The Hemp Connection:
stress

Happy Monday to all of you!

Sorry for the silence, I was in Boston for a sports nutrition conference, promoting the Nordic Naturals line of fish oils. I've been sidelined from my half marathon training with a cranky knee, and it was so nice to get off of the elliptical trainer, get outside, and walk along the Charles River to and from my hotel and the conference!

Something I was very happy to see, throughout the conference, was the emphasis on nuts in general as a healthy food. I've been frustrated for a long, long time that the walnut people seemed to be the only nut commodity board with media contacts. Not that I don't like walnuts, but there's nothing wrong with other nuts as well.

I did an analysis for an article a few years ago, in which I compared the ratios of beneficial fats (omega-3's and monounsaturated) to potentially detrimental fats (omega-6's and polyunsaturated). And when they were all lined up in terms of most beneficial to least beneficial…walnuts actually turned up at the bottom of the list. Macadamias came out on top!

I use that analysis in my trainings, and dietitians will always immediately say,"But macadamias are so high in fat." Precisely. But it's the kind of fat that keeps us healthy. Lucky for me…my very favorite way to have nuts is macadamia nuts roasted in coffee, the way they fix them in Hawaii.

Anyway…(I tend to get distracted in this blog, don't I?)…

…one of the presentations showed data for macadamias, pecans, and pistachios, suggesting that they, too, are good foods to include in an anti-inflammatory (aka anti-PCOS and pro-fertility) diet. Nuts, in addition to good fats, have a variety of antioxidants that can delay and prevent aging and help fight stress. I even learned that the green part of pistachios contains lutein, which makes them good for eye health. Who knew a food so fun to eat would also be so helpful to my health?

Of course, there's a limit to how many nuts can be healthy, and fat has calories, no matter where it comes from. But if you're reaching for a handful of pistachios instead of a bag of Fritos, it's nice to know you're also reaching for better health.

So this week…go nuts!

Sasha Ottey of PCOS Challenge posted this video on Facebook yesterday. It shows what happens to a man who accepted the challenge of trying to live without all of his electronic connections for a week. He didn't make it…and his reaction was pretty extreme.

I love how these techno tools, if used properly, can help to make life easier. I wouldn't be able to do what I do for a living without the Internet.

However…

…I have observed over time, that people seem to be more electronically connected than they are in real time.

I live near an intersection in Phoenix where a lot of law offices are clustered. It's not uncommon, on a sunny day, to see groups of attorneys on the corner, waiting for the green light to cross, all looking at their Blackberries and iPhones instead of up at the people next to them. They usually seem to be completely oblivious to their surroundings.

I am disturbed at the number of people I see on the canal (even the mountain trail) where I run, and at the gym where I lift, talking on their cell phones while they exercise. They cannot put their toys down for even a half hour to enjoy their workout.

I am learning to love the power of Twitter, as it is helping me to reach women I would not otherwise know, who can benefit from the wisdom of our network members.

However…

…I am noticing a troubling trend, that people seem to be more interested in telling people what they are doing, instead of just doing it! If you're sitting in a meeting, and you're telling people you're sitting in a meeting, you're not really paying attention to the speaker who has taken time to prepare the presentation you're supposed to be listening to. You're either participating in the meeting or you're Twittering/Facebooking about it…you cannot effectively simultaneously do both.

What does that have to do with PCOS, your weight, your health?

One of the most important tools you have to fight and manage PCOS…is your brain.

Your brain is an incredible tool. More powerful than any Internet service provider, communication tool, website. It receives and transmits billions and billions of pieces of information every day: the temperature outside, your mood, your fatigue level, your blood sugar, your hunger level, etc. 24/7, whether or not you consciously think about it.

When things are out of balance, your brain is programmed to let you know. It will tell you if you need to pee, eat, address a conflict, seek companionship, whatever it needs in order to stay in balance.

There is one important caveat. You have to be available to listen to what your brain is saying in order to take the action you need to. If you're jamming your life with toys that fill up your brain's time with information you don't really need (like what your Twitter buddy in Outer Mongolia had for lunch or what the results of your"where you should live" Facebook quiz are)…you're not making time to listen to the REALLY important messages--Are you tired? Hungry? Angry? Anxious? Lonely?

Those messages don't go away just because you ignore them. They pile up in your inbox and keep sending you message alerts until you open them. Kind of like that annoying little red box that pops up on Facebook until you check to see what it wants you to know.

The Perfect Storm often comes during the evening hours, when things finally start to quiet down, and all the messages we've put on the back burner all day long start popping up. If we've ignored hunger…we can binge. If we've ignored anger…we might not sleep well, which we pay the price for the next day. If we're lonely, and were too busy with electronic friends to do something social in real time…we can eat or drink alcohol to self-medicate.

We often don't like the messages that our brain sends us, so it's easy to fill our lives with Tweets and quizzes and status reports to ignore them. But it's only when we listen to them that we have a shot at being healthy.

I like to recommend yoga to clients as a stress management activity. Early into making that recommendation, my clients would routinely come back and complain that they hated it. I couldn't understand it, until I started asking why. Often they would complain that it made them feel"tired" (which I learned later was actually relaxed but it had been so long since they'd felt that way they couldn't recognize it).

