I recently mentioned that I was embarking on a mini-series of blog posts about the grief process, and how it relates to PCOS. I talked about a handy summary term known as DABDA, which stands for denial, anger, bargaining, depression, and acceptance. Denial is present in our lives in many ways, and it’s actually a very helpful defense – sometimes our minds go into denial, because unconsciously, they know that we’re not quite ready to handle a crisis, trauma, or issue yet. For example, the woman who sees signs of cheating in her marriage, yet overlooks the hints, bypasses opportunities to question her husband, and insists that her neighbor can’t be right – yet she KNOWS in her heart that it’s true. That’s denial.
In death, denial is often quite literally a failure to recognize or believe that a person is dead, that they died a certain way (i.e., suicide), that the death was unavoidable, or that they are not at fault in the death. While one is in the process of dying, the denial may simply be a belief that it is not possible to be dying from THIS – not me, not now.
Specific to PCOS, denial looks: • “I don’t have PCOS – it’s something else – they just haven’t come up with the right diagnosis for me.” • “PCOS is no big deal – I mean, I had to have an IVF and all, but whatever – I got my baby, and now I can ignore it.” J • “PCOS isn’t like a terminal disease or anything, so why do I have to deal with it?” • “Having a baby will fix it. That’s 10 years away, but in any case, I don’t have to deal with it now.” • “Those medications don’t really work (so I’m not going to take them).” • “If I just can find the right combination of supplements, this will all be okay.” • “If I go gluten-free, I’ll be cured – but that’s so impossible, I won’t even try.” • “I’m pretty sure that dark chocolate is a health food, so I’m going to have this entire 3.4 ounce bar.” • “Exercise is overrated – I’ll just gain weight if I gain muscle mass, right?”
Denial’s great when it really is needed and protects you, like the child who is being molested and denies it until she’s an adult, when it’s actually safe for her to tell someone. Or when you just got a cancer diagnosis, and you don’t quite get that your particular cancer has a 75% mortality rate – and maybe if you realized that before you got a chance to explore treatment, you’d consider suicide to be a good option. Sometimes it’s protective.
Yet, as adults, most of the time, denial is working against us. It prevents us from seeing the real picture of what’s happening with our bodies, our lives, and our relationships. It prevents us from grieving. It keeps us from making decisions that will improve or protect our future. It stops us from eating better, or exercising more, or getting enough sleep (another favorite form of denial that I hear all the time is “I don’t know how I do it, but I can totally get along on five hours of sleep” – to which I say, BALONEY!). It stops us from spending money on the help we really need. It allows us to continue engaging in damaging behaviors, poor self-care, and unhealthy relationships.
If reading this gives you a little stinging sensation of recognition, there’s good news. You can start to acknowledge reality. Talking to someone who cares about you, sharing your fears and the thoughts you’ve been hiding, is a good start. If you can’t do that, put it in writing – it’s amazing how seeing it in black and white can help to bring clarity to your random thoughts.
Next week, I’ll address anger, and the insidious impacts that it has on your health.
Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She has completed the inCYST training. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.
If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at AskDrHouseMD@gmail.com. You can also follow her on Twitter @askdrhousemd.
Mindfulness. You hear that word a lot from people like me trying to help you move toward health…it's kind of a tough concept to describe. Over the weekend we were experimenting with the iPad and filming a pilot"Yoga for PCOS" class, and something happened during filming that perfectly illustrated how mindfulness works.
We live in a culture that is constantly bombarding us with stimuli. It has gotten worse in the past 5 years or so with the advent of smart phones, as we can literally be on alert 24/7 with beeps, buzzers, and"push" notifications. We can get so drawn in to social networking sites that we feel if we don't read every single status update, watch every single video, respond to every single event invitation, we are somehow missing out.
It is possible to spend an entire day connected to a screen, at the expense of losing connection to real people right in front of us. To see this for yourself, I challenge you to go for several hours with your phone and tablet left behind, and spend time in a public place. Look at how many people are focused on their phones…texting, IM'ing, talking…instead of participating in the world right in front of their faces. I have actually started turning off email and wireless connection on my writing days, so I am focused on one thing, and not constantly being tempted to shift my focus by random, multiple notifications coming at me from all directions.
The drawback to this is that when you are absorbed with your techno toys, you are also not listening to important messages your body is sending you.
You might ignore hunger. Which might seem like a good thing…except that in ignoring hunger, you often push yourself to the point of being ravenous before you respond to the cue.
