The Hemp Connection [Search results for anorexia] 

I have been out of the full-time eating disorder world for awhile now, so issues that are daily topics of debate for some colleagues aren't on my radar as frequently. One that just came to my attention is that the proposed diagnostic criteria for eating disorders for the new Diagnostic and Statistical Manual, version V, may not work in the favor of women with PCOS.

For those of you not familiar with this manual, it is a handbook written by the American Psychiatric Association containing diagnostic criteria for diagnoses ranging from schizophrenia to learning disabilities. Eating disorders are all included, and treatment teams at eating disorder centers use this manual daily as a way to diagnose and categorize treatment plans for their patients.

Here is the main link with further links to all three proposed eating disorder diagnostic criteria: anorexia nervosa, bulimia nervosa, and binge eating disorder.

The nice change that I am happy to see, is that binge eating disorder is actually a proposed official diagnosis. It has been very hard for men and women with this diagnosis to be taken seriously when asking for help. This step on the part of the APA is a much-needed advancement in eating disorders treatment.

What I'm very troubled by, is that there is no recognition, whatsoever, in any of these three diagnoses, of the hormonal changes that are an important part of the diagnosis and treatment of them.

--Loss of menses in anorexia nervosa, part of the diagnostic criteria in DSM-IV, has been removed from the proposed DSM-V version.

--Changes in menstrual health, though well-documented to exist in bulimia, are not noted as a diagnostic criteria.

--No mention of menstrual function exists in the new proposed criteria for binge eating disorder.

My personal belief is that one of the most crucial points of identification for PCOS…is eating disorder treatment. When a woman recognizes that her hunger and appetite mechanisms are not working, and she asks for help with this problem from eating experts, it seems to me that one of the very first things this team should be evaluating, is whether or not the problem has a physical/metabolic origin. If you try and treat a metabolic issue primarily as if it is a psychiatric and/or behavioral issue, you're likely going to have a lot of trouble succeeding in the treatment of that problem.

I'm not the only person who feels that way. A dietitian who completed the inCYST training and who worked in an eating disorder treatment center screened the population of that center for the potential presence of PCOS. The findings were so profound that she shared with me once that she believes screening for the presence of PCOS, by anyone working in eating disorders, should be a universal precaution.

I'm optimistic that some of the research I hope to fund with our up and coming nonprofit foundation will change the way eating disorder treatment professionals currently think. To not include neuroendocrine disruption in the diagnostic criteria, is a huge oversight and it keeps the professionals working in eating disorder treatment from improving their reported rates of treatment success from being higher than they currently are.

And that by the time I am hopefully long retired and working on my screenplay that has nothing to do with PCOS, the diagnostic criteria for the DSM-VI, for all three eating disorders, will certainly include menstrual irregularities.

When I ran across this research study, it immediately brought to mind most women I know with PCOS--because they focus so much on restrictive eating as a way to improve their condition. Women with PCOS that has not yet been diagnosed often develop eating disorders as a way to manage it. If their eating disorder is anorexia or bulimia, it encompasses deprivation. And it often bounces back into binge eating disorder when the PCOS wrangles control back in its direction.

And if you've tended to lean toward the binge eating direction, you've likely been advised to lose weight. And much of the advice you have been provided for how to do this, even by licensed health care providers, has been about eliminating--calories, carbohydrates, even entire food groups. Most of what I see on Facebook, Twitter, Yahoo Groups, where women with PCOS are talking about what they're eating, it's about extreme programs and denial.

It seems to be especially prevalent in women who are trying to conceive. So when I saw this study, I wanted to share it.

This is a study done on cows, but I believe there is a good takeaway lesson. So bear with me.

