The Hemp Connection:
drug

The last time I wrote about marijuana it brought enough traffic to this blog with the search words,"PCOS" and"marijuana" I figured the subject should be addressed in more detail.

Did you know that our bodies naturally make their own cannabinoids? They are compounds that are needed for a variety of processes, ranging from appetite to pain sensation to mood to memory.

Cannabis, an external cannabinoid, affects these functions as follows:

1. Interferes with both long and short term memory. If you're smoking pot and experiencing brain fog, there just might be a connection.

2. Increases appetite (like I had to tell you that!) When your internal (endo) cannabinoid system is out of balance, it too affects appetite. Leptin and endocannabinoids antagonize each other, and when the latter levels become higher, obesity is more likely. Just as cannabis intensifies cravings for sweets, so do high levels of endocannabinoids.

3. Affects fertility. In both directions. Cannabinoids can increase or decrease the probability of an embryo implanting in the uterus. My guess would be that if you're a person who is craving sweets and struggling with weight, you layer smoking pot on top of that…you're pushing that baby farther away from reality, rather than in the positive direction.

What is fascinating is that omega-3 fatty acids, the ones you see all the time mentioned in this blog, are crucial for good endocannabinoid function. If you're omega-3 deficienct, you're more likely to make it harder for your body to respond to its own naturally produced cannabinoids. So that craving for pot may have a valid foundation. The problem is, it's not the lack of cannabinoids that's causing the problem. It's that they are there, all dressed up, ready to help regulate memory, mood, appetite, and hormone function, but the body has lost the ability to understand what those chemicals are trying to tell them. Flooding your system with more of those chemicals holds potential to create an even worse imbalance, even worse cravings, a vicious cycle that it can feel impossible to break out of.

In addition, omega-3 fatty acids help to be sure that when it comes to maintaining muscle mass and reducing fat mass, the endocannabinoids push that relationship in the right direction.

Why not try improving how your body uses these chemicals and see if it helps reduce your need for the external stuff?

1. Work really, really hard on getting those omega-6 fatty acids out of the diet. They are likely to be found in baked goods, chips, all the stuff you tend to want to eat when you have the munchies. So it seems like a really important strategy is to not bring your munchie foods into the house. Fill your kitchen with fruits, vegetables, crackers made with olive oil, etc., to turn to while you're transitioning to a better hormone balance. Remember, the oils you want to stay away from begin with the letters"s" and"c"--safflower, sunflower, soybean, sesame, corn, cottonseed. Canola is ok.

2. Get as many omega-3 fatty acids as you can in your diet. If you supplement, start with a dose of 500 mg DHA per day. If, combined with #1, you don't see a change within 2 weeks, add 500 mg more DHA. I've seen some cases where titrating up like that, over time, the end dose was 1000 to 1500 mg per day. Hang in there. If you're diligent, it works.
Lafourcade M, Larrieu T, Mato S, Duffaud A, Sepers M, Matias I, De Smedt-Peyrusse V, Labrousse VF, Bretillon L, Matute C, Rodríguez-Puertas R, Layé S, Manzoni OJ. Nutritional omega-3 deficiency abolishes endocannabinoid-mediated neuronal functions. Nat Neurosci. 2011 Mar;14(3):345-50. Epub 2011 Jan 30.

Watkins BA, Hutchins H, Li Y, Seifert MF. The endocannabinoid signaling system: a marriage of PUFA and musculoskeletal health. J Nutr Biochem. 2010 Dec;21(12):1141-52. Epub 2010 Oct 8.

Kirkham TC, Tucci SA. Endocannabinoids in appetite control and the treatment of obesity". CNS Neurol Disord Drug Targets 5 (3): 272–92, 2006.

Ryusuke Y. Endocannabinoids selectively enhance sweet taste. PNAS 107 (2): 935–9, 2010.

Das SK, Paria BC, Chakraborty I, Dey SK. Cannabinoid ligand-receptor signaling in the mouse uterus. Proc. Natl. Acad. Sci. U.S.A. 92 (10): 4332–6, 1995.

Paria BC, Das SK, Dey SK. The preimplantation mouse embryo is a target for cannabinoid ligand-receptor signaling. Proc. Natl. Acad. Sci. U.S.A. 92 (21): 9460–4, 1995.

Last week I had the opportunity to hear James May, the founder of Wisdom Natural Brands, based here in Phoenix, tell his story of how he became involved with developing the stevia industry. Below is a white paper he shared with us that is referenced and provides a lot of very interesting information. This is a business paper, not a scientific publication, but it does contain references that can get you started if you're looking for more information.

It's not just a sweetener, apparently it has some endocrine and appetite effects as well (may decrease your appetite for sugar), and a new study suggests it may help to improve memory.

Also, I'm providing a link to a brand new website, Stevia University, which is a resource for all things stevia. Be sure to bookmark it!