You might ignore that you are tired, and stay up half the night playing Farmville, and you know if you regularly read this blog, poor sleep hygiene drives insulin resistance and worsens the symptoms of PCOS.
You might also ignore emotions. Feeling angry, sad, lonely, are uncomfortable to allow yourself to do. But those emotions are no different than physical cues, they are guiding you toward actions you need to take. If you ignore your emotions, they don't go away, they just amplify and amplify until they get your attention. If this is how you choose to deal with your emotions, their magnitude by the time that you are forced to acknowledge them, can be so great, that your response to them is at risk of being extreme--rage fits, excessive exercise, binge eating, alcohol dependence--are all common ways that people often deal with emotions they are afraid to face.
Mindfulness is a conscious exercise that develops your ability to be more aware, throughout the day, of how you are feeling. It is also called"being present". Your attention is on you, your immediate surroundings, and how you feel in those surroundings. If you pay attention to those things on an ongoing basis, and make conscious decisions about how you are going to address the situations, you can avert a lot of emotional outbursts, and binge/compulsive-type behaviors that sabotage PCOS management.
Meditation is a way to practice staying focused on yourself without being pulled away by distractions. Most people struggle with meditation at first, because until they start, they are not even aware of what thoughts and feelings they have been avoiding. It can be extremely uncomfortable. If you stick with it, it does get easier, you do develop more comfort with those thoughts and feelings, and they tend to not hit the magnitude where they convert into toxic behaviors.
When we were filming the other day, one of Sarah's kitties really wanted to help. So while Sarah and Deborah were busy focused on practicing meditation, kitty felt a little bit left out because her usual attention-getting behaviors were not working for her. (That is often what happens when we stop allowing ourselves to be distracted…the people who are positively reinforced by distracting us lose their own distraction and"up the ante" to pull us back into the unhealthy thing they need to do.)
So in this video, Kitty works and works and finally gets Deborah 's attention. For a split second, Deborah's focus on meditation was broken. But she quickly caught herself and got right back into the groove.
Now if it wasn't Kitty wanting some loving that could wait, and rather a sudden thunderstorm, Deborah may have chosen to prioritize getting out of the rain.
Practicing mindfulness is exactly like that. You develop the ability to close out distractions. You can't ever really make them go away, life is about prioritizing and ably handling then,any distractions that are thrown in our path. The goal is to acknowledge them, just as Deborah acknowledged Kitty, and get back to more of a personal focus as quickly as possible.
Enjoy the video! It is one of several segments the kitties helped with…as the person behind the camera I was experiencing my own special mindful moments, working extremely hard to not disrupt the session with laughing, or peeing in my pants from not laughing.
We had a great time, and will have updates soon on how you can participate in our yoga program.
Back in November, I shared my story of my remodel with you, along with photos of what my dining room looked like with the contents of my entire life piled into the dining room.
Last week when this popped up on my daily calendar, I figured it would be a good time to update you on my progress, as some of you asked.
To refresh your memory, here is what things looked like just after the remodel. I cannot even express how overwhelmed I was! I was happy to have new flooring, don't get me wrong. But the timing was tough, right before the holidays. The year before, at the same time, I was so consumed with caring for a beloved dying kitty, there were no festivities. I'd consoled myself by looking forward to a better next year. And then this.
I was exhausted just thinking about it. But the words of my friend Katja, who loves to say when faced with an insurmountable problem,"the best way to eat an elephant is one bite at a time," were there to inspire me.
Rather than let the pile overwhelm and exhaust me out of doing anything with it, I decided to just deal with 10 pieces a day. That was it. They either had to be placed in a storage place or thrown away. I knew if I did more, I would start getting frustrated and shove things out of sight just to get rid of them…which is exactly how people accumulate junk in the first place! This was going to be my opportunity to go paperless.
Here is how it looked this past weekend! Much better!
There were days when it felt I wasn't getting anywhere. And days where I felt like things had taken a huge leap. Days when I didn't want to deal with it at all.
And then I noticed, when I had busy days on my schedule, I would actually make time to work ahead so I wouldn't get behind on days when I was traveling. I just kept going at it.
And then there was the day my parents brought me 3 boxes of childhood belongings from their home for me to go through. I was happy to see them, but it felt like it pushed me back to where I'd started.
But I just kept plugging away.
As you see, I still have a ways to go! Here is a look behind the table. But I'm getting there. I have decided to treat myself when this room is all finished, to a new table and chairs.
And I will check in with my progress in a few months.
Hopefully using this analogy, outside of your personal situation with weight or infertility, can help you to understand that any time you take on a big change, regardless of what it is, persistence and commitment are what you're going to need to have in order to get to the goal. It won't happen overnight and it won't be easy, but it will be worth it.
