anxiety, stress and bi-polar disorder. So in terms of various mental health issues, yes, acupuncture can frequently help.
I caution to say that acupuncture is not in lieu of continuing or being in therapy. I do not take patients off of their Western medication if they’re already on it. Medication is a discussion between the patient and their doctor. Acupuncture, and in many cases Chinese herbal formulas, work just fine in conjunction with Western medication as the mechanism of action is quite different. They can complement each other beautifully.
When a patient comes in with a Western diagnosis of depression, anxiety or bi-polar disorder, my job is to determine what the underlying problem(s) are from a Chinese medical perspective. For example, if someone presents with anxiety along with insomnia, excessive worrying, hypervigilance and internalizing feelings, the strategy might be to balance the heart and kidney channels. However, if the main complaints include depression, irritability, sleep disruptions and digestive problems, the approach might focus on smoothing the liver channel.
Usually, a patient will present with a combination of the above plus more. After a thorough evaluation, a point selection is chosen based on the most disruptive concerns working our way in to the deepest and most chronic issues. We as human beings are rarely uni-dimensional, therefore it is more complicated than I have described. However, it gives you an understanding that the treatment strategy is quite individualized.
I have treated bipolar disorder and have found that acupuncture can be stabilizing; but with bipolar, it’s really important to stay on your Western drugs and/or be in regular communication with your therapist. What the acupuncture can do is help balance and stabilize some of the mood swings: the degree, frequency and intensity of the ups and the downs. You might be able to reduce the dosage of some of the medications, but again, that’s between you and your psychiatrist.
Stress is a major variable in just about every health issue we have. I think that stress is the one variable in our life that cannot be controlled in a double-blind, placebo control study. So you can have everything, all variables equal, but how do you really control for stress? Stress definitely triggers mental health issues and it triggers health issues overall.
Because stress is a major factor in all of our lives, acupuncture in and of itself helps with mental health issues because it works to balance the mind, body and spirit. When we are in balance, our emotional and physical health is improved.
You’ve heard it a thousand times, from every doctor, dietician, and well-meaning person you’ve ever encountered – you’ve got to lose weight, get out there and get some exercise, and change what you’re doing with your body when you’ve got PCOS. It’s important advice, to be sure, yet tedious to hear – and sometimes when we’re in the midst of trying to change our lifestyle and behaviors, we forget why we’re doing it.
All we hear is this pointed and difficult direction to improve things, and we fail to spend time linking it intellectually and emotionally to positive outcome, which helps drive motivation. It’s particularly frustrating with PCOS, because change occurs painfully slowly, and when you don’t see change, you lose motivation. Others can go on a diet and lose five pounds immediately, whereas that’s rarely the case for someone with PCOS.
Sometimes the changes are only visible when you get your lab results every few months, and the doctor congratulates you on lowering your cholesterol 20 points (personally, I don’t find that terribly exciting, although I know that it’s good) – in which case you might get it intellectually, but still be saying “yeah, yeah, yeah, that’s great, but where’s the weight loss?!” What we want is weight loss, pregnancy, a reduction in hirsutism, or some other visible proof that what we’re doing is working.
When you really understand the importance of exercise for both your body and your brain though it’s a little easier to stick with a program of self-improvement. In a 2011 study entitled Lifestyle Changes in Women with Polycystic Ovary Syndrome, researchers examined numerous studies, papers, and research projects and validated the benefits of lifestyle change. Women with PCOS who made positive dietary, exercise, and lifestyle changes (i.e., stress reduction, increased movement, lower glycemic diets) experienced reductions in weight, testosterone levels, waist circumference, and other meaningful markers of the syndrome.
To support not only weight loss and improvement in body composition, but also, from my perspective as a psychologist, the stress reduction and mental re-wiring that goes on as a result of exercise are spectacular. I particularly like the following forms of exercise:
Walking – the cross-lateral motion of walking oxygenates and re-synchs your brain, and leads to a literal feeling of “clearing out” – plus walking is an excellent low-impact exercise that leads to improved glucose control. Does it get any better than that?!
Yoga – numerous studies continue to validate the importance of yoga for stress reduction and pain management. A study entitled Stress, Inflammation, and Yoga Practice indicated that yoga practice, regardless of skill level, resulted in marked reductions in both stress level and, even more exciting to those with PCOS, inflammation! Many fertility improvement programs involve yoga and other forms of stress reduction. And, while you’re improving your physical balance, you might just be improving your mental balance as well.
