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.
OK. Today's the day. There was finally a quiet morning to read the research about d-chiro inositol. Ever since I posted a link to Sasha Ottey's interview on the topic on her PCOS Challenge radio show, traffic linking to us with that keyword has been very high. I've known we needed a blog post, but I just wanted to be sure it was scientifically accurate and presented information in a way that was beneficial, not hurtful.
What is inositol? It is a chemical that is necessary for several body functions, including: cell structure, insulin function, nerve function, fat breakdown, and maintenance of healthy cholesterol levels.
Inositol comes in nine different forms. Two of those types of inositol, myo-inositol and d-chiro-inositol, have been found to have therapeutic value. Myo-inositol supplementation has been found to alleviate symptoms of bulimia, panic disorder, obsessive-compulsive disorder, agoraphobia, depression, and bipolar disorder. d-chiro-inositol supplementation has been found to be useful for symptoms associated with insulin, high androgen levels, and menstrual irregularity. It is also reported that myoinositol can help prevent hair loss.
Both categories of symptoms are common in PCOS, so it appears that inositol levels and metabolism may be problematic with a high percentage of readers of this blog.
One thing you can do to help improve your levels of both myo- and d-chiro-inositol is to know their dietary sources. Myo-inositol is found in brewer's yeast, liver, milk, whole grains, brown rice, oats, nuts, citrus fruits, molasses, legumes, raisins, and bananas. The best sources of d-chiro-inositol are buckwheat and garbanzo beans (hummous, anyone?)
The theory is, that women with PCOS have trouble converting myo-inositol into d-chiro-inositol. So they need to bypass that metabolic bottleneck with a supplement.
I haven't had the opportunity to use d-chiro-inositol with my clients yet. I haven't wanted to recommend anything unless I'd researched it. But I had a client once, with severe OCD, who responded well to myo-inositol in a way medication and behavioral therapy never achieved. The only issue she had with the supplement was the large dose she needed to take (10 grams per day) in order to see benefit.
Fast forward to today, I've been wondering for awhile if maybe the symptoms attributed to myoinositol deficiency weren't actually myoinositol issues at all, but d-chiro-inositol issues, and the large dose needed was because the conversion in this population is so low.
So here's the best way I would think it would work to determine if d-chiro-inositol deficiency is your problem.
1. Be sure to include all the foods I mentioned above in your diet on a regular basis.
2. Try d-chiro-inositol. Give it three months of regular use to see if it helps. --If it helps with your insulin levels, androgen levels, and menstrual cycles, then by all means continue using it! --If it helps with the above, but doesn't help with binge eating, mood, or obsessive thinking, then consider adding some myoinositol to the mix.
3. And please, check back with us. I'm really curious to know what happens. If d-chiro-inositol also helps with mood, etc., that's very important information.
Recommended doses of each: myo-inositol 12-30 grams per day d-chiro-inositol 100 mg, twice per day
I know, I know, if you're obsessive, you're going to want to take the higher dose of myo-inositol, or even double the dose I've listed.: ) I strongly encourage you to resist the temptation and start low and titrate up as you need to.
I spent quite a bit of time in the supplement department at Whole Foods, to get an idea of what readers would find if they went to buy inositol. As you can see at this link, the options on amazon.com, as they are in most health food stores, are primarily myoinositol.
If you'd like to purchase d-chiro-inositol, the most popular source for women with PCOS appears to be www.chiralbalance.com.
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.
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
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.
The last two clients I evaluated are struggling with acne. And recently, we were linked to an acne care website that is bringing in a whole new audience. So I thought it might be a good time to talk a little bit more about this topic.
First of all, thanks to Fran Kerr for linking to Susan Dopart's testimonial about flax and fish oil! It was a great way for our two organizations to become connected. I am going to put Fran's blog (http://www.highonhealth.org/) in our resource list because she has so much great information to offer. Not just on skin, but on living healthy in general.
Secondly, for those of you who are coming to us from Fran's blog/website, I'd like to ask you if you have ever heard about polycystic ovary syndrome (PCOS). It's the focus of this website, and many women find out they have it when they seek help for their acne. And…many women don't get that assessment. I actually had a dermatologist tell me she'd rather just give her patients birth control pills and end the appointment rather than get into it because it's such a complicated diagnosis.
A very common scenario is just that. A young girl goes to the dermatologist for her acne, gets birth control pills, takes them for 10 years or so, goes off them, tries to get pregnant…and can't. What happened was that the birth control pills treated the symptom…but essentially shoved the problem under the rug…where it continued to fester and create havoc elsewhere in the body.
So I want to take a moment to list the symptoms of PCOS for those of you who might have had this experience but either didn't have a doctor who wanted to deal with it, or who had a doctor who thought if you just"got your act together" you wouldn't have the problem.
Symptoms of PCOS include: A family history of infertility, irregular periods, or diabetes Being of an ethnic heritage that tends to have a high rate of diabetes A history of early puberty (first period at 11 years or younger) A history of taking medication for depression, bipolar disorder, seizure disorder, epilepsy, or migraine? A history of gestational diabetes in any of your pregnancies. An android ("apple shaped") body type (measure your waist to hip ratio; greater than.8) Irregular periods (or none at all) Dark velvety patches of skin on you neck, groin, or in your armpits Hair loss or male balding spots Difficulty losing weight Intense cravings for carbohydrates or sweets Problems conceiving Decreased sex drive Excess hair growth on your face, like a mustache or beard Excess hair on your chest or back Acne on your face, chest or back
If you see yourself painted in this symptom set, please print this out with your symptoms marked and show them to your physician. Ten percent of all women who have this syndrome will be diabetic by age 40, and with diabetes comes a whole other list of problems.
And keep checking back here. There are lots of ways to manage PCOS that do not involve medication, and we'd love to help you learn about them. In fact, the list of practitioners at the right is a list of registered dietitians who have taken the time to complete a 20 hour course in the management of PCOS. They are just waiting to hear from you.
For more information, please visit my web page on the topic: http://www.afterthediet.com/polycystic.htm
Have a wonderful week, it's a short one with the upcoming holiday!