Anything in life that is really worth having requires effort and sacrifice. If it was easily obtained…it would not be something you valued in the first place.
In my experience, dietitians tend to come from one of two schools of thought: (1) those who believe in structured meal plans and (2) those who promote a concept known as intuitive eating. It is very all-or-nothing. Which is ironic, since intuitive eating is supposedly about eliminating all-or-nothing thinking.
I've worked with both, and at this point in my career, in my chosen specialty, I am a blend of both. And that is what seems to work best with PCOS.
It would be nice if women with PCOS could be intuitive eaters. But it isn't a natural talent, and it often isn't possible out of the starting gate.
Here's a story from my caseload to illustrate.
A few years ago, I met with a young woman with PCOS. We met for an hour and half. I sketched out a meal plan for her and explained how it would help her cravings and make it easier for her to eat intuitively. She was very polite and accommodating, but at the end of the session she asked me,"But what am I going to do about my cravings?" I reminded her that her cravings would decrease. She asked the same question again. We went in this conversational circle several times, and it finally hit me, that my poor client had struggled with her intense carbohydrate cravings for so long that she no longer even knew what hunger was. She had also been let down by so many health professionals giving her bad advice that she didn't trust mine.
I finally asked her to tell me what she normally did when she had cravings. She motioned me to follow her into her kitchen, where she opened a drawer and showed me her stockpile of Snickers, 3 Musketeers, and Baby Ruth bars. I was completely humbled. I realized that since I don't have PCOS myself, I had no way of relating at all to the women who had the syndrome who I wanted to help.
I told her to do her best to follow my meal plan, and if the cravings got to be really bad, to have a candy bar.
The good news was…she never once needed a candy bar.
Lesson two for ME was…now that we'd eliminated the cravings, I was working with a completely blank slate, with a person who really had never had an opportunity to learn what foods she liked and didn't like, or what hunger and fullness really were. She had been at the mercy of cravings for years.
We had to start with a structured meal plan in order to learn what many of us learn as children. I literally had to put foods on the list for her to commit to preparing and trying. Gradually, she started to understand what hunger and fullness was, and a good chunk of the time, she was able to use some intuitive eating skills.
But the story doesn't end, even THERE!
As the layers of disordered eating peeled off, and food became less of a priority, my client now had to deal with the reality that she now had quite a bit of free time on her hands that once belonged to food procurement. She had to learn to deal with that time in ways other than boredom eating, or eating in response to emotions she was becoming aware of.
Something else that I've learned is that there are times when intuitive eating can be the primary tool a woman with PCOS uses, and there are times when it simply won't work. You may need to be a little bit more structured when you are under stress, when you've got a cold, haven't slept well, are pregnant, etc. When you are insulin resistant, and you're increasing activity and decreasing food intake, you may have times when you feel very hungry, to a degree that doesn't match what you observe about your routine. It can feel scary, and it can be tempting to binge. You may need to gently back yourself out of that corner with some simple structure.
Each one of you has a different story, a different PCOS presentation, a different hormone function, a different brain, and a different response to food. The most important thing you can look for in a dietitian, is not one who is going to tell you that you need to be an intuitive eater, or a structured eater, but one who empowers you to discover who YOU are and to help you design a lifestyle that accommodates what you need to do in order to maximize your potential.
Our inCYST dietitians are all trained to help you map out this path of discovery. If you've tried the"all or nothing" approach to restoring eating sanity, and no way seems to work well, consider engaging the help of someone who understands that you are unique. Our referral page is getting longer as professionals complete the training. Be sure to check in the next few weeks as I add names and contact information for options that might work for you.
This post continues our mini-series on PCOS and the grief process. Today, we’ll focus on anger, which is the second stage of the grief model known as DABDA (denial, anger, bargaining, depression, and acceptance). Anger is a tricky emotion. People often label anger as bad, or undesirable. They deny it, refute it, avoid it, hide it, and act out around it. Anger and sadness that feel unmanageable are two of the most common reasons people show up in my office.
In death and dying, the person who is dying may be angry at god, the doctors, herself, her family, the guy who gave her the disease, the environment, and a number of other things. Likewise, the loved ones who are losing someone may have the same types of anger. In chronic illness, we may have the same targets for our anger, which may result in self-hatred, low self-esteem, acting out, and damaged relationships.
