…and I'm guessing it is, since our own research has shown that most women with PCOS simply do not get enough sleep…
…consider joining us in Los Angeles this July to learn more about how to change that.
Poor sleep can worsen insulin resistance, trigger carbohydrate cravings, promote weight gain, and, well…just make you crabby.
I've been working on a project with colleague Nancy Carballo, that is designed to give you some ideas for how to improve your sleep, hopefully eliminating the need for that godawful and totally unromantic CPAP machine that's all the rage in some circles. We decided to make it fun and interactive, because, well, when you're sleep-deprived, why the heck would you come out on a beautiful Saturday to fall asleep during a bunch of dry medical lectures?
We have a Facebook group if you'd like to learn more and be updated on our event details; you can find us at"Insomniacfest".
Please consider joining us! After all, there's no point losing sleep over your PCOS, your weight, your infertility…or your insomnia.
Lots of responses to part one of this, which confirmed that this topic really hit home and the carbo-loading phenomenon is common amongst people who bounce back and forth between low carb eating and carbohydrate bingeing.
The second thing that happens when most people get to the point where they are so carbohydrate depleted, is that they tend to look for foods that are processed carbohydrates. In all the years I have been doing this work…I have yet to hear someone tell me they binged on asparagus, or on brown rice, or on quinoa! It's always the packaged foods, or it's something from some sort of restaurant.
And the worst binges always seem to happen over the weekend, when people are out of their weekly routine, they're tired, they're with friends…all their defenses are down and it's easy to go for the tortilla chips in the basket or to say,"Yes, I'd like fries with that!"
The important thing to remember about processed food, is that it is higher in sodium compared to the"clean" eating you're trying to pursue the rest of the week. And it can take some time for your kidneys to process and eliminate all of that sodium. While all those molecules are waiting in line to get out of your system, they're hanging around with water molecules. That's just how it works…where there is sodium, there is water.
Think about the head game you set yourself up for if this is what you've done and you're a little obsessive with the scales.
Your weight looks pretty good on Friday morning, and about 3 pm on Friday your co-workers talk you into joining them for Mexican food at the joint down the street from the office. Saturday morning, one margarita, two baskets of chips, and a chimichanga later, you wake up feeling a little bloated. You get on the scale…and it's 4 pounds heavier than it was the morning before!
Talk about demoralizing! It's enough to throw you into a weekend-long"what's the use" binge.
Here's a little tip that can really help get you out of that obsessive cycle.
Remember, we are creatures of habit. Our Mondays are more like Mondays than they are like Wednesdays or Fridays. What we eat on Mondays…doesn't really vary that much. So it makes no sense to compare a Monday weight to a Wednesday weight.
If you tend to go out on Fridays, you are likely going to carry some water weight related to the sodium intake, for a couple of days. Even if you eat the amount of food you intended to.
It's best, if you're someone who is obsessive with the scales, to compare Monday weights to Monday weights, and Friday weights to Friday weights. Comparing Monday morning's weight to the past Friday morning's weight…is sure to set you up for head games and unnecessary bingeing.
Part 3, later this week…will be about hormones and weighing in.
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!
Why is it that we have a need to wear on our sleeves how little we sleep, as if it's a badge of honor?
People who don't sleep are physically hurting themselves in ways that diet and exercise can't always repair.
The large and famous nurses' study showed that women working night shifts had a greater incidence of breast cancer than those working during the day.
Accumulating research is connecting poor sleep with weight gain, insulin resistance, and diabetes.
What is it about sleep that is so crucial?
Melatonin. It's our body's most powerful antioxidant. It literally acts like a scrubbing bubble when we sleep, scouring that inflammatory damage from a day's worth of living, thinking, and stressing, leaving the brain and nervous system clean and ready to go the next day.
When we cut ourselves short on sleep, we don't give melatonin a chance to do its job.
We age ourselves much more quickly than we do when sleep is something we prioritize.
First thing you need to do to change things, is change your attitude about sleep.
You are not a better person because you deprive yourself of it.
You can't make up for what you lost during the week, over the weekend. Once it's lost, it's lost.
You may not be able to overcome the damaging effects of too little sleep with better eating and more exercise. In fact, it may be harder to achieve this while sleep deprived, because you are more likely to accelerate aging even more with the caffeine and sugar you're using to get through the day.
Want to get your weight under control? Reduce your cancer risk? Improve your fertility?
It's not uncommon to read blog posts, tweets, and chat room conversations in which women with PCOS describe their depression, and attribute it to the weight gain and appearance that their PCOS has promoted. It can be easy to blame the discomfort, fatigue, restless, and anxiety that depression provokes, on tangible and unwanted physical changes
A recent study helps to verify what I've believed all along…that depression, like hirsutism, weight gain, and infertility, is another condition that PCOS has potential to create. It is not the result of other symptoms associated with PCOS.
Here's the study.
Thirty women with PCOS and thirty women without PCOS participated in this study. All subjects had similar BMI's/weights. Only women who were not on any psychotropic medication were included. Women with PCOS scored higher on an anxiety scale than women without PCOS. They also slept less, worried more, and experienced more phobias than women without PCOS. Weight was not associated with any of the symptoms, except for sleep.
In other words, regardless of your weight, you can be depressed if you have PCOS.
If you attach or blame your depression on your weight, your appearance, or your infertility:
--you can set yourself up for an eating disorder…if you actually lose weight and discover it didn't change how you feel. --you can feel even worse if you spend time and money on cosmetic surgery, only to realize you don't feel as good as you hoped you would. --you can put yourself through the tremendous stress of infertility treatment, and get the baby, only to discover that you still feel depressed, and now you've got a baby who isn't sleeping through the night who is dependent on you.
