The Hemp Connection:
weight loss

I was standing at the grocery check out line last night, and my eyes unavoidably wandered to the magazine rack as I waited my turn. The weight-loss headlines on all those health and fitness magazines seem to scream, competing for my attention!

“The only workout you’ll ever need!”

“5 easy steps to a flat belly!”

“Lose 10 pounds this week without giving up dessert!”

“Get back into those skinny jeans with these three easy moves!”
I can’t help but roll my eyes and wonder if anyone who writes these really cares what happens beyond the purchase of the magazine. Most of those types of articles tend to recommend crash diets disguised as sound nutrition plans, and play to readers’ desires of maximum return on minimum investment with regard to exercise. But none of these things will set you up for long-term success.

If I could rewrite some of those headlines, they might look more like this:

“Get back to basics to get back in shape!”

“Lose the ‘extras’ and shed the extra weight!”

“Move it to lose it!”

“Get SMART about your goals!”

Those are my go-to tips for realistic weight management. There is such a focus on the “losing” part, and not much talk about what happens afterward! It’s easy to forget the work isn’t done after you’ve lost the weight. The ultimate goal then, isn’t just to lose the weight, it’s to maintain your new, healthier weight and the habits that got you there.

Get back to basics. In the kitchen, that means get back to fresh food, things that don’t tend to come in boxes and bags or are delivered through a drive-thru window. In life, that means, go outside and take a walk. Or, step away from the computer once in a while and walk over to your coworker’s desk to talk (instead of emailing) about that project you’re working on.

Lose the extras, like soda, excessive alcohol and mindless snacks. Ask yourself: Do I really need to sip on Mountain Dew all day while I work? And do I have to get the cookie with that salad I ordered just because it’s free? One beer or one glass of wine to unwind or enjoy with dinner is nice… but do I really need more than that? And when I’m at the movies… seriously. Is it that hard to watch a whole movie without a vat of popcorn or a suitcase-sized box of M&Ms on my lap?

Move more! It doesn’t matter if the perfect conditions for a regular workout routine are not in place. That should eliminate excuses like “I have no time.” And “I can’t afford a gym membership.” Just do something – NOW. Just make the commitment to moving more than you currently do.
Not starting, or giving up simply because things aren’t going perfectly are the complete opposite of jump starting anything. I choose instead to aim for progress, not perfection.

Get SMART about your goals! SMART goals are specific and measureable, attainlable and realistic, with a time-sensitive deadline. One of my clients set great SMART goal this year: “I will train to complete the Pat Tillman Run on April 16th in under 40 minutes by running three times a week for the next three months, building up my endurance and distance until I can run 4.2 miles within my goal time.”

How about you? What have you found to work best, what real-world tips would you offer to someone who wants to get their health and their weight under control?

Last night I was watching"The Biggest Loser" while taking down my Christmas decorations. It's not that I agree with everything the show says or does…but it helps me to understand where the people I work with get their ideas about nutrition and exercise.

Anyway…the first pair to be removed from the competition was a father and daughter team. The father was not too motivated to participate in the competition, much to the frustration of his daughter. Adding to this woman's frustration was the fact that, despite her being in the gym and working at least twice as hard as her father, she lost only 1/3 of the weight.

And every season it seems to be just like that. The women who work the hardest see the least weight loss. And every time I see some woman removed from the show for her low weight loss…I want to throw something at my television and scream,"DUH…insulin resistance!!!"

A few years ago I participated in a local TV station's version of this program. Four teams of two screened videos in order to choose the people who would be competing under our guidance. The trainer I was teamed with actually turned to me in the middle of watching a video of a woman with a PCOS-type body and said…"I hate working with this type of person" I asked why, and he responded,"Because it takes them forever to lose weight."

If you happen to be one of these people who would be kicked off of national TV for not losing weight quickly enough, or if your doctor rolls her eyes when you mention that you're eating less and exercising more with no results…take heart.

It's not that you can't lose weight and get into shape, it's more that the ways we tend to believe it needs to be done in our culture are working against the hormone profile your body has drifted into when it was not getting the right mix of good nutrition, physical activity, sleep, and relaxation.

If you watch to the end of the show, these women always do lose weight, it just takes longer for their body to respond to the new way of doing things.

So don't take these messages or slow weight loss as signs that you're destined to have the body you currently have. Just remember that your body is one that responds better to consistency and diligence and slow changes better than it does to quick fixes.

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.

I am a regular exerciser. I'm not super buff, but I am pretty active. Over the last year I have been working out on weights to try to add weight to my (rather wimpy) upper body.

So when I was told at my gym that I had an opportunity to be analyzed for free by a personal trainer, I thought I would take advantage and see what the measurements were.