There is SO much to be angry about when it comes to PCOS, I’m sometimes surprised that we’re not all raging, all the time. At various times in learning that you have PCOS, and then starting to deal with it, and then just living with it for a long time, you might experience anger towards:
• God, because you have it • The universe, for creating this thing • Doctors, because they can’t cure it • Your parents, because they gave you the genes that cause it • Any woman who doesn’t have it • Men, because they can’t have it • The medical industry, because they haven’t cured it either • Your body, because it’s not working “right” • Other people, for not understanding • Anyone who has children, if you want them and don’t or can’t have them • Anyone who seems to enjoy perfect health, in spite of living an obviously unhealthy lifestyle (think, daily consumer of fast food who still has a perfect cholesterol panel, and no weight issues) • Yourself, for not doing your self-care better, or more perfectly • Any other medical professional, personal trainer, or other well-meaning individual you’ve ever encountered who said something stupid, irrelevant, pointless, misdirected, or just generally lame, in an effort to get your body to behave • Dieticians who tell you what to eat without understanding your particular brain chemistry
All of this anger might lead you to act out, which could look like:
• Eating whatever you want, whenever you want – in spite of knowing better • Failure to exercise – again, in spite of knowing better • Overspending – because if you’re going to be fat, you might as well look good • Unhealthy sexual behavior – “I’ll take whatever I can get, since no one would want me otherwise.” • Manifesting other illnesses that are stress-related • Being verbally or emotionally abusive towards your spouse, your kids, or others
Note that these things are not purely related to anger; they may also be indicators of other conditions, including mental health disorders.
These are big lists, and you are absolutely right to have a lot of anger about a lot of things related to PCOS. But you can’t live in anger all the time. Well, you can, but it’s surely not a healthy choice. So, how do you deal with all this anger, and get it out of your system, so you can move on to something more productive? And why do you even need to do that in the first place? I believe you need to get over the anger for the simple reason that Freud was right on this count – anger turned inwards becomes depression, and we’ve already got enough trouble with that, given the hormonal set-up we’re dealing with. Also, it tends to lead to negativity, self-hatred, and a more pessimistic perspective, none of which is helpful.
You can get rid of your anger in a lot of ways. Journaling, talking to friends, and talk therapy are certainly good choices. Creative expressions may help as well – creating collages, photographs, movies, music, or poetry that express your feelings are all great. I don’t like to encourage violence, but some clients report that there can be some great satisfaction in doing things like playing one of those video games where things explode when you hit them.
In other words, anger is actually a healthy emotion, but you’ve got to handle it the right way. Next week, we’ll address the concept of bargaining, in the context of grieving your PCOS.
Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She has completed the inCYST training. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.
If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at AskDrHouseMD@gmail.com. You can also follow her on Twitter @askdrhousemd.
Polycystic Ovary Syndrome (PCOS) is a complicated, often frustrating condition that affects many women who are experiencing infertility, or may even be a primary cause of infertility. Symptoms typically include recurrent ovarian cysts, excess hair growth (or hair loss similar to male pattern baldness), acne, skin darkening, difficulty losing weight, and, of course, trouble getting pregnant. Often, the condition is not accurately diagnosed until failure to get pregnant results in referral to a reproductive endocrinologist, who has specialized training in PCOS and other endocrine disorders.
Any of these conditions taken singly are difficult to deal with – but the combination is often overwhelming for patients who have been diagnosed with PCOS. PCOS is particularly difficult because it’s under-diagnosed, so you may have years of vaguely troubling symptoms before the diagnosis is made and treatment begins. The physical side effects are unattractive and visible to the world — “I’m fat, pimply, and hairy,” as one of my clients stated tearfully. Friends and relatives may assume that you’re lazy or eat too much, and that’s why you aren’t losing weight. As a result, depression and low self-esteem are very common among women with PCOS.
I was diagnosed with PCOS in my early twenties, and, as both a patient and a professional, I have learned that there are many things you can do to improve the quality of your life and your health with PCOS. You can take control of your health and mood now by doing the following:
Get educated: Do some research on the web, ask your doctor a lot of questions, join a support group and use it, read the RESOLVE newsletter, and stay on top of developments in treatment.
Obtain skilled medical help: Although an internist or general practitioner may diagnose PCOS, it is more likely that a gynecologist, endocrinologist, or reproductive endocrinologist will do so. If you have PCOS, you will most likely want to have an endocrinologist who will prescribe appropriate medications, monitor you for the potential development Type II diabetes, and coordinate with your reproductive endocrinologist while you are trying to get pregnant. Because it is common to experience higher rates of thyroid disorder and heart disease when you have PCOS, it is a good idea to have frequent monitoring.