Seventy-two pregnant cows, about a month before their due dates, were assigned to 6 different dietary regimens:

Ad lib eating with canola-supplemented feed Ad lib eating with linola-supplemented feed Ad lib eating with flax-supplemented feed
24% calorie restriction with 8% canola-supplemented feed 24% calorie restriction with 8% linola-supplemented feed 24% calorie restriction with 8% flax-supplemented feed (Linola is a low omega-3 form of flax often fed to cattle)

After the calves were born to these cows, they were fed the same non-supplemented lactation diet.

From one week after birth, the cows underwent reproductive ultrasounds twice a week until they again ovulated. Here are the very interesting findings (I discuss them below).

1. Cows fed without caloric restriction had higher body weights before delivery, but after delivery, they had fewer ovarian cysts.
2. These cows, regardless of what kind of fat they were given, did have a higher incidence of uterine infections.
3. Regardless of diet treatment, the time it took for the uterus to return to its normal size did not differ.
4. It took longer for cows to ovulate after giving birth if they were fed canola oil, regardless of calorie level eaten, than it did if they were fed linola or flaxseed oil.
5. A greater percentage of cows whose diets were not restricted during their first pregnancy were able to conceive a second time with the first round of artificial insemination.

OK, the obvious omission in this study is the overfed cow. But cows are not natural binge eaters so it's understandable why this condition was not included in this study. But…what this study really highlights, is that restricting calories is not really the best fertility-friendly strategy. (The degree of restriction was actually far less in these cows than what many of our inCYST fans impose on themselves. It was the equivalent of a 1350 calorie diet for someone who would normally need 1800 calories to maintain their ideal weight.)

Secondly, even though we do talk about using canola oil because it has a nice omega-6 to omega-3 ratio, continuing to eat your favorite fried foods and using a"healthy" fat may not really be a productive strategy. You will help yourself most if you learn to eat foods that are not too high in fat.

Bottom line, it's not about the quantity of calories, it's more about the quality. It's not about extremes, it's about balance.

If you're having a hard time with balance, let us help you!

Colazo MG, Hayirli A, Doepel L, Ambrose DJ. Reproductive performance of dairy cows is influenced by prepartum feed restriction and dietary fatty acid source. J Dairy Sci. 2009 Jun;92(6):2562-71.

Unless you live in a rock in a Pakistani cave where the wi-fi signal can't reach, you are well aware that there are a lot of indignant people this week. They're upset because Facebook made some significant changes to its format.

Some people stomped and screamed and threatened to move to Google Plus. I saw some of them later in the evening after they'd cooled off.

Some people just dealt with it.

The incident reminded me so much of my 3 1/2 year tenure as the Director of Dietary Services at an eating disorder treatment center. I was in charge of the menu, and more importantly to the 30-40 women with anorexia and bulimia I was feeding…the rules defining how they could interact with that food at the table. For the most part, other than the expected negotiations around foods like butter and dessert, things went smoothly and the rules were honored.

Except…and I'm telling you, I always had to hunker down and grit my teeth and drag myself to work on these days…we changed a menu item or a food rule. Those days, without fail, triggered the worst migraines I have ever had. I'd jokingly write up invoices for my boss for extra hazardous duty pay, since those days I'd sometimes even find notebooks and cans of Ensure flying millimeters from my ear from the direction of a dissatisfied patient. My staff kept a chalkboard in the back on which they took bets on how many petitions for special dispensations from the rules I would get…it was that bad. Humor was our main coping skill for working with such a high-maintenance population.

The degree of mutiny didn't correlate at all with the amount of change I introduced. I could simply be changing the order of who got their plate first, or I could be adding a new item to the menu. Anything that required adjustment to a new and different way of doing things, met with resistance.

Unlike Facebook, we did a LOT of proactive work, educating our population about what our changes would be, so they could be prepared. But I can tell you, even with the exhausting degree of communicating we provided our change-averse demographic…the mutinies occurred like clockwork.

So the other day, watching the reactions to the Facebook changes brought back a lot of flashbacks from my treatment center days. I have a pretty good idea how it felt to be working on the Facebook campus the last 48 hours.