Stevia Rebaudiana Bertoni Prepared by James A. May and provided as an educational service by Wisdom Natural Brands
Stevia has been correctly framed as the promised sweetener that can help resolve many of the world's sweetener, obesity, and diabetes concerns. Stevia can also solve much of the poverty of the farmers in third world countries by giving them a cash crop to grow, even improving the productivity of their soil and the quality of their other crops.
Stevia can be the next generation of the world's most preferred steetener. Consumers are becoming even more excited as they learn that stevia extract was not originally a chemical invention targeted for a totally different purpose, such as a drug or insecticide, which, after it was tasted, became an artificial sweetener (1).
Stevia, in its various forms has always been a natural sweetener that also offers numerous health benefits. In its natural forms it has been in use in parts of South America for more than 1500 years and, as a high intensity sweetener, in Japan and Asia for over 35 years. (2) Millions of people have ingested stevia daily and there has never been a documented adverse reaction reported (3).
Modern consumers have joyful anticipation for increased use of this sweetener that does not cause fat storage, does not adversely affect blood sugar or blood pressure, reduces caries and gum disease, does no harm, is good for the human body and — can taste great — depending on the extraction methods utilized.
The Joint Expert Committee on Food Additives (JECFA) of the World Health Organization has studied and approved 9 of the numerous naturally occurring glycosides residing in stevia leaves to be safe for human consumption in high intensity sweeteners. They are: stevioside, rebaudioside A, rebaudioside B, rebaudioside C, rebaudioside D, rebaudioside F, dulcoside A, rubusoside, and steviolbioside. Any combination of these glycosides totaling a minimum of 95%, the balance being other components of the stevia leaf, meets the standard set.
HECFA refers to steviol glycosides rather than stevia glycosides in determining acceptable daily intake (ADI) amounts of 4 mg per kilogram of body weight. This provides a 100-fold safety factor, meaning the human body can handle 100 times this amount and still be within the safety limits. However, steviol is one of three metabolites (i.e. the breakdown aglycones being steviol, isosteviol, and a unit of glucose) of the stevia glycosides, therefore, this related to 12 mg of the naturally occurring stevia glycosides per kilogram of body weight. Stevia glycosides are broken down into the three metabolites by bacterial action in the intestinal tract. It is well documented that steviol and the other metabolites are entirely excreted from the body.
In a presentation of the recent science regarding stevia at the 2009 annual meeting of the Calorie Control Council, Claire C. Kruger, PhD, DABT, CEO of Spherix Incorporated, a biopharmaceutical company, reported that"Stevia glycosides have very low toxicity in animals and there is no evidence of risk in humans, including repeat dose systemic toxicity, carcinogenicity, developmental, or reproductive effects. The weight of evidence indicates that steviol glycosides are not genotoxic." She also reported that"Stevia extracts and steviol glycosides show no DNA damage in a broad array of in vitro and in vivo assay," and that the"safety of ingestion of steviol glycosides in hmans has been corroborated in clinical trials; measures of tolerance, body weight, clinical chemistry, hematology and urinalyis did not show any evidence of untoward effects." She reported that critical newly published studies (5) resolve questions about any untoward effects after long term repeated exposure to steviol glycosides.
The Proceedings of the 3rd Stevia Sumposium 2009, held in Belgium reported recent scientific studies that found that,"Stevioside (i.e. the combination of Stevia glyucosides- lowered glucose, insulin and cholesterol. It had no effect on triglycerides or glucose tolerance," and that it"inhibited atherosclerosis by reducing macrophage, oxidized LDL and lipids. Furthermore, stevioside treatment increased the smooth muscle area of the plaque. This increase, together with the reduction of macrophages resulted in an increase of the smooth muscle cell-to-macrophage ratio". The scientists concluded by stating that"this is the first report showing an association between stevioside treatment and increased adiponectin and insulin sensitivity, improved antioxidant defense and reduced atherosclerosis. The decrease of oxidized LDL by stevioside is particularly important in view of our recent observation that LDL is associated with metabolic syndrome components." (6) No allergic reactions to stevia have been reported (7).
A patent application submitted to the US Patent Office, dated February 17, 2011, makes several significant claims, as a result of their scientific research, pertaining to stevia and brain function."Thus to summarize, stevia extract enabled improved learning and memory performance, to a similar, or better, extent as a natural reference substance, ginkgo biloba, and a pharmaceutical positive control compound, rolipram. These data showed that stevia-treated mice not only learned better than other groups but also retained their memory for a longer time period." When the product was given to human subjects they reported that,"Cognitive function, alertness and the ability to focus on work are seen to improve." The product they used was make by cooking leaves in water and is basically the same product sold by SweetLeaf (R), as stevia concentrate, since 1982.
SweetLeaf Stevia Sweetener is the only commercially available stevia extract that is made with a revolutionary new technology that uses only cool purified water and a series of filters. All other brands, currently in the market, utilize old technology that incorporates various chemicals, solvents and alcohols, including ethanol and methanol. Because stevia extracts can be between 200 and 300 times sweeter than sugar, they must be blended with other ingredients utilized as a carrier to make them palatable as a table-top sweetener. While all other brands use a sugar product, SweetLeaf(R) uses inulin, extracted from chicory root, which is a natural soluble fiber and prebiotic, thus creating a sweetener that improve health and vitality. SweetLeaf (R) wass the first stevia brand in the United States to acienve the FDA GRAS (Generally Recognied As Safe) designation.
REFERENCES
1. Aspartame was developed in 1965 by GD Searle, a pharmaceutical company, to be a prescription only drug for peptic ulcers. After it was tasted the company began the process to obtain FDA acceptance as a sweetener,which was achieved in 1981. According to Discover Magazine, 20 Things You Don't Know About Sugar, Sucralose (Splenda) was originally developed to be an insecticide (Oct. 2009, 121).
2. May, James A, The Miracle of Stevia, Kensington Publishing Corp. New York City, NY, 2003, 7, 32-42.
3. Geuns, Jan MC. Review: The Safety of Stevioside Used as a Sweetener, Proceeding of the first symposium: The Safety of Steviiside, KULeuven, 2004, 112.
4. http://www.steviauniversity.com/. Health and Healing Benefits of Stevia.
5. Ferri et all 2006; Jeppesen et al 2006; Barriocanal et al 2008; Maki et al 2008.
6. Gerraert, Benjamine et a, Natural Sweetener Stevioside Inhibits Atherosclerosis by Increasing the Antioxidant Defense in Obese, Insulin Resistant Mice, Atherosclerosis and Metabolism Unit, Deptarmtne of Cardiovascular diseases and Leuven Food Science and Nutrition Research Center Laboratory of Functional Biology, Katholieke University, Leuven, Belgium.
7. Geuns, op cit p. 85.

First of all…it's great to be back! I was traveling, and while it's kind of fun to say I saw both the Atlantic and Pacific oceans in the period of a week, I do like my base camp and I really missed reading research. I'm looking forward to getting back into my daily groove.

Last week, I read an article in the New York Times about insurance companies, and how they are starting to ask consumers to absorb the cost of medications by asking that these medications be paid for not by flat copayment, but proportionate to the cost of the medication.

Nice. First we're convinced that we absolutely need all these drugs, and that we can get them for cheap, then once we're dependent on them…we're thrown under the financial bus.

Right now, the medications that are being sold under this new proportionate plan are not any of the medications that I focus on with this blog. However…since several of the medications you readers are on, are some of the most popular medications out there, I suspect it won't be long before these insurance companies start to see dollar signs in terms of the quantity of people they can expect to help finance this venture. Categories of medications like antidepressants…and insulin sensitizers and statins, which are commonly prescribed when the antidepressants start to mess with hormone balance.

That's the bad news.

The GOOD news is, I finally felt vindicated for having sat through this scenario for the last 25 years, wishing people would see what I have always seen…that when you take responsibility for your own health, and don't depend on people who make money off of you to help you, you have a good chance of getting better results. Think about it. Why would a drug company spend millions and millions of dollars to develop a product that you eventually wouldn't need once you started using it?

My goal, ever since I started what I do, is to put myself out of business. I started learning to play golf last year and it has been very frustrating to have to put it aside to attend to the demands of my growing business. I have a children's story I'd like to publish. And there are a couple of screenplays roaming around in my head that I'd love to get into theaters.

But the drug and insurance industries don't have that goal. Their goal, as is the goal of most corporations, is to increase market share and return on investment. Which means you can (1) increase the dosages of medications you sell to already existing customers, (2) find new customers for your medications by either creating new diagnoses or finding off-label uses for your already developed products, and/or (3) increase the price you charge for the product. Hmmmmm…nowhere in there do I see"helping the patient feel better".

Of course, I'm not naive. I know some medications are entirely necessary and even life-saving. But I also see so many conditions that could drastically improve with a few judicious lifestyle choices.

Last week I listened to the husband of a friend tell me what it was like to go through an in-vitro fertilization (IVF) procedure with his wife. He was near tears as he spoke about the trauma, the callousness of the providers, the emotional stress…the expense, and the feeling of failure as a human being when the entire investment of time, emotions and money did not produce the desired result.

He drove me to the bus stop, and I headed to the airport. As I was standing in line to board my plane, a colleague phoned me. She'd gone through my professional training and had been using my protocol on women with infertility. And she told me, that with just a few nutritional tweaks, these women were getting pregnant! Not only that, their depression was responding with equal profundity. Even the women who'd failed with the same IVF procedure as my other friend and who had given up on ever having children, were seeing results.

There's something very wrong with a system that promotes a $20,000 emotional and financial (mis)adventure over a $12 bottle of Coscto fish oil…but we as consumers need to shift our expectations for help from those who stand to make money off of our misfortunes and invest in choices, behaviors, and financial purchases that are empowering and affirming. You'll never get a company making money off of you to change how they do things if it means less money. But we can certainly get their attention if, collectively, we start to say"no" to some of their answers to our problems and"yes" to options that make more sense.

You bet the power of where you pull out your wallet is tremendous. And when groups of thousands of wallets get together…well, that's the vision I have that will finally get these screenplays out of my head!

Eating well. Physical activity. Adequate sleep. Less stress. It's that simple. It's incredible what prioritizing these four areas can do to your overall health. Not to mention your budget.

http://www.nytimes.com/2008/04/15/opinion/15tues1.html?hp

In this segment on Wednesday, April 15, 2009 at 6pm EDT, Sasha Ottey speaks Dr. Andrea Dunaif, one of the world's most prominent PCOS researchers. She is Director of the Northwestern University NIH-Supported Specialized Center of Research (SCOR) on Sex and Gender Factors Affecting Women’s Health.