Your physician can also:
help you lose weight with the assistance of certain medications, and/or referral to a skilled dietician, who can teach you how to eat in a way that contributes to balancing your hormones and managing your symptoms;
refer you to a good dermatologist, who can help to control or eliminate skin conditions related to PCOS, such as skin darkening and acne, and even help with treatments for hair loss;
suggest a therapist or support group to help you cope with the stress of infertility, symptoms of depression, and frustration of dealing with a chronic disease;
Exercise: Yoga will resynchronize your brain, produce deep relaxation, reduce stress, and enhance your acceptance of your body, just as it is in the moment. The cross-lateral motion of walking is also highly effective in regulating PCOS-related insulin resistance, controlling weight – and, surprise! – resynchronizing your brain waves.
Look better so you feel better: In addition to seeking the help of a dermatologist for skin and hair conditions, you might want to actively manage excess hair growth cosmetically. There are many ways to do this, but electrolysis is the only method that has been proven permanent. A licensed electrologist will have a great deal of experience with PCOS patients. Your dermatologist can provide you with a reliable referral.
Although weight gain around the middle is frustrating and hard to overcome when you have PCOS, you can learn how to dress well, no matter your size or shape – and you deserve to do so! Seek out current fashions that are figure-friendly, and get help when you need it – if you’re just not good at putting outfits together, ask a friend who is good at it to go shopping with you, use the free services of a department store personal shopper, or spring for a stylist who will help you figure out what works on you.
Don’t forget your brain: Education is only one element of what your mind needs to effectively cope with the stress of PCOS. Sometimes friends, partners, and physicians aren’t quite enough to help you work through your anger, frustration, irritability, and sadness about having PCOS, not being able to get pregnant, or the difficulty you experience losing weight in spite eating well and exercising regularly. A licensed counselor or therapist can help you decrease stress, develop personalized coping methods, enhance your support group, and identify additional resources. Many therapists utilize mind/body methods that include meditation, guided visualization, mindfulness, and other ways of supplementing your good health practices.
By actively taking care of your physical and mental health and appearance, you can learn to feel better by knowing that you are doing the best you can with a challenging condition.
Dr. Gretchen Kubacky is a licensed clinical psychologist in private practice in West Los Angeles. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders. If you would like to learn more about Dr. HOUSE or her practice, please visit her website atwww.drhousemd.com, or e-mail her atGretchen@drhousemd.com.
Reprint permission granted by RESOLVE: The National Infertility Association, 2009.www.resolve.org.
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.
Every other Sunday morning, I pull out my “old lady pill boxes” and load them up with my current selection of supplements, some of which are for PCOS. At times, I confess, I’ve been known to take as many as 90 pills a day. If that sounds kind of crazy, I’m in full agreement with you. I often incorporate Chinese remedies prescribed by my acupuncturist, and those are typically dosed at three to five capsules, three to four times per day, which can quickly add up. I don’t do that anymore. But I routinely take a hearty little handful of things like fish oil, D-Chiro Inositol, Vitamin C, and alpha lipoic acid. I’m sure many of you do too – or you think you should be, if you’re not.
Some doctors want to know everything you’re on, and some don’t bother to ask beyond the fish oil or the Vitamin D3. I actually keep an Excel spreadsheet listing everything I currently take, both supplements and prescription medications. This is for my own tracking purposes (so I can see if there’s something I’ve tried in the past and deleted because it didn’t do anything for me – no point in trying those again), and for the doctors who want a comprehensive record. It’s too much to track on, and often doesn’t fit on the few lines given on a doctor’s intake form. “See attachment” is my favorite labor-saving phrase!
As I updated my spreadsheet today, I got to thinking about the lure of supplements. Americans spend $20.3 BILLION dollars (NIH, 2004) per year on supplements. That’s a staggering amount of money for something that isn’t guaranteed effective, may be irregularly dosed, and can be just as powerful as prescription medications. And yet, we continue to buy. PCOS patients in particular are prone to chasing the latest and greatest potential cure – or at least, anything that might offer some symptomatic relief. When you’ve got a condition that’s frustrating, complex, inconsistent, and impossible to permanently resolve, you’re vulnerable to the seduction of marketers, Twitter feed, and anecdotal reporting.
At this point, I try to limit my supplementation to things prescribed or recommended by my physician, dietician, and/or acupuncturist to treat the symptoms that most concern me, such as high blood sugars and inflammation. If I hear about something new that holds some promise for my PCOS, I research it independently and then make a decision about whether or not to add it to my repertoire. I’m mindful of the fact that there’s a great deal we don’t know about supplements, just as there’s a great deal we don’t know about prescription medications. My goal is to support my body in becoming as normal as possible.