What happens when you're new to yoga is that it tends to slow your body down very quickly. But if you're not working on the"head" part of yoga, you can find yourself in the corpse position, with a racing head, throwing all of your unpleasant thoughts and feelings back atcha, and you can't run away from them because your body is too relaxed to do its dysfunctional thang.

Many people give up on yoga at this stage because they simply cannot tolerate the reality of how they feel when they listen to their brain's truthful feedback.

I quickly learned to tell my clients experimenting with yoga there was a"Five Session Rule". They were not allowed to tell me they hated it until they'd been to five sessions. They don't tell me that anymore. They get hooked on the feeling.

If what comes up when you listen is too much to bear, a trained counselor (such as Stacy Korfist in our network) can be invaluable in helping you sort through the discomfort and figuring out what to do about it.

For those clients who are not at a point where an hour of direct communication with their brain is tolerable, I challenge them to start with five minutes of"disconnect". It's not really disconnecting, it's setting aside the barriers to TRULY connecting. Just long enough to think about how you're feeling. Away from the phone, the office, the Blackberry, the iPhone…just to see what comes up.

Once they've accomplished that, five becomes ten. Some people get into the challenge so much they…imagine this…don't read their e-mail or check their iPhone messages for an entire weekend!

Just think about it. Are you living a"virtual life", connected to"virtual friends" and"virtual activities"…or are you living a real-time life, with an occasional jaunt into the virtual world for a bit of fun?

I'll appreciate your feedback here, on Twitter, and on Facebook later on. But I've planned my day so I can quit work early and go for a long walk on the canal to enjoy the spring flowers. I hope you have some real-time connectivity planned in your day, too!

That is the number one reason I hear from my clients about why they cannot do yoga. They fear that because of their weight, they are not going to be able to move in a way that is"right".

The good news about yoga is, there is no"right" or"wrong" way to do it! There are plenty of people in those classes with injuries, arthritis, unique anatomical makeups, and sheer lack of flexibility. And they do just fine.

A good yoga class will offer more than one option for a pose, to give each person in that class an opportunity to participate. You can start with…and even stay with…the first option, or if you're feeling like you would like to challenge yourself…try a new option. And even if you can't do the first option, or hold it, the first time around, the effects of your moving your body in new and different ways are still there.

So with yoga, you simply get credit for showing up and trying!

Afraid you can't get through a class? The power of a simple pose can be significant. A simple downward dog (see photo) is associated with the following:

•Increased strength in your arms, shoulders, sides, chest and upper back, while stretching the muscles in your ankles, calves, thighs and lower back.

•Improved digestion.

•Improved symptoms of menopause, and relieved menstrual discomfort.

•Relief from mild depression and stress.

http://hatha-yoga.suite101.com/article.cfm/benefits_and_best_practices_of_downward_dog

If you've never been to a yoga class, you have no idea what you might gain. Give it a try and see what happens!

I don't know if it's because so many women with PCOS are struggling with weight, or if it's the attitude that health practitioners often have toward people working on weight issues (negative and judgmental), or what, but I meet and hear from many women who overlook activity possibilities that don't involve pushing yourself, in a very punitive way, to the point where exercise is painful and lacking in pleasure.

The Biggest Loser certainly doesn't help that mentality. If I have to see one more person pushed to the point of vomiting by a verbally abusive trainer who justifies that attitude by saying"This is what they come here for," I think I'll vomit myself.

But I digress.

Exercise should be challenging, and sometimes you'll feel sore, but it shouldn't feel like punishment.

One of the exercises I love to recommend is yoga. There are many reasons why yoga is helpful to PCOS.
1. It increases flexibility. If you haven't exercised much in awhile, your flexibility has likely diminished, and you're more prone to injury. The last thing you need, when you're just starting to take care of yourself, is to knock yourself out of commission with that!
2. Yoga can help to alleviate depression. And in turn, when you're less depressed, you are less likely to crave sugar, or to binge.
3. Yoga is good for improving circulation to your internal organs, including the reproductive ones.
4. It helps to release that pain-causing lactic acid I wrote about yesterday.
5. It helps to increase range of motion and fluidity in joints.
6. It helps you to improve your posture and stand taller, which can help you to have a longer, leaner look.
7. It reduces stress hormone levels.
8. It improves focus and concentration.
9. It can reduce cholesterol.
10. It can reduce symptoms of asthma, back pain, and arthritis, other inflammatory conditions often found in women with PCOS.

I'll be writing about various aspects of yoga throughout the week. But for now, just consider that even though cardiovascular exercise and strength training are important, you don't have to kill yourself with those, and exercises that don't emphasize those have benefit, too!

Why in the world, the day after Thanksgiving, if I'm trying to de-stress you…would I put up a piece of pie…pie being something you likely don't even want to think about today?

Because my concept of stress is exactly like pie. Life tends to be less stressful if your"pie of life" is divided into more pieces. If your life has only a few facets, and something happens in one part of your life that is stressful, you have fewer places to go that can provide you a diversion while your mind works out a solution.

I'm posting my pie here, so you can see what I mean. I do what I do because I love it. But I can get really hyperfocused on it. And when business is slow…like it was just before the election…that can be very stressful. Fortunately, I also love to garden. There were weeds outside that needed to be pulled, so I started taking a work break every afternoon to clear a small piece of land. And you know what? While I was weeding, some new ideas for my business came to mind that jump started sales again.