Swimming – swimming in a pool, lake, river, or ocean can be soothing and meditative. We are made primarily of water, and it is a return to water, and to the center of our selves. The silence and internal nature of the echoes and ripples brings us back into alignment with our natural rhythmic movement patterns.
Dancing – improves coordination, synthesizes mind/body, and is a form of creative expression. Much emotion is stored in the body, and can be expressed through the body. Plus, dancing is fun, at least when you “dance as if nobody’s looking!”
Weight training – feeling a strong body is empowering, and increases confidence. Sure, it’s hard work, but it has profound mental benefit when you conquer that final set, and your lifting is finished. There’s a sense of accomplishment and pride that boosts your self-esteem for hours. You’ll move better in your body too, and perhaps respect it a little more, for its ability to become so strong. (By the way, this is one really positive aspect of PCOS – that androgen imbalance will allow you to develop muscles more quickly!)
The mind and body are inseparable. If you work on improving the mental (motivation, drive, commitment), you will improve the physical. If you work on the physical, you’ll achieve the psychological rewards of calming, anxiety reduction, and depression reduction. Additionally, you’ll have fun and also be doing the right thing to keep your self-improvement program going. That leads to increased confidence, self-esteem, and overall improvement in your sense of well-being.
Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.
If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website atwww.drhousemd.com, or e-mail her atGretchen@drhousemd.com. You can also follow her on Twitter @askdrhousemd.
References:
Kiecolt-Glaser JK,Christian L,Preston H,Houts CR,Malarkey WB,Emery CF,Glaser R. Stress, inflammation, and yoga practice. Published in final edited form as:Psychosom Med. 2010 February; 72(2): 113.Published online 2010 January 11. doi:10.1097/PSY.0b013e3181cb9377.
Moran LJ, Hutchison SK, Norman RJ, Teede HJ. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database of Systematic Reviews 2011, Issue 2. Art. No.: CD007506. DOI: 10.1002/14651858.CD007506.pub2.Australia, 3168.
Gretchen Kubacky, Psy.D, is a psychologist practicing in Los Angeles who specializes in helping people diagnosed with endocrine disorders.
She's dedicated to helping women like you, and we're so excited to have such an awesome member on our team!
PCOS may be about hormones, but hormones are what create emotions. If you don't recognize both parts of the disorder, it's going to be hard to get better.
Gretchen, we're so glad you are here and we look forward to your contributions!
Yesterday I had the honor and pleasure of speaking to a group of eating disorder professionals in Santa Monica, California, about what happens when an eating disorder and PCOS collide in the same person.
Here are some of the statistics I shared with them:
**Women with PCOS have a higher lifetime incidence of depressive episodes, social phobia, and eating disorders than controls.
**Suicide attempts are seven times more common in women with PCOS than in other women.
**In a sample of women with facial hirsutism, the prevalence of eating disorders is 36.3% (Compared to about 10% in the general female population).
**Depression, anxiety, low self-esteem, and poor social adjustment are more common in participants suffering from an eating disorder, and the presence of PCOS was universal in eating disordered cases.
Those are some pretty heavy statistics…and the points I was making to the audience were that medical doctors who treat PCOS need to understand its emotional and behavioral components, and professionals who treat eating disorders cannot be effective if they don't understand the hormonal implications of PCOS. You need to know how to treat both.
The good news is, the professionals in the room were interested in helping. And inCYST dietitians happen to be very interested in disordered eating as well as PCOS. So we're ready and very eager to help you negotiate your way to solutions for both. inCYST providers Ellen Reiss Goldfarb, Diane Whelan, and Mary Donkersloot were with me in Santa Monica, putting a friendly face onto PCOS and eating disorder help and networking with capable and sympathetic doctors and psychologists. With the teambuilding that happened, I have to say, anyone in SoCal who needs help, is going to be in very capable hands!
Please check out our referral list and reach out to someone who can help.
If the topic of eating disorders and PCOS interests you, be sure to catch Ellen Reiss Goldfarb, RD, (West Los Angeles) in her interview on the topic on PCOS Challenge, Wednesday, June 24, 6 pm EDT.
REFERENCES
Mansson M, Holte J, Landin-Wilhelmsen K, Dahlgren E, Johansson A, Landen M. Women with polycystic ovary syndrome are often depressed or anxious--a case control study. Psychoneuroendocrinology. 2008 Sep;33(8):1132-8. Epub 2008.
Morgan J, Scholtz S, Lacey H, Conway G. The prevalence of eating disorders in women with facial hirsutism: an epidemiological cohort study. Int J Eat Disord. 2008 Jul;41(5):427-31.