Periodically, I get disgusted with the whole thing, decide it’s too many pills, too complicated, too much money, and too overwhelming. Then I take a supplement vacation. And in the meantime, I’m continuously researching and contemplating what I can delete, or if perhaps it’s best to eliminate supplements altogether. The supplement vacation usually lasts a couple of weeks, and then I go back into it a little more strategically, and with greater consciousness about my own need to be “fixed,” and how that can lead to bad decision-making.
If you take supplements, I encourage you to think about them consciously, and not just chase the promises. If you don’t, don’t feel bad about it, but consider what might actually be beneficial to your mental as well as physical health (fish oil comes to mind!). Be willing to experiment, monitor, and make adjustments. Be patient with your body and your brain. Seek consultation with experts. Do your own research. Treat yourself with the importance you deserve.
Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She has completed the inCYST training. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.
If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at AskDrHouseMD@gmail.com. You can also follow her on Twitter @askdrhousemd.
6:30 a.m., Miami International Airport, feeling jet-lagged and just about destroyed from over 24 hours of travel, I looked through my stupor at the people who have come to reside in my head as “The Airport Couple,” a poignant lesson in what happens when you don’t take care of yourself. I love to people-watch at the airport, but this was not my usual people-watching.
They both have canes, are morbidly obese, and have extra-large sodas and pound bags of candy – plain M&Ms for her, peanut for him. The breakfast of champions, especially if it’s Diet Coke. They are struggling to breathe, to move, to walk, and even to eat the candy, yet they persevere. They both have an unhealthy pallor that comes more from poor health than bad airport lighting. Neither one makes eye contact with anyone else, not even their spouse. Their isolation, even in the midst of dozens of people, is profound.
Their misery and shame is palpable, and I feel like I should avert my eyes from their pain, and the practice of their addiction to food/sugar. It hurts to watch them, but I am unable to stop glancing sideways at them, in the way that children do when they notice a grotesquely fat or deformed person and simply cannot keep themselves from staring. I am wondering how they are going to make it onto the plane, and if they’ll even survive the flight, let alone whatever comes next. Selfishly, I hope I won’t have to spend the next six hours stuck sitting next to one or both of them. I feel intense sadness for the way that they’re trapped in their bodies, in their diseases, and their disconnection. I wonder which diseases they have, and how many. I make assumptions about diabetes, thyroid disorders, cholesterol problems, and heart disease. As time passes, and my flight is delayed, I add gout, emphysema, and of course depression to the list.
She is probably 52, but looks closer to 70. Walking is laborious, studied, and painful. Her thighs are so fat that her ability to walk a straight line is distorted. Yet she proceeds to the nearest shop to purchase more snacks for him; clearly, this is a form of care-giving. I think he is older, although it is hard to tell. He is almost immobilized, stuck in the confines of the narrow, hard-railed bench/chairs that are uncomfortable even for people of average size. I look for an oxygen tank, certain that must be part of their apparatus. He is wearing extra thickly cushioned diabetic shoes. I wonder about toe amputations. I think long and hard about this human catastrophe, and how preventable almost all of it is.
We struggle, day in and day out, to manage our PCOS, and whatever other diagnoses come with it. We get tired of eating right, limiting sugar and other carbs, avoiding alcohol and grain-fed meat, getting up at 5:30 a.m. to make it to the gym, taking supplements, and going to the doctor quarterly for check-ups. We complain that it isn’t fair that we’re stuck with this condition. We deal with, or don’t deal with, our depression, our anxiety, our obsessions and compulsions, or the thoughts that we might be bipolar. We adhere to diets and violate the diets. We struggle, and wonder why. I’ll tell you why – you don’t want to be The Airport Couple.
Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She has completed the inCYST training. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.
If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at AskDrHouseMD@gmail.com. You can also follow her on Twitter @askdrhousemd.