Dr. Dunaif’s research focuses on the mechanisms linking reproduction and metabolism. Her studies have led the way in redefining PCOS as a major metabolic disorder that is a leading risk factor for type 2 diabetes. She has translated her findings into novel therapies for PCOS with insulin sensitizing drugs. Most recently, her group has mapped the first major susceptibility gene for the disorder. This spells progress!

Dr. Dunaif will be able to tell us about the latest discoveries, developments, and medical breakthroughs in Polycystic Ovarian Syndrome research.

To listen to Dr. Dunaif, tune in on Wednesday, April 15, 2009 at 6pm EDT to learn more about PCOS the strides the medical community are taking to learn more about treating it.

To listen go to http://www.blogtalkradio.com/pcoschallenge. You can ask questions live via the chat room or call in with a live question during the show at (646) 929-0394. If you would like to send your questions in advance, please leave a comment here and it will be asked during the show.

If you are a registered dietitian, you listen to this program, and you would like to receive credit for your time, you may do so for a small fee. Please contact me at marika@google.com for more information.

Last week on the PCOS Challenge Radio Show, I was asked about the relationship between CoQ10 and fertility. I promised Sasha I would investigate the issue, since I did not have an informed answer on the tip of my tongue. Here is that answer!

My gold standard for information is peer-reviewed literature in the National Library of Medicine database. When I used the keywords,"CoQ10" and"PCOS", there were no studies listed. When I used the keywords,"CoQ10" and"fertility", 16 different references appeared, but none of those references were about fertility in women. Two studies did report an association between low CoQ10 levels and miscarriage.

When I used the keywords,"fertilization" and"CoQ10", abstracts from the list of studies done on men were all that appeared.

Bottom line: CoQ10 could be important for conception and maintaining pregnancy, but there have been very few studies on the topic, and none of them that I found had a recommended dose. It may be important with this particular supplement to consider the father's regimen as well.

What is CoQ10, anyway? CoQ10 is an antioxidant made by our own bodies. As the Mayo Clinic writes, CoQ10 levels are reported to decrease with age and to be low in patients with some chronic diseases such as heart conditions, muscular dystrophies, Parkinson's disease, cancer, diabetes, and HIV/AIDS. Since PCOS is a pre-diabetic, inflammatory condition, it makes sense that there would be interest in its role in this diagnosis as well. The link I provided above also evaluates the strength of the evidence supporting the use of CoQ10 for a variety of medical conditions.

For adults, Mayo also reports a dose 50-1,200 milligrams of CoQ10, in divided doses, by mouth, to be what was commonly reported.

Even though CoQ10 may help prevent miscarriage, it has also been known to reduce blood glucose levels. This can be a plus…but when another life is being taken into consideration, and the detailed effects of exactly how blood glucose responds to CoQ10 in supplemental amounts, given the fact that the use of CoQ10 has not really been studied during pregnancy, my first inclination is to not recommend it for women with PCOS who are trying to conceive and who may be pregnant without knowing it.

CoQ10 levels have been found to be lower in people using certain medications, such as statins (which lower cholesterol), beta-blockers (which stabilize heart rate), and blood pressure medications. If you are not trying to conceive and you are on medications in any of these categories, it wouldn't hurt to ask your pharmacist and physician about the potential benefits of supplementation.

CoQ10 is an antioxidant. It makes sense to me that in an inflammatory condition such as PCOS, there would be a risk of lower levels. But rather than view this as a situation where you have PCOS because you have low levels of CoQ10, I encourage you to consider whether your CoQ10 levels are lower than they should be, because of choices you are making that promote inflammatory processes. This blog is full of information about ways to slow down inflammation (which, in essence, is accelerated aging). There are many things you can do which can head off the need for even needing a supplement.

And you thought this potentially magical compound was going to replace the need for healthy eating, activity, stress management, and sleep hygiene choices. Cyster friends, if that was true, you wouldn't have spent all that money on all that CoQ10 and still be here looking for another answer. Dang!

Mancini A, Leone E, Festa R, Grande G, Silvestrini A, de Marinis L, Pontecorvi A, Maira G, Littarru GP, Meucci E. Effects of testosterone on antioxidant systems in male secondary hypogonadism. J Androl. 2008 Nov-Dec;29(6):622-9. Epub 2008 Jul 17.

Littarru GP, Tiano L. Bioenergetic and antioxidant properties of coenzyme Q10: recent developments. Mol Biotechnol. 2007 Sep;37(1):31-7. Review.

Li W, Li K, Huang YF. [Biological function of CoQ10 and its effect on the quality of spermatozoa]. Zhonghua Nan Ke Xue. 2006 Dec;12(12):1119-22. Review. Chinese.

Mancini A, De Marinis L, Littarru GP, Balercia G. An update of Coenzyme Q10 implications in male infertility: biochemical and therapeutic aspects. Biofactors. 2005;25(1-4):165-74. Review.

Li K, Shi Y, Chen S, Li W, Shang X, Huang Y. Determination of coenzyme Q10 in human seminal plasma by high-performance liquid chromatography and its clinical application. Biomed Chromatogr. 2006 Oct;20(10):1082-6.

Sheweita SA, Tilmisany AM, Al-Sawaf H. Mechanisms of male infertility: role of antioxidants. Curr Drug Metab. 2005 Oct;6(5):495-501. Review.

Balercia G, Mosca F, Mantero F, Boscaro M, Mancini A, Ricciardo-Lamonica G, Littarru G. Coenzyme Q(10) supplementation in infertile men with idiopathic asthenozoospermia: an open, uncontrolled pilot study. Fertil Steril. 2004 Jan;81(1):93-8.

Mancini A, Milardi D, Conte G, Bianchi A, Balercia G, De Marinis L, Littarru GP. Coenzyme Q10: another biochemical alteration linked to infertility in varicocele patients? Metabolism. 2003 Apr;52(4):402-6.

Balercia G, Arnaldi G, Fazioli F, Serresi M, Alleva R, Mancini A, Mosca F, Lamonica GR, Mantero F, Littarru GP. Coenzyme Q10 levels in idiopathic and varicocele-associated asthenozoospermia. Andrologia. 2002 Apr;34(2):107-11.

Ducci M, Gazzano A, Tedeschi D, Sighieri C, Martelli F. Coenzyme Q10 levels in pigeon (Columba livia) spermatozoa. Asian J Androl. 2002 Mar;4(1):73-6.

Palmeira CM, Santos DL, Seiça R, Moreno AJ, Santos MS. Enhanced mitochondrial testicular antioxidant capacity in Goto-Kakizaki diabetic rats: role of coenzyme Q.
Am J Physiol Cell Physiol. 2001 Sep;281(3):C1023-8.

Sinclair S. Male infertility: nutritional and environmental considerations. Altern Med Rev. 2000 Feb;5(1):28-38. Review.

Alleva R, Scararmucci A, Mantero F, Bompadre S, Leoni L, Littarru GP. The protective role of ubiquinol-10 against formation of lipid hydroperoxides in human seminal fluid. Mol Aspects Med. 1997;18 Suppl:S221-8.

Lewin A, Lavon H. The effect of coenzyme Q10 on sperm motility and function. Mol Aspects Med. 1997;18 Suppl:S213-9.

Angelitti AG, Colacicco L, Callà C, Arizzi M, Lippa S. Coenzyme Q: potentially useful index of bioenergetic and oxidative status of spermatozoa. Clin Chem. 1995 Feb;41(2):217-9.

Mancini A, Conte B, De Marinis L, Hallgass ME, Pozza D, Oradei A, Littarru GP. Coenzyme Q10 levels in human seminal fluid: diagnostic and clinical implications. Mol Aspects Med. 1994;15 Suppl:s249-55.