I'm not obsessive about things like this, in fact, I had to go back to the locker room to weigh myself because it had been so long since I'd been on a scale I didn't know how much I weighed. But I've been the same size for so long I know I have not been a victim of weight creep.

So when the trainer told me that my body fat percentage was 33%, I was floored. I work out 4 times a week, I run, lift, swim, rollerblade…and my clothes still fit.

What gives?

I had the presence of mind to say to the trainer…"Did I mention to you that I have a master's degree in exercise science and I am a registered dietitian?" I've done lots and lots of body composition measurements on other people and I would like to understand just how you got that reading on a person such as myself when I know how much I exercise and what I eat."

At which point he quickly said,"Well, I was just going to shave a few points off of that number and tell you that you're probably more like 27% fat."

Interesting. According to his machine I was in desperate need of his services until I asked him for some science to back up his claim, at which point I suddenly didn't look so bad.

I left the gym thinking how fortunate I was to (1) have enough knowledge to know when I was being scammed and (2) to have enough self-esteem to not be devastated by this poor attempt at marketing a service to me I didn't really need. But…I continued to think about how many women reading this blog might not have either, and who might be driven into some pretty dysfunctional and dangerous behaviors when delivered this kind of news.

A word of caution: any apparatus that claims to measure your body fat using a technique called"bioelectrical impedance" is likely to be grossly inaccurate. Those are the handy little machines you hold for a few seconds while they estimate your body water and work backwards to figure out how much of what is left, is fat. If you are at all dehydrated…you'll look fatter on those machines than you really are.

If it's really important to you to get a body fat measurement, the most accurate way to get them done is using a very inconvenient, high-maintenance technique called underwater weighing. If you can get this done, go for it! If you can't, make sure you find a trained exercise professional who can do a caliper reading. Good caliper technicians can come pretty close to underwater weighing.

You can also measure inches--waist circumference, hip circumference, thigh, arm, etc. It can be really helpful on those weeks when you may be plateauing on the scales to see that your waist is continuing to shrink.

In my case, it turned out that I'd gained 3 pounds of weight since I'd last weighed, but all my pants and skirts were fitting exactly the same, likely meaning I'd gained some muscle in my upper body. I chose to be excited about that rather than let the used car salesman…er…personal trainer…ruin my day.

Be sure you focus on the right reasons for exercising and do it for the fact that you sleep better, have more energy, and are helping to balance your hormones, not because you're making money for someone else who doesn't deserve to have it.

A few years ago I stumbled on a website that is a great resource for people wanting to learn about the relative health benefits of individual foods.

This website, www.nutritiondata.com, provides some PCOS-pertinent information in addition to the the traditional calories/carbs/vitamin content most other websites provide:

1. Fullness Factor: An indication of how physiologically full a food is likely to leave you feeling. For those of you who are trying to lose weight, the closer to the upper right hand corner you get, the more supportive of your weight loss goal that food is likely to be.

2. Caloric Ratio Pyramid: If you've been advised to eat a certain percentage of carbohydrates, proteins, and fats, this section will tell you how closely you are meeting that goal.

3. Estimated Glycemic Load: Gives you an idea how your food choices are promoting…or discouraging…good insulin function.

4. Inflammation Factor: Since PCOS is a disease of inflammation, your goal is to have as anti-inflammatory of an eating pattern as possible.

You can keep your food diary here and see how a daily total adds up.

It's important to remember when using a tool such as this, there is no perfect way of eating, and no good or bad food. A food that is more inflammatory or less filling isn't bad, it's just one that needs to be eaten in smaller quantities in order to not throw your daily nutritional value in the pro-inflammatory direction.

I italicized the word physiological above because this tool does not work with emotional hunger. If you're using food to cope with depression, in response to negative pregnancy tests, or as an outlet for feelings you may have about PCOS-induced appearance issues…it's important to ask for help in learning outlets with less potential to be self-destructive.

Our"Food of the Week" feature is designed to help encourage a variety of foods, since many women dealing with PCOS have been on so many restrictive diets and yo-yoed back to an even higher weight, they often find themselves in a place where they don't even know how to get started on truly healthy eating. We can't possibly tell you every single food that will work, but we can trigger some ideas. With a tool such as this website, you can hopefully take the information you've learned here and apply it to your entire daily intake.

Have a great week!

Ten percent of women with PCOS will be type II diabetic by the time they are 40. One of the primary risks of pregnancy with PCOS is the same problem, diabetes. It is very important to understand that choices you make regarding food, activity, stress, and sleep, affect whether or not this problem…becomes YOUR problem.

Fortunately, in many cases, it is not necessary to do anything different than we already recommend in this blog. One study looked at four different ways diet could be manipulated to encourage weight loss: (1)calorie restriction without any seafood included, (2) calorie restriction with lean fish included, (3) calorie restriction including fatty fish, and (4) calorie restriction including fish oil pills. It didn't matter if it was lean fish, fatty fish, or fish oil pills…the more fish oil consumed, the better the insulin function.

