The Hemp Connection:
bulimia

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.

Hello everyone,

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!

Here is the link to the article:

http://www.womensonlinemagazine.com/losangeles/category/health-fitness/ask-dr-gretchen/.

Not long ago, Renata Mangrum (who you'll soon see more of on our blog, she's studying to be an inCYST provider) forwarded me a note from a discussion list for lactation consultants. Someone on that list wanted to know if excessive vomiting during pregnancy (hyperemesis) was common with PCOS. The person asking the question had a patient who was experiencing that problem. There didn't seem to be much information about it in the scientific literature, but when this person lurked on a few PCOS listserves, it seemed to be commonly accepted as an issue.

LESSON ONE: Be sure to report all your unusual symptoms to your physician. When they start to see trends, that is when they can research the problem…the first step toward finding a solution.

I wrote Renata back and told her I'd never heard about it, but I did know that there was a very strong correlation between PCOS and bulimia, another medical diagnosis including vomiting. I did post about two weeks ago to see if any of inCYST's readers had experiences to share with their own pregnancy. One reader did write back to say that yes, she did experience vomiting, and was told it was due to having a low progesterone problem.

LESSON TWO: inCYST is as much about our readers sharing their experiences for us to learn from as it is about our giving advice. It's important that this be an interactive forum with communication moving in both directions.

Curious, I went into the National Library of Medicine database and used the keywords"bulimia" and"progesterone". It turns out, there were several articles reporting progesterone imbalances in bulimia. And, a correlation between imbalanced progesterone and binge eating. (References below.)

Hmmmmm…

What I know from my eating disorders work is that bulimia has many different colors. Sometimes it's induced. Sometimes it just happens. Sometimes women binge specifically so they can induce vomiting. Sometimes they overeat, and induce vomiting to relieve the discomfort that overeating produced. I learned that it is very important to get as much detail about how, why, and when the vomiting occurs, and not just lump all of it into one symptom with one cause and one motivation.

What I know from my PCOS work is that cysters have a low stress threshold. Meaning it takes less stress to activate the stress response. If you are prone to vomiting, that means you might be prone to feeling more nauseous with less stress than the average person. You may have learned over time that throwing up is a quick way to relieve discomfort other people quite simply never feel.

Here are some new insights I'd like to share and propose that all of you consider.

1. If you have bulimia, whether or not you have been diagnosed, and you honestly believe you are doing everything you possibly can to not vomit, and it's still coming, ask your physician if s/he might be amenable to checking your progesterone level. Correcting that (and natural ways to do so are written about elsewhere in this blog), may make it easier to stop vomiting.

When I worked in an eating disorder treatment center, I always felt for women I knew were doing their best to stay in recovery, who couldn't, who were considered by treatment teams as somehow being noncompliant or rebellious. I'm not saying you don't have a responsibility to work on challenging behaviors to the best of your ability, but I do think there may be an important physiological factor being overlooked that may be undermining the very best efforts of some of you.

2. The very first thing I thought of when I envisioned how these pieces fit together, was the poor woman who'd worked her tail off to get out of an eating disorder, finally became pregnant, and despite everything going seemingly well, having vomiting come back, with a vengeance. It might cross your mind to just silently live with it, thinking the first thing your treatment team is going to think is that you've relapsed. Which is why physicians may not be hearing about this.

Don't freak out…be proactive! Tell your physician, tell them your fears, and ask for help. Your problem may be low progesterone, and hyperemesis. And a susceptibility to low progesterone may actually have been the loaded gun that set you up as a candidate to get into bulimia in the first place.

If you have PCOS, with a history of an eating disorder, have become pregnant, and have found yourself all of a sudden vomiting or wanting to vomit again…we're here to help you find solutions. And we very much look forward to that.

LESSON THREE: inCYST needs to continue to challenge itself to think in a hugely interdisciplinary fashion. We are best at that when our readers are comfortable sharing their PCOS stories with us, trusting that we aspire to be inquisitive and scientific, not judgmental and shaming.

Pirke KM, Fichter MM, Chlond C, Schweiger U, Laessle RG, Schwingenschloegel M, Hoehl C. Disturbances of the menstrual cycle in bulimia nervosa. Clin Endocrinol (Oxf). 1987 Aug;27(2):245-51.

Pirke KM, Dogs M, Fichter MM, Tuschl RJ.Gonadotrophins, oestradiol and progesterone during the menstrual cycle in bulimia nervosa. Clin Endocrinol (Oxf). 1988 Sep;29(3):265-70.

Schweiger U, Pirke KM, Laessle RG, Fichter MM. Gonadotropin secretion in bulimia nervosa. J Clin Endocrinol Metab. 1992 May;74(5):1122-7.

Edler C, Lipson SF, Keel PK. Ovarian hormones and binge eating in bulimia nervosa. Psychol Med. 2007 Jan;37(1):131-41. Epub 2006 Oct 12.

Klump KL, Keel PK, Culbert KM, Edler C. Ovarian hormones and binge eating: exploring associations in community samples. Psychol Med. 2008 Dec;38(12):1749-57. Epub 2008 Feb 29.

Hello everyone,

I missed the live version of this interview but stayed up until midnight listening to it. I was going to just catch the first few minutes but Ellen and Sasha did such a wonderful job of talking about body image, eating disorders, and PCOS, I was hooked!

It's such a great, thorough, and compassionate look at a part of PCOS that is not easy to discuss. A lot of physicians who treat PCOS are more skilled at managing your lab values than your emotions…and it can be frustrating to feel that such an important part of your disorder is not being acknowledged.

I do not intend to criticize physicians with my comment. They are often under pressure to see their patients in a tightly scheduled day, and if they're good at managing your insulin level, they need to be respected for what they're best at.

One of the things PCOS Challenge AND inCYST are trying to do, is provide support that sometimes simply is not available in a medical office visit. A major goal at inCYST, as well, is to network with physicians and help them understand the importance of recognizing this very important aspect of PCOS, and knowing where to refer their patients if they can't or don't want to be the caregiver offering emotional support.

If you've been feeling like that support is what you need, then a good start might be to listen to this broadcast. I guarantee, at the very least, you will learn that you're not alone. www.pcoschallenge.com

Thanks, Sasha and Ellen, for taking the time to talk so compassionately about such a challenging topic!