Noia G, Littarru GP, De Santis M, Oradei A, Mactromarino C, Trivellini C, Caruso A. Coenzyme Q10 in pregnancy. Fetal Diagn Ther. 1996 Jul-Aug;11(4):264-70.

Noia G, Romano D, De Santis M, Cavaliere AF, Straface G, Alcaino S, Di Domenico M, Petrone A, Caruso A, Mancuso S. [The antioxidants (coenzyme Q10) in materno-fetal physiopathology][Article in Italian] Minerva Ginecol. 1999 Oct;51(10):385-91.

In a study I did with over 1,000 women with PCOS who visited my website, over 85% described symptoms of anxiety and/or depression, conditions commonly treated with antidepressants. Therefore, any information I find regarding these medications and their effect on pregnancy is crucial to share.

In the study referenced in this post, over a period of almost 10 years, a total of 1,780 women who experienced 1,835 pregnancies over this time while also receiving either paroxetine (Paxil) or a combination of Paxil and at least one other antidepressants, during the first trimester of pregnancy. These women were compared to 9,008 women experiencing 9,134 pregnancies while on other antidepressants and antidepressant combinations that did not include paroxetine, in the first trimester of pregnancy, over the same period of time. The researchers report that there is a modest increased risk of congenital malformation (birth defects) in women who use paroxetine alone or in combination therapy during the first trimester of pregnancy.

Bottom line? Since often times you don't even know you're pregnant during that first trimester, if you are trying to conceive, or even having sex, and you are being treated for depression, it would be prudent to discuss an alternative to paroxetine with your caregiver.

Better safe than sorry!

Cole JA, Ephross SA, Cosmatos IS, Walker AM. Paroxetine in the first trimester and the prevalence of congenital malformations. Pharmacoepidemiol Drug Saf. 2007 Oct;16(10):1075-85. Comment in: Pharmacoepidemiol Drug Saf. 2007 Nov;16(11):1181-3.

It keeps happening. I keep getting inquiries that are pretty clearly indicative of how little attention is focused on a huge issue, PCOS, and how much ground inCYST has gained in the progress of trying to change that.

--Several months ago, a noted researcher with an interest in PCOS wrote and told me he was interested in being considered to join my"board". I had to tell him I didn't have one!

--A reporter recently asked me for a photo of our"institute". I had to tell her that right now we're just virtual.

--Twice in the last week, I've been asked where someone might donate money to support PCOS research.

The second inquiry, yesterday, was my inspirational moment. It came through one of our network members, who had inspired one of her support group members enough to start exercising. This woman decided she wanted to run her first 5K race to celebrate her commitment to wellness. And she wanted to use her race running as a means to raise money to donate to PCOS research.

Only everywhere she turned and tried to give money…she was turned away. Someone actually told her the cause wasn't"sexy enough" to be worth raising money for.

I was appalled. I've spent years at this point listening to women with PCOS share their stories, their frustration, their heartache, their desire to just know what they need to do. I've seen, time after time, the benefits of simple lifestyle changes. And I've also personally witnessed the battle these women have to fight to be taken seriously. They deserve better than to be told their illness is not sexy enough for researchers to care about.

My emotional response was probably fueled by the story WVEC reporter Lucy Bustamante recently put together, in which a physician treating PCOS admitted that women don't often get the right diagnosis because the tests it would take to do so"are just too expensive."

Over the summer, someone in the reproductive medicine department of Bristol Myers Squibb spent about 7 hours of time reading 378 pages of inCYST content. I remembered that during my conversation yesterday, and thought two things.
--Apparently these women are sexy enough to keep making medications for and taking their money for.
Even though these women are too expensive to thoughtfully treat, given the fact that they comprise 10%
of the female population, they are a great revenue source to target in research projects.
--If we got that much attention from the people doing the"real" research, it seems to me that on our own
inCYST has what it takes to be a rockin' research institute.: )

I decided, the moment I heard the words"not sexy enough", that it was time to stop turning all these inquiries away and start pulling together all of those resources to do something different.

So, thanks to the small but profound and genuine gesture of the exact kind of person inCYST was created for, a woman who simply wants answers, I'm going to start the procedure for pulling together a not-for-profit arm of inCYST, devoted to research. Only our research will be different in nature. We want to encourage the kind of research that has a hard time getting funded, because it does not involve drug research. We want to balance the message that is out there and add credibility to the message we want you all to hear. And we want to be sure the supplements you all spend money on…are actually worth spending money on.

I have a lot of work to do, but I'm willing to do it if you're willing to help make it happen. My first step is the paperwork, and because that involves an attorney's work, it will cost money. I do not have an avenue for collecting donations right now, but I am posting this announcement so that anyone who might be interested in making a donation in the future might be able to write me and let me know where to find them when we're ready to take the plunge. It's not really all that much to get started, about $1000, so I think it's entirely doable.

If you are interested, please send me an email at marika@google.com.

Remember, it was a small gesture that prompted me to act. A lot of small gestures, pooled together, can make a huge difference.

Let's get this research party started!

I was just posting on my other blog (www.thisisyourbrainonpsychdrugs.blogspot.com) about the association between epilepsy medications and folate deficiency. It reminded me that folate is important for women trying to conceive. And you can get it in places other than supplements…like food!

Dark green vegetables can be hard to get into your diet if you're busy, but they're important to prioritize. I think spinach gets a bad rap because many of us remember it plopped in a cold blob on our school lunch trays waaaay back when. But it's really not that bad!

An easy way to add spinach to your diet, if you're already eating salad, is to remember to pick up a bag of spinach leaves along with your regular lettuce, and mix them together when you're tossing a salad. Spinach is an easy thing to add to some of your simple favorites--like a quesadilla. When I lived in Chicago spinach pizza was all the rage. Why not put a few leaves on your favorite sandwich? Or add it to your next omelet?

If you want to cook spinach the old fashioned way, dress it up with pine nuts and raisins.

It's not so much that spinach isn't a good food, it's more about getting in the habit of keeping it around and making it a habit of including it in some of your old favorites.

Source: amazon.com via Jason on Pinterest

One of the most frequently asked questions we get at inCYST, is whether or not a specific food raises blood glucose. It is understandable, given the fact that women with PCOS are insulin resistant and highly likely to develop diabetes, that this would be a concern.

And in response to that concern, it is understandable that nutrition and wellness experts often quote a list of foods to avoid in order to maintain a low-glycemic diet.

Did you know, this"low glycemic" list is highly variable? That even though there are trends, certain foods may affect one person more than another? and that a food that has a tendency to be"high glycemic" on its own…may be perfectly fine when eaten with a mixed meal?

Those high glycemic lists floating around the Internet tend to report the response of your body to a food when it is eaten by itself. So all of those people telling you not to eat carrots or bananas are not telling you the entire story. We rarely eat that way. If you dip carrots in hummus, or eat a banana in a smoothie with Greek yogurt, for example, your body will respond completely differently to that nutrient mix than it would eating either of those foods by themselves.

So when you ask us if a food raises blood sugar and whether or not you should eat it, unless someone has measured YOUR blood sugar two hours after you have eaten it, any advice they give you is pure surmising and not based on relevant factual information.

You can do these tests yourself, you know. All you have to do, is buy a glucose meter at your nearest drug store and test your blood sugar a couple of hours after eating a meal. And before you conclude whether or not a food doesn't work for you, you need to try it alone, in a mixed meal, and at different times of day in order to determine how your body interacts with it.

My point here is, a nutrition, fitness, or wellness expert who is merely parroting information he or she has read on another website and is not customizing that advice to YOU is doing you a disservice. You may be cutting out perfectly healthy foods that you could eat in the right situation. You may be dealing with a food sensitivity that is not going to respond to a low glycemic diet.

Why waste time on information anyone can Google when you can tailor information to your own personal situation?