I'm not one of those nutritionists who focuses entirely on salmon when advising to eat fish. First of all, it's simply not eco-expectable that there are enough salmon on the planet to feed everyone who needs omega-3's. Secondly, it's a seasonal fish and it's expensive enough to price itself out of the food budgets of many people I work with. A few years ago I looked up the omega-3 contents of many kinds of seafood, and discovered that whether it was salmon, shrimp, clams, tilapia…or bass…if it lived in the water, it had omega-3's in its flesh and it was a proactive health choice.

Don't like"fishy" flavor? Try halibut or tilapia. Or look for one of the many flavored fish oil supplements available in your local health food store. There's a way for anyone who has the will, and if you're at risk for diabetes…there's NO way you want to miss out on this wonderful dietary opportunity.

Ramel A, Martinéz A, Kiely M, Morais G, Bandarra NM, Thorsdottir I. Beneficial effects of long-chain n-3 fatty acids included in an energy-restricted diet on insulin resistance in overweight and obese European young adults. Diabetologia. 2008 Jul;51(7):1261-8.

Many of you living in Los Angeles saw the story on PCOS the past two nights. For those of you who didn't see it, I'm posting the first half of the story here.

I found this piece moving and was especially thankful to the women for letting LA (and the Internet) into their lives. Los Angeles can be such an appearance-focused community, and to talk honestly about how it feels to live with a syndrome that doesn't allow you to live up to your community's unspoken code of appearance…well, I'm not so sure I would be that brave.

A crucial component of my professional PCOS training is to invite women with PCOS to come tell their stories to the health professionals aspiring to help them. I never cease to be amazed at the unsympathetic, uninformed, and even abusive things that are said to"cysters" that is intended to be advice, but only leaves the women feeling even more hopeless. At one conference in particular, every physician in the room personally apologized to the"cysters" who spoke, not just for themselves, but on behalf of the colleagues who were not there to hear their stories.

I know it's really hard to reach out for help if insults, condescension, and not being believed are what you've experienced when you tried. As you can see in these videos, there are people who care, who understand, and who can help. We hope you reach out to them.

The second half of the story is here. I wish there had been more time for more nutrition information, as there is so much that can be done that was not mentioned. And, as many of you know, if not done wisely, well-intentioned dieting can easily flip into a vicious eating disorder. If you like the story, please email Fox News and let them know. If they know these kinds of honest portrayals are what bring them viewers, they are much more likely to give you more of what you like!

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

If you look to the right, you'll see an ad for Green Mountain at Fox Run, our sponsor on this blog. I wanted you all to get to know them, since they're not your typical weight spa and they're not your typical program. So I sent them a few questions. Here's what they shared. And if you want to learn more, just click their ad to get to their website.

The photo I chose is of Ludlow, Vermont, where Green Mountain at Fox Run is located. No matter what time of year you choose to go, it is breathtaking, a perfect place to step out of life for a bit and recharge your PCOS battery.

1. How did GMFR develop its interest in PCOS?

It's a pretty common problem for the women for come to Green Mountain. Although many of them aren't diagnosed with the problem before they come to us, we recognize the signs/symptoms and are able to help them explore whether they do indeed have PCOS. Our awareness of PCOS has allowed us to help our participants much more effectively as a result. We also feel it is very important to educate women on this subject so they can be proactive in discussing signs/symptoms with their healthcare providers.

2. Do you have a specific program for PCOS? If not…how do the programs you have help with PCOS?

We do offer a workshop on the topic and also offer individual consultations for any of our participants who either have been diagnosed with PCOS or are questioning whether they have it. Our whole program, however, is designed to combat insulin resistance, from the physical activity classes to what we serve in the dining room. This, of course, while also presenting a livable approach to healthy living that feels great, makes a real difference in our health and helps us feel better about ourselves and our bodies.

3. Can you share a success story of someone with PCOS who visited GMFR?

Before going to Green Mountain, I had a lot health concerns associated with having PCOS. I felt like there was nothing in my power to change my situation. I’d had no success losing weight and felt tired and drained all the time. I hadn’t had a regular cycle in over 6 months and had serious concerns about fertility in the future. While at Green Mountain, I learned how to not hate my body for “failing” me. I learned how to motivate myself and how to make my body work for me, not against me. With Green Mountain’s help, I have taken control of my PCOS and become proactive in my quest for healthy living. M.L., Texas

4. What's for dinner tonight?: )

Panko-Encrusted Fillet of Cod with Basil Aioli
Red Onion & Herb Quinoa
Gingered Carrots
Strawberry-Maple Parfait