It is easy, as hard as I work, to become a little inbred as far as my social life goes. So I decided a few years ago, to volunteer every Friday afternoon at a local no-kill shelter (which you should visit sometime if you're in Phoenix!). I have befriended a whole group of people who have absolutely nothing to do with my business. I love going down there and having a place where I'm Monika the cat adoption counselor, not Monika the nutritionist. (Well, that plus it's impossible to be stressed out after 5 minutes of being in the nursery with a dozen little ones simultaneously using you as a scratch post.)

I love to work out, but on days when it's raining or I'm just not feeling good and need to rest, I love to do calligraphy, read a Presidential bio, or refinish one of my antiques. Again, so many perspectives and ideas come to mind for work and social situations that seem to be locked up when I focus too hard on places where there are problems.

If you're struggling with fertility or weight loss, or any stressful situation, for that matter, the problem can just become larger than life. It can be all you think about. You can find yourself on the Internet, visiting blogs, reading books, etc., focusing entirely on your problem. And all the stress that builds up when you go to places where you only immerse yourself in more of the stuff that bothers you…can make it hard for your body to make progesterone.

Take a minute and look at your own pie. How many slices is it divided into? How many different communities of friends, coworkers, activity parteners, etc., do you belong to? Are you so focused that you have yourself backed into a stress corner?

Could it be…today is the day you have your coffee in a new Starbucks and strike up a conversation with a new person in line, rather than blasting in and out of the same place without looking at a single thing around you? Is it the day you buy that basil plant at Trader Joe's as a starter piece for your new herb garden? Is it the day you sign up for that Italian class you've been wanting to take? I'm so appreciative that you're reading my blog, but I would never expect it to be a complete and total answer to your PCOS, or to substitute for the well-rounded life that you deserve to have.: )

OK, now that THAT has been settled, I am going to paint my dining room today and then finish off that James Buchanan bio I found at the library. But first, I think it's time to head into the kitchen for some leftovers. Yes, I have to admit, leftover pumpkin pie is one of my very favorite breakfasts!

We know that about 10% of women have PCOS (recently, some sources say 20% of women). About 20% of women also have irritable bowel syndrome (IBS), which is characterized by abdominal pain or cramping; a bloated feeling; gas (flatulence – aka, farting); diarrhea or constipation — sometimes even alternating bouts of constipation and diarrhea; and mucus in the stool. But a recent study indicates that about 42% of women with PCOS also have IBS – more than twice as many of the women who don’t have PCOS. As if that’s not enough, gastrointestinal irregularities can be caused by:

• Menstruation (those hormones surging will slam your gut, as well as your mood);
• Travel (unusual schedules, foods, or water supply);
• Stress and anxiety (ever have to go running for the toilet right before a big test, or a job interview?);
• Too much alcohol or caffeine;
• Side effect of medications, particularly metformin when it’s first introduced. Many women also report bowel disruption from birth control pills;
• Irregular eating habits – oddly spaced meals, excessive carbs, which can be constipating (remember the BRAT diet – bananas, rice, applesauce, and toast – for diarrhea);
• Wheat, dairy, soy, or other food sensitivity or allergies; and
• Undiagnosed celiac disease (inability to tolerate the gluten most commonly found in wheat).

In other words, if you’ve got PCOS, there’s an excellent chance you also struggle at least intermittently with some sort of gastrointestinal distress. The effects can range from mildly embarrassing and uncomfortable (a little gas, some cramps) to wildly humiliating and awkward, up to and including bowel accidents while out in public, urgency that brings your condition to the attention of friends or family members, acute pain from chronic cramping, and fear of having an undiagnosed serious illness. These problems can cause or contribute to social anxiety and depression.

From a health psychology perspective, there are many things that can be helpful in managing gastrointestinal distress. Chief among them:

• Improved diet (consult with your doctor or dietician about your specific condition), or shifting the content/balance of your diet – this may also help with mood;
• Medications, extra fiber, or supplements to help regulate the bowels (again, consult with your doctor or dietician about what’s best for you specifically);
• Daily meditation, or other stress reduction techniques, such as yoga or Tai Chi;
• Talk therapy to reduce the stress and anxiety that triggers an attack of IBS; and
• Hypnotherapy is also recognized as an important treatment for IBS.

While these symptoms may be embarrassing, and even seem shameful, it’s important to know that you don’t have to suffer from them. They are not normal and, while they may not be entirely curable, there are many effective ways of managing or reducing them to a point where you’re no longer self-conscious about going out of the house. Treatments usually result in fairly quick improvements, so there’s no reason not to try implementing some changes. Here’s to your healthy gut!

Reference:

Dig Dis Sci 2010 Apr;55(4):1085-9. Epub 2009 Aug 21. Polycystic ovary syndrome is associated with an increased prevalence of irritable bowel syndrome. Mathur R, Ko A, Hwang LJ, Low K, Azziz R, Pimentel M. Source: Department of Obstetrics/Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.

If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at Gretchen@drhousemd.com. You can also follow her on Twitter @askdrhousemd.