We love to do this kind of detective work at inCYST, and our network members have taken a lot of time to learn how to interpret that kind of data and make specific recommendations based on how YOUR body works.

Listen to someone who doesn't know you and who may be misguiding you, for free…or get evidence-based, customized information with personal relevance. It may cost you in the short term but save you a lot of trouble in the end.

This just seems to be something that should be common knowledge, especially with this audience. I was pretty surprised to happen on it myself. Aspirin and ibuprofen may promote insulin resistance and sleep problems.

Way back in 1981, researchers reported that aspirin and ibuprofen, in doses commonly considered to be therapeutic for humans, experienced an increased level of insulin secretion. More insulin tended to be secreted at lower levels of blood glucose, and higher levels of insulin were secreted at high blood glucose levels. This is hyperinsulinemia, the first step in the chain reaction of problems including insulin resistance and diabetes.

And it may also interfere with sleep! Researchers at Bowling Green State University found that non-steroidal anti-inflammatory medications (which includes these two over the counter medications)awakenings and percentage of time spent awake during the night. Ibuprofen also delayed the onset of deeper stages of sleep. Acetominophen, also known as Tylenol, did not affect sleep in these ways.

Researchers propose that the reasons for these effects may include the interference that these medications have on prostaglandin production, suppression of nighttime melatonin levels, and changes in body temperature.

We learned awhile back that women with PCOS also have trouble with arthritis, which means they are likely to be taking over-the-counter NSAIDS, thinking they're harmless. And, if they've got cardiac complications, they may have been advised to take baby aspirin prophylactically. That may not be the best strategy.

Fortunately, the fish oil I'm often teased about being such a fan of…is an excellent weapon against arthritis as well.

I'm ok with being teased about my obsession, if it means it helps our blog readers. The last laugh is the best one to have.: )

Metz SA, Robertson RP, Fujimoto WY. Inhibition of prostaglandin E synthesis augments glucose-induced insulin secretion in cultured pancreas. Diabetes. 1981 Jul;30(7):551-7.

Murphy PJ, Badia P, Myers BL, Boecker MR, Wright KP Jr. Nonsteroidal anti-inflammatory drugs affect normal sleep patterns in humans. Physiol Behav. 1994; 55(6):1063-6.

Here's an interesting Cochrane Review hot off the presses, evaluating the effects of insulin-sensitizing agents on fertility.

A group of 31 studies that compared the effectiveness of these agents to a placebo were evaluated for what they said overall about the potential benefit for their use in women with PCOS who are trying to conceive. Of these, 27 were studies about metformin (likely because it is the most widely researched/used and more studies exist in the first place).

What the researchers concluded:

There is no evidence that metformin improves live birth rates whether it is used alone or in combination with clomiphene. However, metformin does improve ovulation and pregnancy rates. (Interpreted, this suggests that metformin does not help to prevent miscarriage.)

Metformin was also associated with a significantly higher incidence of gastrointestinal disturbance, but no serious adverse effects were reported. (I don't know about those of you reading this blog post who have tried metformin, but I would question the assertion that the gastrointestinal disturbance this medication causes is not a"serious adverse effect"!

IN THE WORDS OF THE AUTHORS:"In agreement with the previous review, metformin is still of benefit in improving clinical pregnancy and ovulation rates. However, there is no evidence that metformin improves live birth rates whether it is used alone or in combination with clomiphene, or when compared with clomiphene. Therefore, the use of metformin in improving reproductive outcomes in women with PCOS appears to be limited."

D-chiro-inositol was not even mentioned in the abstract, suggesting that the findings were not significant.

As with any information shared in this blog, only you and your provider can make the ultimate decision. I can tell you what went through my own mind--and heart--as I read this, was that this medication may create a lot of false hope and hurt for those who trust that it has more power than it actually does. I wouldn't wish a miscarriage on anyone.

Tang T, Lord JM, Norman RJ, Yasmin E, Balen AH. Insulin-sensitising drugs (metformin, rosiglitazone, pioglitazone, D-chiro-inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD003053.

In addition to PCOS, I specialize in the nutritional aspects of medications affecting the brain and nervous system. That includes psych meds, Parkinson's meds…pretty much any medication that has the potential to affect how the brain and nervous system function.

A few years ago, while compiling a series of fact sheets about the nutritional implications of these medications, I started reading about the anti-obesity medication called Meridia (generic name sibutramine). This drug appeared on the market after the famous phen-fen combination was deemed dangerous. It was supposed to be a kindler, gentler alternative. And it supposedly can reduce the severity of symptoms associated with PCOS.

I was floored by what was showing up, unedited, in the peer-reviewed literature about this medication. But not at all surprised with the announcement yesterday that this drug is potentially dangerous for people with heart conditions.

Repeatedly and consistently, researchers were reporting reactions. Some of the most common problems this medication seemed to incite, were anxiety, hypertension, and elevated heart rate.

If Meridia was a drug intended to treat cancer, or glaucoma, or hangnail, and it caused this battery of symptoms, I don't think the FDA would have tolerated consistent reports that it had the ability to send the cardiovascular system into a tailspin.

Yet, in the obese research subject, in the face of these observations, researchers continued to report some of the following conclusions:

**In a 21 patient study, 40% experienced sleep disturbances and 30% complained of irritability, unusual impatience, or"excitation".
RESEARCH CONCLUSION: Sibutramine, 5 and 20 mg, added to a multimodal program assisted participants in losing weight.
Weintraub M, Rubio A, Golik A, Byrne L, Scheinbaum ML. Sibutramine in weight control: a dose-ranging, efficacy study. Clin Pharmacol Ther. 1991 Sep;50(3):330-7.

**In a review study, the author reported,"In controlled studies, 84% of sibutramine-treated patients reported adverse events, compared with 71% of patients receiving placebo. The most frequently reported adverse events are related to pharmacological actions of sibutramine, and include dry mouth, decreased appetite, constipation and insomnia. Despite the high incidence of"side effects" in the control population, the author of this article attributed the problems in the tested population to"pharmacological actions of sibutramine".
Lean ME. Sibutramine--a review of clinical efficacy. Int J Obes Relat Metab Disord. 1997 Mar;21 Suppl 1:S30-6; discussion 37-9.

**In a study of 226 people comparing sibutramine to dexfenfluramine, researchers reported,"174 patients (77%) experienced adverse events; 17 patients withdrew due to adverse events. Pulse rate increased significantly in sibutramine-treated patients." Then they concluded,"Sibutramine (10 mg once daily) is at least as effective as dexfenfluramine (15 mg twice daily) in achieving weight loss in patients with obesity."
Hanotin C, Thomas F, Jones SP, Leutenegger E, Drouin P. A comparison of sibutramine and dexfenfluramine in the treatment of obesity. Obes Res. 1998 Jul;6(4):285-91.

**In a study of 235 people, the following was reported,"a significant increase in heart rate (about 4 beats/min) was noted for patients who received 10 mg or 15 mg sibutramine, compared with the placebo." Then it was concluded,"Doses of 10 mg and 15 mg once daily were shown to be similarly effective, well tolerated and significantly more effective than the placebo."
Hanotin C, Thomas F, Jones SP, Leutenegger E, Drouin P. Efficacy and tolerability of sibutramine in obese patients: a dose-ranging study. Int J Obes Relat Metab Disord. 1998 Jan;22(1):32-8.

**In a study of 11 men, it was observed that"the sibutramine-induced increase in energy expenditure was accompanied by an increase in plasma epinephrine, heart rate, blood pressure, and plasma glucose. The conclusion:"Sibutramine caused a significant increase in both energy expenditure and satiety, which may both contribute to its weight-reducing properties.
Hansen DL, Toubro S, Stock MJ, Macdonald IA, Astrup A. Thermogenic effects of sibutramine in humans. Am J Clin Nutr. 1998 Dec;68(6):1180-6.