There’s been a great deal of attention lately to the practice of “positive psychology,” which focuses on optimism, gratitude, and creating hopefulness. Some of us are optimists by nature, while some are pessimists. Either can be learned, and there are some advantages to each approach. Personally, I veer toward the optimistic side, which informs my clinical practice. Quite often, when people seek therapy, they are feeling hopeless, helpless, and not even remotely optimistic. They’re depressed, anxious, and out of sorts. If they’ve got PCOS, there’s a good chance that their moods are more easily affected by stress than those of other folks. They don’t know how to handle what’s going on in their lives effectively. The smallest stressors send them out of synch. If they are, by nature, the pessimistic type, they often feel validated in their suffering. They believe that they deserve to feel bad, that life isn’t fair, and that there’s very little that can be done to improve things. And yet, they show up. I see the act of showing up as an act of bravery, and the indicator that there is some hope to be found, even if it’s hidden away. What I look for is the tiniest hint – a mere pinprick of light in an otherwise bleak landscape – that indicates a positive potential lies inside my client. It may take some digging, and perhaps some persuading and negotiating, but if we can find just the tiniest thing to be positive or hopeful about, it is encouraging, and it’s something we can build on in their therapy. Sometimes I have to plant a few seeds and it takes a very long time for those seeds to germinate. In the therapy, I keep watering the seeds, fertilizing them, and cultivating the ground until it’s fertile enough to support their growth. Sometimes, the ground is weak, under-nourished, or even toxic from years of damaging abuse, violence, depression, and unhealthy relationships. That may mean that I need to hold hope for the client until she can hold it for herself. My relentless optimism, a double-edged sword (because sometimes I mainly see the good where there is a great deal of bad) is a tool here. Clients occasionally wonder, given what they present to me, how I could possibly find a bright spot in any of it. I’m not sure precisely how I do it, but I guess that it comes from having an intention of finding hope, and a keen eye for the openings. Years of practice tells me that it works. When you’re frustrated to the ends of the earth and back, and you really can’t believe that anything will ever change, and you’ve got a list of dark, negative things that you’re focusing on, you’ll continue to identify with the pessimistic aspects of yourself. But if you can find that one tiny seed, and focus on it every day, it will begin to grow. Your mood and attitude are like the sunshine that every garden plot needs. Remember though that darkness is a necessary part of the germination process. The sun doesn’t have to shine on a seedling all day long to make it do its thing. You don’t either. Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She has completed the inCYST training. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses. If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at AskDrHouseMD@gmail.com. You can also follow her on Twitter @askdrhousemd.
Moving along with our new Fitness Friday feature (pun completely intended, ha!)…
…one of the reasons I decided to prioritize bringing qualified exercise professionals into our network, is because over the years I have seen a lot of everything-but-best-practices in this industry. Women with PCOS are not, in general, treated very well by fitness professionals.
It is a bad combination in general. Women with PCOS often don't feel great about how they look. A lot of people working in the fitness industry, honestly, don't feel great about themselves, either, and they often focus on their physical appearance at an extreme level to compensate for that.
Of course, if you have PCOS, you may be living with the fantasy that if I could only look like THAT…I wouldn't feel so badly about myself…and you may be projecting the false assumption onto an apparently fit person that they have credibility to help you, that they may not have.
We are working on creating a training to increase the number of truly qualified fitness professionals out there, but until we have that available, I wanted to give you a list of things you can ask while interviewing potential trainers to see if they are a good fit.
1. What are their credentials? Have they taken the time to formally study their claimed area of expertise? Or have they just lived in a gym most of their lives? If they cannot name a credentialed fitness organization that they have taken the time to study with, they do not deserve your time or money. You wouldn't go to a doctor who was self-taught…you shouldn't lower that standard for your trainer.
2. What is their experience with PCOS? Have they formally studied the disease? Who is the physician they refer to? What physicians refer to them? No trainer is qualified to take on your case alone, without being part of a comprehensive healthcare team taking care of the other parts of the problem. If they cannot give you names of registered dietitians and endocrinologists with whom they have productive relationships, they are not qualified to work with you.
3. Can the trainer provide references? And by references, I mean other women with PCOS who enjoyed and benefited from the experience.
4. If the trainer is not a formally trained nutrition professional, are they willing to refrain from giving nutrition/diet advice and/or selling supplements? Are they willing to endorse whatever food choices your chosen nutrition professional is helping you to make, even if those choices are not the ones they would personally make for themselves?
5. Will there be some sort of initial benchmark evaluation to see where your program needs to start and from which progress made can be measured? Is your program being customized to accommodate your personal energy levels, blood glucose trends, medications, etc.?
6. Will your trainer listen to and accommodate any incidents of pain or discomfort? This is a tough one, as the most important job of a trainer is to push you out of your physical comfort zone. That being said, they need to be confident enough in their work to trust that letting up or modifying the workout in response to pain is sometimes the best choice. It is never right to push someone through pain that may be causing permanent damage, or creating a negative association with activity.