That's the bad news. The good news is that the inCYST program is very helpful at reducing anxiety and depression. So in addition to helping you normalize your weight, reducing the progression of testosterone-related programs, and increasing your fertility, it helps you to feel better. It literally rebuilds your nervous system so it can reduce the influence depression can have. And in rebuilding the nervous system, it helps to balance hormones so that symptoms can lessen.
We like to focus on feeling better, since we know that in women who do, the other problems tend to fall into place. That's not to say that being anxious about your PCOS doesn't worsen when you focus on your symptoms, and that when you learn better coping skills you won't feel even better. Gretchen Kubacky has done a great job of discussing that here, on her blog, and on PCOS Challenge.
It's just that you want to be sure you're tackling the core cause of the problem, and not simply putting band-aids on the symptoms. Nothing can be more frustrating than investing all your time, resources, and money into diets and medical procedures, only to feel the same or even worse once you've done so.
Anxiety and depression symptoms in women with polycystic ovary syndrome compared with controls matched for body mass index
REFERENCE E. Jedel1, M. Waern2, D. Gustafson2,3, M. Landén4, E. Eriksson5, G. Holm6, L. Nilsson7, A.-K. Lind7, P.O. Janson7 and E. Stener-Victorin8,9 Anxiety and depression symptoms in women with polycystic ovary syndrome compared with controls matched for body mass index
1 Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden 2 Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 3 Rush University Medical Center, Chicago, IL, USA 4 Department of Clinical Neuroscience, Section of Psychiatry, Karolinska Institutet, Stockholm, Sweden 5 Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 6 Department of Metabolism and Cardiovascular Disease, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 7 Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 8 Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 434, 40530 Gothenburg, Sweden
It's great to be back with the new team of PCOS course graduates! I hope you enjoyed Susan Dopart's recipe and that other contributions will be educational and practically useful.
Today I wanted to share some recent findings about the effects of elevated glucose on a developing baby. If you have PCOS and you are pregnant, you are at risk for gestational diabetes. I realized while reading this study that rarely is the effect of hyperglycemia on the fetus ever discussed. You might hear that it can effect your weight and the baby's weight, but can it do anything else? Some researchers think so.
A group of chick eggs were injected with glucose. Significant changes were found in the babies that developed from those eggs, including: --their own hyperglycemia --elevated oxidative (degenerative) activity in body and brain tissue --lower body weight --lower brain weight There also seems to be lower levels of DHA in babies exposed to hyperglycemia. This may be due to the elevated oxidative activity destroying any DHA that might be there.
You're likely aware that taking folate is pretty much an across the board recommendation to pregnant women. In this study, hyperglycemia seemed to induce a level of oxidation/inflammation that was not significantly helped with a folate supplement.
Bottom line, it's important to eat well not just to avoid weight gain or to keep your blood sugar low to keep your doctor and dietitian happy, but because your baby's brain and body depend on you to do so.
I did not write this post to scare you, I did it to make you aware. However, if you're feeling as if you now don't know what's right to eat, or you're trying and having a hard time, please take a look at the right hand of this blog screen. There is a whole list of professionals ready and waiting to help you figure it out.
Most of my clients express surprise that healthy eating includes as many tasty foods as it does. So before you write off a visit to the dietitian because you're afraid of what you WON'T be able to eat, consider that it may be your ticket to freedom and guilt relief to work with someone who can introduce you to the many foods that will BENEFIT you and baby!
Cole NW, Weaver KR, Walcher BN, Adams ZF, Miller RR Jr. Hyperglycemia-induced membrane lipid peroxidation and elevated homocysteine levels are poorly attenuated by exogenous folate in embryonic chick brains. Comp Biochem Physiol B Biochem Mol Biol. 2008 Jul;150(3):338-43.
Is depression an inevitable consequence of PCOS, or any other hormonally related diagnosis, for that matter? We know that the diabetic population experiences a rate of depression nearing 30% overall, which is significantly higher than the rate of depression in the general population. Women tend to suffer from depression, or it's lesser cousin, dysthymia ("depression light"), far more than men. The infertility that results from PCOS is yet another common cause of depression. Looking at all these causative health factors almost makes depression seem like an inevitability if you have PCOS, doesn't it?
However, it's important to remember that depression is not a thing — it is not a particular spot in the brain, an object like a tumor in your body, or even a set of cells that gets activated and can be turned on and off like a light switch. Depression is a concept — a construct that tries to define and systematize a sometimes vague set of symptoms that includes tiredness, loss of energy, loss of interest in things that once brought you joy, weight gain or loss, sleep difficulties, and even thoughts of suicide.
So, even if you have a diagnosis of depression or dysthymia, remember that you are not your symptoms. You are an individual who has a certain set of symptoms, but how you approach the management of those symptoms is subject to your individuality. Just as you must personalize other aspects of your PCOS treatment, you must personalize treatment for depression or dysthymia. This may include individual therapy, group therapy, support groups, mindfulness, meditation, dietary changes that support better brain chemistry, supplements, or perhaps antidepressant medications.
If you are feeling depressed, talk to your primary health care practitioner about your symptoms. They are not necessarily an inevitabile outcome of living with PCOS, and there are many ways to obtain relief. In a future post, I'll be discussing the prevalence of anxiety and anxiety disorders in women with PCOS, how depression and anxiety overlap, and what you can do to decrease your anxiety.
Gretchen Kubacky, Psy.D. Los Angeles, CA 90064 ph: (310) 625-6083 gretchen@drhousemd.com