As of 2006, I had found 14 studies reporting an elevated heart rate with use. You can easily find them yourself in http://www.ncbi.nlm.nih.gov/pubmed/; I encourage you to see for yourself. I've supported myself here with enough references and my Saturday has other obligations prohibiting me from using it to repeat work I've already done. I hope I've encouraged you to see for yourself what I've been talking about with colleagues for several years.

I like to call this the Biggest Loser Mentality. It doesn't matter if we make these people vomit, pull a muscle, or give them a bloody heart attack. This market of obese people is just too lucrative to ignore.

If you have PCOS and you are obese, you deserve better. You're not where you are because you have a deficiency of ANY kind of medication in your body. Don't let anyone convince you otherwise.

Source: Uploaded by user via Monika on Pinterest

Last week I was at the farmer's market, admiring a beautiful box of greens. I noticed a woman looking longingly at the same box. So I asked her if she liked kale.

"Oh, I do!" she answered."But I had to give it up when my husband went on Coumadin."

Coumadin is a blood-thinning agent that is being prescribed more frequently than it used to be, as blood that clots too easily is one consequence of inflammation. Since leafy greens are high in vitamin K, a nutrient that promotes blood clotting, patients prescribed Coumadin are advised to limit their intake to a level they can consistently commit to eating. That commitment factor intimidates many people out of eating them at all.

What is ironic about the Coumadin dilemma, is that leafy greens are packed with omega-3 fatty acids and antioxidants, both of which hold potential to fight the very inflammatory process that is likely creating the need for Coumadin in the first place.

So how does one back themselves out of this corner once their previous lifestyle has backed them into it?

Here are a few things to try. Note, Coumadin is NOT a drug to mess with, so if you choose to make these suggested changes, it is essential that you communicate with the physician in charge of managing your blood clotting issues. If your condition is improving, medications will have to be adjusted to maintain clotting balance. It is best to make these shifts one at a time and wait 6 to 8 weeks to see how your body responds, rather than make too many changes at once, which can make it challenging for your physician to keep up with what is happening.

1. Shift your fat consumption, as much as possible, away from omega-6 fatty acid-dominant fats. They are easy to remember, they primarily begin with the letters"s" and"c"--soybean, safflower, sunflower, sesame, corn, and cottonseed. (Canola is the exception to this rule). They are primarily found in processed foods and in restaurant cooking, places where the price, not the quality, of the oil, is determining recipe makeup.

Check in with your physician to see how you are doing.

2. Add more vegetarian, non-leafy omega-3 foods into your diet. Flax is one of my favorites. You can add ground flaxseed into your smoothies, oatmeal, homemade vinaigrettes…and you may want to try a relatively new product on the market, flax milk, as a substitute for coffee creamer. If you are adventurous, try some chia seeds on your salad!

Check in with your physician to see how you are doing.

3. Try a protein-containing snack at night. It can help to stabilize blood sugar and cravings for sweets throughout the day, which keep you from being tempted by baked goods containing those oils.

Check in with your physician to see how you are doing.

4. Work on getting your seafood omega-3's. Note: ALL seafood, not just salmon, contain omega-3 fatty acids. If salmon is too fishy for your taste, spend some time at a knowledgeable seller such as Santa Monica Seafood, and try some of the recommendations they have. One of my favorites, which is available at Santa Monica Seafood, as well as Safeway, is barramundi, a sustainably farmed, mild-flavored whitefish that has a lot of versatility with regards to cooking technique.

Check in with your physician to see how you are doing.

5. If you are not a fish eater, consider a fish oil supplement. Despite what the supplement companies tell you, fish is fish; I've seen great changes in clients using Costco's Kirkland brand. The most important thing about using fish oil when you are taking Coumadin, is that you take it consistently. If remembering it is a challenge, program your smart phone to send you a daily reminder.

Check in with your physician to see how you are doing. If your clotting times have improved enough to get the greens-eating go ahead, good for you!

Later this week I will share some ideas for getting greens in your diet consistently without burning out on them.

I just received word from Lori Corbin that the story we shot several months ago about PCOS will be airing this afternoon on Los Angeles' ABC-7. We are so grateful to Lori for giving us time to tell a few stories…Amber's specifically, and the story of PCOS in general.

Most importantly, we are grateful to Amber for putting herself out there on behalf of women everywhere. It took a lot of moxie!

If this is the first time you have ever heard of us, and you were moved enough after Lori's story to come here for a visit, welcome! I hope that the inCYST concept we have been building over the last 15 years has something of value for YOU.

We started out as a small network of health professionals who wanted to be as educated about PCOS as possible, so we could better serve them. Along the way, we have learned a lot:

--There are an awful lot of women suffering silently with PCOS. They often feel very alone…when in fact, 1 in 5 of you on the planet have it!

--There is a lot of bad information out there, and a lot of people waiting to capitalize on your distress.

--Your problems are not always taken seriously.

--The stress of being given this diagnosis is extreme, often to the point of being paralyzing.

--Many of the most effective treatments for this diagnosis do not even appear in research journals because they are natural, not able to be patented, and therefore not likely to be funded by drug companies.

--We do feel a sense of urgency about inspiring all of you. We know we're working against a lot of depression and fear of change, but we also know the many extremely serious consequences of not taking action. So while we are very passionate about our women, we try to present a combination of posts and information that balances between making you feel safe with us, and information that gets your attention enough that your old comfort zone no longer feels so comfortable. We want to keep you around for a long time!

We have seen some great results with our small network, and last year decided to start a research institute to raise money to be sure some of the most important treatments get researched and published. As well as to test some of our own findings to see if they hold up to scientific scrutiny.

We would love to help you personally! Our list of network members is on the right, and many of us Skype if you do not see your location listed. We have a Facebook page, a Twitter account, a radio show, and a monthly newsletter. Please take advantage of all of them!

We could also really use your support of our research foundation! We are brand new, and still getting our name out there. Donations of time, talents, money, no matter what size, are deeply appreciated.

Our sister organization, Power Up for PCOS, has also been very busy organizing local Power Up groups for women who are ready to be proactive about PCOS. Their organizer, Beth Wolf, regularly reminds her group that women with PCOS who are managing that diagnosis with diet, exercise, and stress management, are actually healthier than women without the syndrome. So we like to think that a diagnosis is not a death sentence, but a wakeup call, inviting you to give yourself permission to treat yourself in the way that you deserve.

Power Up has some fun fundraisers, including an annual walk-a-thon, and an online store with items created by women with PCOS. We hope you find something that interests you enough to get involved!

Most importantly, we're glad you found us! Thanks for stopping by!

Please contact me directly if you have any questions. I divide my time between Los Angeles and Phoenix, and also make time for conversations with women around the globe.

Monika M. Woolsey, MS, RD
CEO and Founder
InCYST Institute for Hormone Health
623.486.0737
marika@google.com

Ringing in the New Year with visions, dreams and intentions is part of our contemporary culture. The ball drops in New York; the sun rises wherever you are, and we all seem to sense change is in the air. January 1 marks the time when many people decide to make a change and transform some aspect of their lives in ways they believe will make their lives better. Often resolutions are related to health and well-being. Here’s a new resolution: recognize health insurance is not heathcare; and vow to seek healthcare, not a payment system.
For the approximately 45% of Americans with health insurance through their employers, January 1 is also the start of the year for most health insurance policy annual contracts. The same holds true for the approximately 11% of Americans have some other type of insurance, and the 25% with a government plan. Whatever the type of insurance, it’s likely the insurance company changed the rules as of 12:01 January 1. And their changes may have a substantial impact on the care of your health, impacting what you envision as a means to have a better life in 2012.
The insurance company didn’t consult you on the policy changes. They didn’t ask you want you need or want to feel and be healthy. In the paradigm of the 80% of insured Americans, insurance companies are in the driver’s seat to decide what healthcare is and who can provide it. It could mean different types of treatments are covered or not covered; different types of allowable “doctors” are considered acceptable or not acceptable; and of course it all revolves around a method to parse the dollars between providers, patients and insurance companies – the power triad of today’s “healthcare system.”
Making money in the healthcare system: insurance & pharmaceutical companies

Insurance is a contractual payment system. It’s a method to pay to certain people what the company determines is allowable care, under the terms of the policy. The payment system has very little to do with actual care that relieves suffering and improves well-being. When you let a payment system determine what care or well-being is, that substantially limits your options to make your life better in any way that resembles your personal concept of well-being.