As you’re reading this blog post, I’ll be heading off to my long-time gynecologist/surgeon for a pre-surgery briefing, signing of consent forms, and preparation instructions for an outpatient surgery to remove a cyst from my left ovary the following week. For some of us, it’s regrettably routine, and for others, the idea of having surgery is very frightening. The fear may be constant or fleeting, depending upon your history.

In my case, I would ordinarily not be afraid, but I had surgery two years ago and ended up with a deep and painful pelvic infection that took months to truly resolve. To say that I was terrified of returning to the same hospital would be putting it mildly – I think I had a near-hysterical reaction initially. Here’s what I did to calm myself, which I hope will be useful to you as you face your medical fears.

Identified alternatives – I considered another hospital (but my doctor is only on staff at this one), another surgeon (no, thanks, I need someone who knows me well and whom I trust implicitly), delaying the surgery (again, no thanks, as this has become a chronic pain situation over the last few months), or not having the surgery at all (this didn’t seem viable either, for the aforementioned reasons).

Researched/gathered information – in addition to talking extensively with my physician, I spent a fair amount of time with my nose in some books, and talking to my medical practitioner friends, as well as reading research and opinions on the internet. I always say, knowledge is power. But in this case, I may have scared myself unnecessarily by being a little too well-informed.

Consulted with other experts – I consulted with a physician/friend who knows the surgeon, an infectious diseases expert about how to ensure that I don’t get another infection, and people who have been through scary medical procedures themselves.

Took my time – I took my time, partly because of my schedule, partly because of my doctor’s schedule, and partly because I really don’t want to have surgery, and I was hoping the matter would resolve on its own. I tried a lot of alternative approaches, which helped, but I’m now confident that surgery is the right choice.

Considered risks, benefits, and outcomes – the risks include loss of the ovary, potential infection, or of course death (they put that on all the consent forms). Benefits include relief from pain, restoration of normal and comfortable functioning, and relieving my body of some diseased and dysfunctional tissue. Given the precautions I’m taking, along with my choice of highly esteemed surgeons, I expect the best possible outcome.

Came to peace with an imperfect decision – I really, really, really don’t want to have surgery! And I don’t want to go back to that hospital, and I don’t want to lose my ovary. But I also know that I can’t reasonably continue dealing with the level and frequency of pain I’ve endured for the last few months, the surgeon is excellent, the hospital’s outpatient department is better than its inpatient services, pharmaceutical treatments aren’t containing it or remedying it, and alternatives work well for a bit, but aren’t a permanent solution. I’m okay with my decision, regardless of the outcome. I’ve done the best for my body and my peace of mind, and that’s all I can do.

Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.

If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at Gretchen@drhousemd.com. You can also follow her on Twitter @askdrhousemd.

This site is all about PCOS, and the Mental Health Monday column is all about coping with PCOS, and yet there’s a whole different yet related realm that we don’t discuss at all – and that’s all the OTHER medical stuff we have to deal with on a regular basis:

• Family member’s appointments – you may have to make the appointment, drive someone to the appointment, pay for the appointment, or actually sit through the appointment or treatment. This is magnified when dealing with someone else’s chronic illness, such as an asthmatic child, or a parent with cancer;

• Medication management for children or elderly family members, which can be complex and confusing, especially when you’re managing your own medication and supplements;

• Dental care – ranging from minimally bothersome to all-consuming, depending upon what you start life with, and how you take care of it;

• Routine check-ups (Oh… yeah… right?! We’re supposed to go the doctor, theoretically, once a year, just because) with someone who is supposed to “know” you so that they can help when you’re having an issue;

• Cosmetic dermatology/plastic surgery (if one chooses to indulge in such things, which can be addictive, time-consuming, expensive, painful, and require a fair amount of discretion or story-telling to disguise);

• Coordinating care between physicians, hospitals, and pharmacies, because it seems like lab results and x-rays always go missing, the mail order pharmacy refuses to fill your prescription as currently written, and you are quite certain that the blood draw you had last week will suffice to answer ALL of THIS doctor’s questions so no, thank you, you do NOT wish to have another blood draw.

• Tending to non-PCOS medical conditions (allergies, asthma, broken bones, etc.), all of which require another set of doctors, treatment protocols, diagnostic procedures, and medications or support aids (glasses, hearing aids, orthotics, and so on), and all of which take far too much time and energy to implement effectively and routinely; and

• Even the veterinarian! Yes, dealing with your pet’s medical issues so closely parallels dealing with your own medical issues that it can be quite stressful for many PCOS patients, as it brings up feelings of loss of control, challenges in understanding the choices, and frustration about not being able to adequately or appropriately resolve a problem. Plus, veterinary clinics smell medicinal, which can trigger some bad memories.
Amidst all of this, you’re expected to work, and take care of your PCOS, which already makes you a little high maintenance if you’re doing it “right.” And, oh yeah — look good, be socially, politically, and spiritually engaged, and perhaps even be creative, philanthropically inclined, and a good and present friend. WOW. I’m exhausted just thinking about it – yet this is our reality.

After years and years of dealing with the medical roller-coaster, for myself and alongside others, I’ve come to realize:

• Doctors think their time is more important than yours; plan for it.

• Pharmacies are really, really picky – know the basics, and check your prescriptions before you leave the doctor’s office.

• Your insurance company definitely doesn’t care, no matter what they say in the nice ads that run during open enrollment time. Be polite, but treat them accordingly.