I've been on Facebook for going on 3 years now. Long enough to know that this is the exact same thing that happens everytime they change. People stomp, scream, whine, complain…then they settle in and learn to use the new system. All is well until the next set of changes rolls out.

What does this have to do with PCOS? The moment you were given your diagnosis is a lot like the moment you logged on to Facebook and found that the old way of doing things was no longer pertinent. You were knocked out of your comfort zone. You were told that you were going to need to learn to do things differently.

How are you dealing with the new changes?

Are you investing most of your energy into fighting the change?

Or are you able to see the humor in the situation and work to learn a new (and maybe even better in a few ways, as I'm finding) way of doing things?

Consider that how you respond to events like the Facebook change may give you insight into how you deal with your PCOS. Learning to roll with, and accept change, can be a crucial part of your PCOS success. The unfortunate reality is, no matter how angry it makes you that you got the diagnosis, no matter how uncomfortable the changes you need to make may make you feel, if you don't eventually get on board, the world is going to progress without you.

I'd really hate to see you be left behind.

You may know of melatonin as a potent sleep aid. So much so, that if you took melatonin and you did not experience an enhanced ability to sleep, you stopped taking it.

Did you know, melatonin is a very powerful antioxidant as well? Some of the benefits of this compound relevant to PCOS include:

--lowered blood pressure
--improved memory
--reduced adrenal gland activity and cortisol secretion
--reduced cortisol response to stress
--reduced blood glucose, insulin levels, and insulin response to a glucose load
--reduced cholesterol and triglycerides
--reduced testosterone levels
--increased progesterone synthesis
--slows gastric emptying (which can help you to feel fuller, longer)

That's a lot of stuff! And it's not just not sleeping well that interferes with melatonin metabolism. So does fasting and starvation…which includes any kind of radical diet, including the medically supervised ones and the HCG ones. Melatonin levels in all three types of eating disorders, anorexia, bulimia, and binge eating disorder, are disrupted. Obesity suppresses normal melatonin daily rhythms. Omega-3 deficiency reduces melatonin synthesis and total tissue levels.

Vitamin deficiencies such as B12, zinc, and magnesium, can interfere with good melatonin status. When I read that, I immediately thought of the many vegetarians reading this blog, as those are common deficiencies when vegetarian eating is not proactively balanced.

Normal melatonin metabolism may be dependent on physical activity.

Medical problems associated with a melatonin imbalance include: affective disorders, Alzheimer’s disease, arthritis, asthma, autism, bipolar disorder, cervical cancer, chronic fatigue syndrome, cluster headaches, congestive heart failure, coronary artery disease, Cushing’s syndrome, depression, diabetes, duodenal ulcer, epilepsy, fibromyalgia, hypertension, idiopathic pain syndrome, lung cancer, metabolic syndrome, migraine headaches, obesity, obsessive-compulsive disorder, panic disorder, Parkinson’s disease, polycystic ovary syndrome, pre-eclampsia, premenstrual syndrome, schizophrenia, seasonal affective disorder, sleep apnea, and ulcerative colitis.

I'm well aware that many people reading this blog are looking for a magic supplement to erase the need for making healthy lifestyle choices. If you choose to supplement with melatonin, it likely will not hurt you, and it may help you to restore normal sleep patterns, but it will never replace the power of regular, adequate sleep. Just sayin'.: )

If you've never used melatonin before, and you decide to start, you may want to try it on a night when it's not essential that you be up and functioning early the next day. It can have a paradoxical reaction in some people.

And, if you happen to be a professional pilot, the FAA advises against using melatonin while on duty. It certainly wouldn't hurt on your days off, especially if you've been on some grueling red eye flights, just beware of this disclaimer while officially on duty.

I have an extensive list of references I've collected from which this blog post was derived. If you would like them you can contact me directly.

Bottom line, if you don't value sleep, your body is going to have a really, really, really hard time being healthy.