Stephan A. Schwartz, a regular contributor to Explore: The Journal of Science and Healing has coined our current healthcare system as the “illness profit system.” And there seems to be plenty of profit to go around. Insurance companies, by their very nature of being corporations, have as their number one job to return shareholder value – to make money. CEO’s get paid a lot of money to do this. The heads of health insurance companies, healthcare consulting firms and other health related companies are among the highest paid executives in any industry. According to the LA Times, McKesson CEO John Hammergren received $145.3 million in compensation in 2010. Fierce HealthCare reports Omnicare CEO John Figueroa was compensated 98 million last year; and Aetna’s Ronald Williams took home $57.8 million before retiring in April 2010.

Pharmaceutical companies are also big winners in the power triad. In 2009-2010, seven of the big pharmaceutical companies paid 17,700 presenters a total of $281.9 million to promote their products. These presentations to physicians were instrumental in a"combined prescription drug sales amounting to 36 percent of the $300 billion U.S. market in 2009." Only 10% of what big pharma makes is spent on research to cure diseases and save lives.

The losers in this system: patients and physicians

According to Bloomberg.com, “Forty-nine million Americans reported spending 10 percent or more of their income on insurance premiums and out-of-pocket costs last year, according to the Commonwealth Fund study.” Patients spend more and more. As of 2008, 38% of adults used some sort of “complementary alternative medicine” (CAM). Anything labeled CAM is generally not covered by insurance, with rare exceptions of some limited use of acupuncture or chiropractic. Not only do people spend money on insurance premiums, they’re paying providers directly for health care that actually works for them. No wonder we have the most expensive health care system in the world.

Many M.D.s are also struggling with this current power triad. Holistic physicians who want to spend more than 7 – 10 minutes with their patients, and want to provide CAM care that works are seeking ways walk away from the insurance model, and serve patients in ways that help patients fundamentally heal. While they’re reluctant to talk about it, a recent CNN article discusses the economic challenges for M.D.s trying to operate in this system, and how many of them are going broke. http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?hpt=hp_t3&hpt=hp_c1

Your resolution for the care of your health

The month of January didn’t even exist until about 700 B.C. when the Romans adjusted the calendar and move the “new year” from March to the new January. Julius Caesar introduced the Roman calendar, a solar-based system, in 46 B.C., and decreed the new year would be January 1. During the middle ages the new year was celebrated on various days in December, January and March. Even today, cultures around the world celebrate the new year on dozens of different days.

So, while January 1 has passed, any day can be the start of a new year. What will you resolve about the care of your health? There is an opportunity for transformation just as significant, if not more significant, than the common “eat right and exercise” resolution. At the core of your being, what’s your vision for the well-being of yourself, your family, or even the planet? Bring your vision, your resolution, to fruition by really knowing what you mean by “health” and “care” and spend your money accordingly. Resolve to not confuse health insurance with healthcare. Those two terms mean vastly different things.

About the author:

Deb Andelt is co-owner of Experience In Motion, which equips organizations with tools to curate meaningful experiences for customers and employees. Deb’s personal journey from decay to wellbeing inspired an emphasis in improving healthcare experiences for patients and practitioners by focusing on experiences that heal and self-caring as a way of organizational being. www.experienceinmotion.net.

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:

• Environmental stressors (e.g., work, school, relationships)

• 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.

One of the main reasons women with PCOS are encouraged to take metformin is because it is widely believed that it can help to improve fertility and reduce the incidence of miscarriage.

A 2009 study challenges this belief. It comes from the Cochrane Collaboration, a not-for-profit organization that evaluates groupings of research independent of for-profit (read"drug company") funding. I like their studies because their sample sizes are large and their findings are evidence-based. It takes them a long time to adopt new ideas, but it is because they so heavily scrutinize the available information rather than jumping on any bandwagons.

In this study, authors searched several comprehensive medical databases for studies evaluating metformin used during in-vitro fertilization (IVF) or intra-cytoplasmic sperm injection (ICSI). They specifically looked at randomized, controlled trials containing a"no treatment" or placebo group to compare to a group receiving metformin. They evaluated several types of outcomes that metformin may have an opportunity to influence: live birth rate, pregnancy rate, miscarriage rate, incidence of ovarian hyperstimulation syndrome, patient-reported side effects, and several hormone levels (estradiol, androgen, fasting insulin and glucose).

This exhaustive review, under rigorous statistical analysis…

"found no evidence that metformin treatment before or during assisted reproductive technique (ART) cycles improved live birth or clinical pregnancy rates."

The one benefit of metformin appeared to be a reduced risk of OHSS in women with PCOS and undergoing IVF or ICSI cycles.

I'm not a physician and therefore, I am not able to prescribe metformin. And I am ABSOLUTELY NOT ENCOURAGING ANYONE READING THIS TO DISCONTINUE USING MEDICATION THAT THEY HAVE BEEN PRESCRIBED. I do, however, see a tendency to hand this medication out without evaluating whether or not it is appropriate. It's important to discuss such issues with your physician and to be sure they are aware of the research supporting (or not supporting) their recommendation.

Here is the reference for anyone who wishes to share it with their personal provider.

Tso LO, Costello MF, Albuquerque LE, Andriolo RB, Freitas V. Metformin treatment before and during IVF or ICSI in women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2009 Apr 15;(2):CD006105.

I've gotten a couple of questions about fish oil lately that are very common. Thought I'd put them up in a blog post so that anyone who has these questions now has the answers now, and this post is available for future times when the questions are also asked.

1. Isn't fish oil full of mercury and therefore something to avoid?

Actually, fish oil is very heavily processed to removed the mercury. The technique used by most companies is called molecular distillation. Organizations like Consumer Reports routinely do random checks by pulling bottles off of a typical drugstore and testing the purity of the product they find. And, routinely, the findings are that the fish oil products tested are practically always pure. Of course, there's the occasional issue, but when it happens, the brand tends to be publicized and it takes care of the problem.

Brands I know and trust include: Kirkland Costco, Barlean's, Coromega, Omega 3 Brain Booster, Carlson's, and Nordic Naturals. That does not mean these are the only safe brands, these just happen to be the brands with which I am most familiar.

Look at it this way. The liability associated with not being careful to remove fish oil is so great that it would be a foolish business to not go through the trouble of distilling out the mercury.

Bottom line: Fish oil, especially if has been molecularly distilled, is relatively mercury free.

2. Is there an upper limit to fish oil?

The American Heart Association recommends no more than 4 grams of fish oil per day. I am guessing that the reason this upper limit exists is because fish oil can affect clotting time, cardiologists treat clotting disorders, and they want their demographic to be kept safe.

However…a 4 ounce serving of salmon has about 2 grams of omega-3's. I have never heard anyone, ever, suggest that we should restrict our intake of fish! So there is a bit of an inconsistency in how we disseminate this information.