• At some point, someone (a doctor, a nurse, an x-ray technician, etc.) will say something insensitive, stupid, or cruel. Viewing this as an opportunity for spiritual and character growth is far more productive than engaging in rage.

• Doctors often have no real idea what their colleagues are doing to/with your body, so keep your own medical records, do your research, ask a lot of questions, remind them pointedly, and take all the time you need.

And if you’re still feeling overwhelmed by the plethora of medical information, advice, procedures, and protocols, ask for some help. Poet Mary Oliver writes of “your one wild and precious life.” I say, this is your one precious body, and it merits your full, loving, and respectful attention, even in the midst of a medical storm.

Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.

If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at Gretchen@drhousemd.com. You can also follow her on Twitter @askdrhousemd.

Something that struck me very early on working with PCOS was how often I heard,"Just tell me what to do." It was clear that a big part of the problem women asking for help was having was feeling out of control. In every other part of their lives, it seemed, they'd been rewarded for hard work and diligence.

PCOS just doesn't work that way.

And when the solution isn't always about DOING something to fix the problem, you can feel completely out of control…tied down…trapped…

For a problem solving personality, a doer, this can leave you feeling completely stressed.

Research has actually studied this phenomenon, it's called"restraint stress."

Restraint stress is any kind of condition that leaves you feeling as if nothing you do can alleviate your discomfort, as if you are destined to live with your situation without any relief. It is the most damaging kind of stress, as it is the kind of stress that best elevates blood pressure, blood glucose, and cholesterol, interferes with sleep…

…can you see where this is going? Not only are you living with a seemingly unsolvable problem, but how you perceive that problem has the power to worsen that problem completely.

Sometimes what I see, is that a person focuses so completely on the problem that they perceive, that they lose perspective with regard to just what they CAN control.

They CAN make healthy food choices.
They CAN be more physically active.
They CAN set boundaries with people and limit their stress.
They CAN surround themselves with positive, supportive people.
They CAN turn the computer off and engage in activities other than surfing and reading about the problem.
They CAN be kind to themselves.

I find that those clients who are most creative at finding ways to repaint their picture, are the ones with the best chance of succeeding in the long run.

It's ironic, but then PCOS is ironic.

Stop focusing on the problem, stop thinking of yourself as an unfixable pathology, start believing you are a whole person with many talents and ideas to contribute to making our planet a great home…and all of a sudden things that felt so elusive start showing up when you least expect it.

It was 1975, and my father had a powder blue polyester double-knit “leisure suit,” a weight-loss plan disguised as a plan to single-handedly re-roof our house, and a keen interest in alternative nutrition and well-being. The latter took the form of upside-down eating, in which we had our smallest meal at dinner and our largest meal at breakfast. My friends thought it was very strange that we ate steaks and pork chops for breakfast, along with huge salads.

We were also eating texturized soy protein, roughly ground grains made into coarse earthy breads, spoonfuls of lecithin, mung bean sprouts, and a whole lot of strange things that you could only get out of the bulk food barrels at Elliot’s Natural Foods. We had a copy of “The Whole Earth Catalog” on the coffee table, and there was also a well-worn copy of my dad’s new bible, Adelle Davis’ “Let’s Eat Right to Get Fit.” There was some new thinking going on in this middle-aged straight-laced German guy, and I was curious about it. Extremely curious. I read the books, and ate whatever weird stuff I was supposed to be eating.

Things got even more curious when my father signed the entire family up to learn Transcendental Meditation (TM), which was developed by the Mahareshi Mahesh Yogi in the 1950s. Although it started elsewhere, by the 1970s, it had penetrated as far as “The Big Tomato,” my hometown of Sacramento, California. He went to a couple of introductory lectures, and the next thing we knew, all five of us were learning TM! It sure seemed exotic at the time, but it’s a technique I have practiced off on and on for over three decades. It’s so simple, I find it the easiest place to return to when I’m most stressed.

TM is a mantra-based meditation technique that has been scientifically validated for stress reduction, blood pressure reduction and, most recently management of the symptoms of Post Traumatic Stress in veterans. The National Institute of Health has spent in excess of $20 million validating the benefits of TM. It increases mental clarity, creativity, and overall health, and decreases stress by decreasing the activation of the sympathetic nervous system. When the sympathetic nervous system’s activity decreases, so do adrenaline, noradrenaline, and cortisol levels. Therefore, it is quite effective for stabilizing mood and even controlling appetite, because your appetite tends to go out of control when you’re feeling stressed.

Technically, it must be taught through an authorized trainer (see www.tm.org), but a great deal of introductory information can be gleaned online. I’ve written previously here about the benefits of meditation, and I’d love to introduce you to this technique.

Simply sit quietly and comfortably. This is essential to all forms of meditation. The mantra would be assigned by your teacher, but you can choose a syllable or sound with no inherent meaning (other forms of meditation might focus on a word with a meaning, such as “love” or “peace.”). The act of focusing on the mantra draws your mind out of its normal state of anxiety, chatter, and activity. If your mind drifts, return your attention to the mantra gently and repeatedly, for a period of 20 minutes per day. Results have been verified with as little as eight weeks of consistent daily practice. Optimally, practicing twice a day for twenty minutes each time is the goal, but benefits can be derived from as little as five minutes a day.

Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses. If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at Gretchen@drhousemd.com. You can also follow her on Twitter @askdrhousemd

References:
Dillbeck M.C. and Orme-Johnson D. W. Physiological differences between Transcendental Meditation and rest. American Psychologist 42:879–881, 1987.
Jevning R., et al. The physiology of meditation: a review. A wakeful hypometabolic integrated response. Neuroscience & Biobehavioral Reviews 16(3):415-24, 1992.
Orme-Johnson D.W. and Walton K. W. All approaches of preventing or reversing effects of stress are not the same. American Journal of Health Promotion 12:297-299, 1998.

The following is a guest post reprinted with permission from the blog of Karen Siegel, MPH, MS, RD, LD, LAc. Karen is a registered dietitian and licensed acupuncturist practicing in Houston, TX. If that's your neck of the woods, I highly recommend you take advantage of her knowledge, experience and talent.

Depression, Anxiety, Bi-Polar Disorder & Acupuncture
Questions about acupuncture for mental health issues are one of the most common inquiries I receive after questions about pain.

I actually do quite a bit of “mental health” acupuncture. Because of my nutrition specialty of working with eating disorders (for over 25 years), I have developed a great network with some of the best mental health professionals in Houston.

Acupuncture can help with depression, anxiety, stress and bi-polar disorder. So in terms of various mental health issues, yes, acupuncture can frequently help.

I caution to say that acupuncture is not in lieu of continuing or being in therapy. I do not take patients off of their Western medication if they’re already on it. Medication is a discussion between the patient and their doctor. Acupuncture, and in many cases Chinese herbal formulas, work just fine in conjunction with Western medication as the mechanism of action is quite different. They can complement each other beautifully.

When a patient comes in with a Western diagnosis of depression, anxiety or bi-polar disorder, my job is to determine what the underlying problem(s) are from a Chinese medical perspective. For example, if someone presents with anxiety along with insomnia, excessive worrying, hypervigilance and internalizing feelings, the strategy might be to balance the heart and kidney channels. However, if the main complaints include depression, irritability, sleep disruptions and digestive problems, the approach might focus on smoothing the liver channel.

Usually, a patient will present with a combination of the above plus more. After a thorough evaluation, a point selection is chosen based on the most disruptive concerns working our way in to the deepest and most chronic issues. We as human beings are rarely uni-dimensional, therefore it is more complicated than I have described. However, it gives you an understanding that the treatment strategy is quite individualized.

I have treated bipolar disorder and have found that acupuncture can be stabilizing; but with bipolar, it’s really important to stay on your Western drugs and/or be in regular communication with your therapist. What the acupuncture can do is help balance and stabilize some of the mood swings: the degree, frequency and intensity of the ups and the downs. You might be able to reduce the dosage of some of the medications, but again, that’s between you and your psychiatrist.

Stress is a major variable in just about every health issue we have. I think that stress is the one variable in our life that cannot be controlled in a double-blind, placebo control study. So you can have everything, all variables equal, but how do you really control for stress? Stress definitely triggers mental health issues and it triggers health issues overall.

Because stress is a major factor in all of our lives, acupuncture in and of itself helps with mental health issues because it works to balance the mind, body and spirit. When we are in balance, our emotional and physical health is improved.

You all are must be sooooooooooooooooooooooooooo tired of hearing me talk about the benefits of sleep. But I work with a sleepless population and it takes a few times to present my case before I make my point. I figure if I hammer at this from as many different angles as I can, and present as many examples of how poor sleep quality can interfere with your health, at least one of my examples will hit home and inspire you to consider your sleep habits and choices.

This doesn't bode well for Jay Leno and David Letterman…unless they team up with TiVo for advertising!

Women whose eggs had been examined and found to be of poor quality had those eggs examined by researchers. It was found that levels of chemicals indicative of oxidative stress were higher in those eggs than they were in the eggs of women whose eggs had been determined to be of good quality.

Taking this one step further, 18 women with low quality eggs were divided into one of three groups and given one of the following 3 regimens: (1) 3 mg melatonin per day, (2) 600 mg vitamin E per day, or (3) 3 mg melatonin AND 600 mg vitamin E per day. Oxidative stress markers were reduced in all three scenarios.

And THEN…in the final phase, 115 women who had not become pregnant with in vitro fertilization (IVF) were divided into two groups. The first group received 3 mg melatonin per day and the second group received no supplement. Melatonin significantly improved the rate of fertilization.

The researchers concluded that oxidative stress (which is what happens when you stress all day and don't sleep well all night), damages the quality of eggs. They also concluded that melatonin supplements can help improve fertilization rate.

Just a note--take melatonin if you want, but don't lose sight of the big picture. If you backed yourself into a corner because you weren't managing your stress and sleep, a pill may not be the complete solution to the entire problem.

Tamura H, Takasaki A, Miwa I, Taniguchi K, Maekawa R, Asada H, Taketani T, Matsuoka A, Yamagata Y, Shimamura K, Morioka H, Ishikawa H, Reiter RJ, Sugino N. Oxidative stress impairs oocyte quality and melatonin protects oocytes from free radical damage and improves fertilization rate. J Pineal Res. 2008 Apr;44(3):280-7.