Here is the advice I like to give. If you are concerned about getting too many omega-3's, and/or you have a history of blood clotting problems, it's best to be conservative. Start low and increase your dose as you gauge you are tolerating the omega-3's. If you are on any kind of medication such as coumadin, it's best to do this under the supervision of a physician, as your medication dose may need to be shifted as your body accumulates omega-3's. If you notice that you start to bruise more easily after starting fish oil supplementation, this may be an indication that your clotting time has changed and that you should drop back on your dose until you can meet with your physician.

My personal feeling is that in many cases, adequate omega-3 intake may help reduce the need for the medication, but the ultimate decision in each individual case must be one made between you and your physician.

I recently spoke to a gentleman whose lab has developed a test that can ascertain whether or not you have too many omega-3's in your diet. I am not completely versed on how the test works or what it measures, but if you are interested, you can get more information at www.metametrix.com.

Last night evening news reporters shared that a new anti-obesity drug is headed toward approval. I Googled this drug,"Contrave", to learn more.

On the the manufacturer's website, there was some technical information about this drug (see below). What caught MY eye, however, was a deviation from facts to the following commentary:

We believe that bupropion helps initiate weight loss while naltrexone may sustain weight loss by preventing the body’s natural tendency to counteract efforts to lose weight.

Really? It has been scientifically proven that the body has a natural tendency to resist weight loss?Well, if you believe that you're helpless and without any solution other than a medication, you're more likely to help this company's profit margin. That's what they need you to believe in order to satisfy their investors!

The buzz on the news was that the drug has been shown to induce a weight loss of 5%. That means if you're 250 lbs, you can expect to lose about 12 1/2 of them. We've been taught as health professionals, to tell the public that a small weight loss of 10% of body weight can have important health effects, and not to focus on large, drastic changes. But taking a pill to achieve only half of that? Not impressive at all.

I'm insulted for this blog's readers. Can't you do better than that? Can't you just tell the truth about the drug and trust that it has potential in certain cases? Which I'm sure it does? I like to think most people who I have ever come in contact with, deserve much more credit than that. They can make intelligent decisions and do not need to be manipulated in this fashion.

Here are the facts about the medication.

1. It is a combination of two medications that have been used for a variety of clinical purposes, naltrexone and bupropion (Wellbutrin).

2. Naltrexone is an opiate antagonist. According to NIH, it is"used along with counseling and social support to help people who have stopped drinking alcohol and using street drugs continue to avoid drinking or using drugs." The link above provides a pretty long list of contraindications and side effects, and they include pregnant and trying to become pregnant…not likely a great option for many of our readers.

3. Bupropion is an antidepressant that has been found to help facilitate weight loss. It's been used for this off-label purpose for a long time. Not that it can't help, especially if there is depression accompanying your weight gain (not ABOUT the weight gain but as a co-existing condition). But I believe there are many things about most of our audience that can be done to alleviate depression and normalize weight which should be tried BEFORE resorting to medication.

If anyone from Orexigen can produce peer-reviewed research supporting the claim that the body resists weight loss, they're welcome to comment on this blog.

Until that happens, I maintain that any time someone tries to tell you that you can't do something, and your believing them holds potential to transfer money from one bank account to another, you should consider the tactic a challenge to prove them dead wrong.

This past week I was watching The Biggest Loser. Not because I endorse their methods for weight loss, but because so many of you watch that show, it's almost required viewing for my job, to know what's being said and how to address it should it come up in our Facebook group.

I was appalled to watch one of the trainers, while a participant was doing situps, dropping a medicine ball on the poor guy's stomach. Nothing about that segment modeled respect for self or others, in my opinion, and it could have done serious damage to the participant. But that is what seems to happen in the world of weight loss. Once your weight exceeds what is deemed medically and culturally acceptable, the rest of the world seems to act as if they automatically have a license to decide how to"fix" you. The behaviors can range from looks into your grocery basket when you're shopping, suggestions that you're somehow not"doing enough" if your weight loss is not linear and predictable (as illustrated by the closeups of the shocked looks of the Biggest Loser trainers when someone does not lose, or…God forbid…gains weight, the assumption that if things are not going the way the trainer needs them to go in order to be the"good trainer"), that the participant must be the one to blame.

PCOS creates an even more frustrating scenario for physicians, dietitians, trainers, family members, everyone watching on as a woman decides she's going to lose weight. We've learned over the years that in many ways PCOS is counterintuitive. When you diet too strictly, weight goes on. When you exercise too much, weight goes on. It seems to be the"canary in the coalmine," so to speak, of imbalances in your life that need to be addressed. And, unfortunately, if you're a person of extremes, and you resort to fixing one extreme with another extreme, you're likely going to find yourself in a place where you plateau, gain weight, etc., with at least a half-dozen people looking on, with a million suggestions for"fixing" the problem.

Years ago I was a dietitian in an eating disorder treatment center. I was literally responsible for the weight gains of anorexics, the weight loss of women with binge eating disorder, and to be sure that bulimics who had been abusing laxatives did not gain too much weight during their withdrawal from those drugs.

Take the scenario I described above and multiply it by 36, which was the census of the treatment center. I absolutely hated Monday and Thursday mornings because those were staff meetings. I had to meet for three hours each morning with all of the therapists, physicians, etc., and discuss the progress of all of the women we were helping. If, God forbid, the weight of one person was not EXACTLY what I'd projected, I was put on the spot to (1) explain why and (2) come up with a remedy. Suggesting that healing from dietary imbalances of any kind was complex and that we were not in charge of all of the parts of the solution was not an option. Much of the rest of the week was spent with patients, family members, and insurance case managers, having the same conversations. In one case it was an attorney of a beauty queen who insisted she'd been promised prior to admission that she would not gain weight despite needing to withdraw from her box-a-day laxative habit and since her temporary fluid gain was in the double digits, I was to blame.

Can you tell how much I thought this job sucked?

The piece de resistance came during one stretch, when we had an overload of laxative abusers in the house (no pun intended) and my boss, desperate to be able to show good weight progress to insurance companies and keep her own"success" record high, asked me to come up with a solution. This was in the days before the Internet, and so I asked to be able to take a day in the local medical library researching intestinal health and dietary strategies. My request was denied. Instead, I was asked to create some type of"cocktail" that would"clean out or speed up the 'progress'" of the constipated individuals.

I looked at my boss and said,"I am a dietitian. I am not a plumber."

As you can guess, it was the beginning of the end of that job, which I actually eventually walked off of, because that particular situation was merely one of many I was expected to endorse that in good conscience I could not.

I learned humility in that job. An Ivy League degree and a master's degree plus stints at Stanford, Apple Computer, and the professional sports world, could not fix what was broken in these women. Only time, self-nurturing, and patience. Every single time I watch The Biggest Loser, I am reminded of that job. And how so many people I worked with based their own success on a patient's numbers recorded in a medical chart. Not on how well she was asserting herself, or sleeping, or challenging herself to eat salad dressing. It was all about the number. That it wasn't about the healers at all, but about empowering our patients to have the confidence to take care of themselves so well that they could fire us because they didn't need us anymore, was completely forgotten.

I guess I was inspired to write this piece because ever since I saw that medicine ball, I've been thinking how badly I wanted the poor guy on the floor to just stand up, tell the trainer to bite it, and walk off the ranch. Because he was being taught that somehow, because of the position he'd found himself in, needing to lose weight, he deserved to be punished and humiliated in the process of regaining his self-esteem. Yup, he had to be humiliated in order to develop self-esteem.

Don't ever let anyone, and I mean ANYONE — a medical professional, coach, or loved one, cause you to believe that they know better than you, what you need for yourself. Or that because your weight is not changing at a rate that THEY have determined is appropriate, that you're somehow doing something wrong. Or that what they have to say about your health supercedes what you believe about your health.

As Eleanor Roosevelt once said,"No one can take away your self-respect, unless you allow them to."