You’ve heard it a thousand times, from every doctor, dietician, and well-meaning person you’ve ever encountered – you’ve got to lose weight, get out there and get some exercise, and change what you’re doing with your body when you’ve got PCOS. It’s important advice, to be sure, yet tedious to hear – and sometimes when we’re in the midst of trying to change our lifestyle and behaviors, we forget why we’re doing it.

All we hear is this pointed and difficult direction to improve things, and we fail to spend time linking it intellectually and emotionally to positive outcome, which helps drive motivation. It’s particularly frustrating with PCOS, because change occurs painfully slowly, and when you don’t see change, you lose motivation. Others can go on a diet and lose five pounds immediately, whereas that’s rarely the case for someone with PCOS.

Sometimes the changes are only visible when you get your lab results every few months, and the doctor congratulates you on lowering your cholesterol 20 points (personally, I don’t find that terribly exciting, although I know that it’s good) – in which case you might get it intellectually, but still be saying “yeah, yeah, yeah, that’s great, but where’s the weight loss?!” What we want is weight loss, pregnancy, a reduction in hirsutism, or some other visible proof that what we’re doing is working.

When you really understand the importance of exercise for both your body and your brain though it’s a little easier to stick with a program of self-improvement. In a 2011 study entitled Lifestyle Changes in Women with Polycystic Ovary Syndrome, researchers examined numerous studies, papers, and research projects and validated the benefits of lifestyle change. Women with PCOS who made positive dietary, exercise, and lifestyle changes (i.e., stress reduction, increased movement, lower glycemic diets) experienced reductions in weight, testosterone levels, waist circumference, and other meaningful markers of the syndrome.

To support not only weight loss and improvement in body composition, but also, from my perspective as a psychologist, the stress reduction and mental re-wiring that goes on as a result of exercise are spectacular. I particularly like the following forms of exercise:

Walking – the cross-lateral motion of walking oxygenates and re-synchs your brain, and leads to a literal feeling of “clearing out” – plus walking is an excellent low-impact exercise that leads to improved glucose control. Does it get any better than that?!

Yoga – numerous studies continue to validate the importance of yoga for stress reduction and pain management. A study entitled Stress, Inflammation, and Yoga Practice indicated that yoga practice, regardless of skill level, resulted in marked reductions in both stress level and, even more exciting to those with PCOS, inflammation! Many fertility improvement programs involve yoga and other forms of stress reduction. And, while you’re improving your physical balance, you might just be improving your mental balance as well.

Swimming – swimming in a pool, lake, river, or ocean can be soothing and meditative. We are made primarily of water, and it is a return to water, and to the center of our selves. The silence and internal nature of the echoes and ripples brings us back into alignment with our natural rhythmic movement patterns.

Dancing – improves coordination, synthesizes mind/body, and is a form of creative expression. Much emotion is stored in the body, and can be expressed through the body. Plus, dancing is fun, at least when you “dance as if nobody’s looking!”

Weight training – feeling a strong body is empowering, and increases confidence. Sure, it’s hard work, but it has profound mental benefit when you conquer that final set, and your lifting is finished. There’s a sense of accomplishment and pride that boosts your self-esteem for hours. You’ll move better in your body too, and perhaps respect it a little more, for its ability to become so strong. (By the way, this is one really positive aspect of PCOS – that androgen imbalance will allow you to develop muscles more quickly!)

The mind and body are inseparable. If you work on improving the mental (motivation, drive, commitment), you will improve the physical. If you work on the physical, you’ll achieve the psychological rewards of calming, anxiety reduction, and depression reduction. Additionally, you’ll have fun and also be doing the right thing to keep your self-improvement program going. That leads to increased confidence, self-esteem, and overall improvement in your sense of well-being.

Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.

If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at Gretchen@drhousemd.com. You can also follow her on Twitter @askdrhousemd.

References:

Kiecolt-Glaser JK, Christian L, Preston H, Houts CR, Malarkey WB, Emery CF, Glaser R. Stress, inflammation, and yoga practice. Published in final edited form as: Psychosom Med. 2010 February; 72(2): 113. Published online 2010 January 11. doi: 10.1097/PSY.0b013e3181cb9377.

Moran LJ, Hutchison SK, Norman RJ, Teede HJ. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database of Systematic Reviews 2011, Issue 2. Art. No.: CD007506. DOI: 10.1002/14651858.CD007506.pub2.Australia, 3168.

If you're a regular reader of this blog, you've seen contributions by Ivonne Berkowitz-Ward. Ivonne's husband, Patrick, has his own fitness business, and he has started producing podcasts on the topic.

I just listened to one that had soooo much pertinence to this audience. Hang with it all the way through the end. He and his interviewee talk, in a really interesting way, about the personality of the person who struggles with food and weight.

I guess what makes it so different from other pieces I've read or heard on the topic, is that it's not coming from a nutritionist, who can sometimes be too logical and mathematical about the issue, or the psychologist, who is trained to empathize with the issues, but rather from two guys in the fitness field, who are simply on the outside looking in at women (and men) who come to them for help. And who observe that it's not the calorie intake or output so much as the person's way of dealing with life in general that gets in the way of their success. So their language is not so detached or politically correct. Sometimes hearing it told just like it is, is what it takes to finally understand.

If you are a regular reader, you also know how much we promote stress management. So understanding a personality that doesn't manage stress, if that is you…and learning how to take the intensity out of your food and exercise, may be the very thing you need to focus on in order to get on the right track with your PCOS.
Thanks, Patrick, for putting together this great podcast!

As I mentioned in the first part of this series, vitex has its strongest effect on four hormones: estrogen, progesteron, luteinizing hormone (LH), and the one this post is dedicated to, prolactin.

Prolactin is primarily associated with lactation. It is also important for sexual arousal, sensing orgasms, and libido. So it's safe to say, you have to have good prolactin metabolism in order to successfully conceive and carry a pregnancy through to nursing!

One of the most important, and often overlooked, influences on prolactin function, is medication. I am most familiar with psychotropic medications because of my specialty, and I believe, with the very high incidence of anxiety, depression, and sleep disorders in women with PCOS, it is incredibly important to use these medications with discretion in order to not interfere with fertility, or successful PCOS management in women who are not in pursuit of conception.

Before considering any supplement, make a list of all the medications you've ever been prescribed and show them to a registered pharmacist. Ask them if any of those medications have any potential for disrupting prolactin function. And if you come up with a"yes" for any of them, ask for a list of alternatives that you and your prescribing physician can use to adjust your treatment plan.

When prolactin is out of balance, funny things can happen. You can produce milk when you're not supposed to (I once had a male client who started to lactate, and it turned out to be a symptom of a pituitary tumor.)

You might not be able to produce milk when you want to. Many, many, many women with PCOS find, much to their dismay, that they get pregnant, and cannot feed their babies. I am shocked at how many medical colleagues with PCOS write me to share that until they heard us mention this at inCYST…they never knew it could be a problem. And they themselves could not nurse their babies!!!

This lack of awareness and the incredible importance of healthy prolactin function to the overall health of mother and baby, is precisely why, our first outreach outside of dietitians, with inCYST, has been with lactation consultants. They understand this physiology best, and they are the most likely to pick up on problems as soon as they become apparent.

Bottom line, PCOS is not just about infertility. It is about successful reproduction, which includes being able to successfully create the next generation of healthy people.

But I digress. Back to prolactin.

Prolactin is controlled by the hypothalamus, the part of the brain we at inCYST are obsessed with learning and teaching about. The hypothalamus also regulates estrogen, progesterone, testosterone, cortisol, thyroid, and growth hormone. You can see why it's your BFF as a woman with PCOS. If you have problems with one of those, you likely have problems with more than one.

Most medical treatments address each of those hormone imbalances as if they are separate, requiring a separate medical treatment…better yet…a separate medication. So by the time you've made the specialist rounds, you've been given a birth control pill, an antidepressant, a sleep medication, a lipid lowering medication (since some of these hormones are made of cholesterol, when they're out of balance…cholesterol will be, too).

We like to think we start where the problem starts. Giving the hypothalamus what it needs to work efficiently. And the number one chemical you can focus on, which should help all of these functions, which I call our"Recipe for a Happy Hypothalamus (SM)"…is DHA, one of the fish oils.

1. DHA makes it harder for the hypothalamus to feel stress. Stress is a very selfish thing. It steals energy away from other things your body might need it for. With enough DHA in the system, the hypothalamus can put its energy into healing the functions that are NOT related to stress, mainly reproduction, sleep, and mood.

2. DHA increases dopamine receptor density. Prolactin is dopamine-controlled, meaning the more receptors there are to communicate with the dopamine that is there, the less prolactin your body needs to make.

An interesting aside--dopamine imbalance is common in people who crave and/or binge on sugar. So if you've got cravings AND your prolactin levels are not right…you just might be DHA-deficient.

I have one more post coming on chaste tree berry that will summarize important findings and recommendations.

But, with regards to prolactin, what I will say is that two very important things you can, and should, do, to move yourself back into balance, are:

1. Make sure your medications are not the source of the problem, and
2. Make sure your food choices are promoting healthy dopamine function.

Even if you DO decide to try an herbal formula, it is much more likely to work for you, if you provide it with an environment that allows it to do what it does best.

I got a little sidetracked with things, sorry for not getting to this sooner.

Progesterone is a topic I've covered before in other posts. Rather than repeat myself, I'll just link you to each part in that 5 part series.

Important things to remember about progesterone:

The basic building block for making progesterone, is cholesterol. Cholesterol is also the building block for testosterone and cortisol. If your body's balance is shifted in the stress management direction, it is likely that any cholesterol you might have had to make progesterone…was used up to make cholesterol.

One of the absolute most important things you can do to improve your progesterone levels, therefore, is to manage your stress.

I noticed after writing the original five part series that traffic to this blog increased significantly. The most common keywords were,"foods to enhance progesterone". Unfortunately, simply adding foods or supplementing with progesterone is not going to be the answer. If you really, truly want to have good progesterone balance, a commitment to better stress management is going to be a very important part of the solution. Some days it will be easy to do that, other days you will be challenged. Being gentle with yourself and accepting the best you can do on any given day…is what you deserve to give yourself credit for!

Here are the other five links with more information.

Watch out for environmental estrogens
Tackling insulin resistance
Enjoying food
Stress management
Physical activity