7. Does this trainer"get" the many phobias and anxieties you may have to overcome in order to be comfortable with exercise? I'm not just talking about the poor body image, the social anxiety, the fear of failure. A little discussed fact about exercise is that for women who have been sexually traumatized, physical exertion can retraumatize them. A trainer needs to be sensitive to this and be professional with language, body language, and how they touch their client in order for the experience to feel safe. If your nonverbal vibes are telling you there is a problem with someone, it is perfectly ok to listen to that and look for someone else.
8. Who is sponsoring this trainer's work--in other words--who subsidizes their lifestyle? How does that commercial relationship influence what they say to you? If your needs run counter to what that trainer is being paid to promote, who are his/her loyalties with?
The reality is, most trainers really don't make much money on training. They make money on endorsements. Endorsement deals often dictate what the person in that deal can say about nutrition and fitness. I know, because I have been offered several. I turned them down, because everyone that came my way, as quickly as it would have increased my standard of living, would have required me to alter the messages I give to all of you. I made the choice not to do business with any company that would require me to give them control of my freedom of speech.
Ironically, companies paying out endorsement deals do so because they believe that having a popular fitness professional promoting their product gives their product credibility. And the trainers live with the belief that they are more credible because they have landed an endorsement deal, when in many cases, they have simply made public the mentality that they are willing to alter their advice for the right price. I encourage you to ask your potential fitness coach who their commercial relationships are with, and whether or not they could give you advice that was best for you, even if that advice entailed not promoting their sponsor's product…or more importantly…a competitor's product. If they cannot…their priority is not your health, it is their personal financial income.
I am thinking of creating a letter that you all could download to give to a trainer that would summarize what you will need, kind of a contract between the two of you, that would allow inCYST to do most of the talking or negotiating for you. There are some trainers who are just bad news, but there are others who simply need awareness. If you think that letter would be helpful, please leave a comment here.
If you have had negative experiences with a fitness professional, I would love to hear from you. The list of questions above comes from my years of experience working with the fitness industry, but I know there are a lot of things I don't know about. I do know, when I have this conversation with women with PCOS, they always share experiences of inappropriate interactions that they had kept to themselves, mostly because they hadmfelt somehow that they deserved to be poorly treated because they were out of shape.
Remember, the fitness industry is quite competetive and there are far more aspiring trainers out there than there are people who need them. Trainers need YOU far more than you need THEM. You can ask for, and expect, professionalism, respect, genuine compassion, and a minimum level of accurate knowledge about the diagnosis you live with 24/7. You don't EVER have to tolerate disrespect because your current physical condition is a place you have chosen to improve.
One of the most difficult aspects of PCOS is what it does to your libido – your sexual fantasies and your desire to express your sexuality. Sometimes you’re up, sometimes you’re down, and with PCOS, maybe a little of both at the same time. According to a recent University of Chicago study, fully 33.4% of women ages 18 – 59 suffer from hypoactive sexual desire, the technical name for low sexual desire. For PCOS women, the percentage is probably higher.
There’s certainly a range of what’s considered normal, but that’s a whole lot of women who just aren’t feeling like having sex. If you’re not having sex, alone or with a partner, or an active sexual fantasy life, you’re missing out on feelings of warmth, love, and connection that enhance your overall sense of well-being.
Some of the major factors affecting sexual desire include hormone levels, availability of a partner, and body confidence. We’re all familiar with the range of moods and symptoms that can accompany the menstrual cycle, and that’s just one part of what affects your sexual functioning. I hope that your endocrinologist, dietician, and gynecologist team are working closely with you to regulate your hormonal functioning. If they’re not, and you’re feeling a disturbing loss of sexual desire, please consult with them. Know that birth control pills and antidepressants (the SSRI variety), which are often prescribed to women with PCOS, can negatively affect libido. This isn’t always a necessary or unavoidable side effect of medication. There are often different medications you can switch to that may improve your level of desire while still effectively treating your symptoms.
Availability of a partner is an issue that may be addressed in many ways. First, consider what’s happening with your current partner, if you have one. Has PCOS brought you down to the point that you no longer feel sexy or attractive to your partner? Do you reject your partner’s advances? Do you hide when you go to bed? Good communication is a must in restoring balance to this aspect of your life. Your partner may very well be wondering what’s up with you, without realizing the complexity of what’s affecting your body and your mind when you have PCOS. If you don’t have a partner, do you want one? If not, and that’s a choice made for practical considerations, great. But if it’s a non-choice you defaulted into because you feel lousy about your appearance, read on.
Body confidence is a critical component of a woman’s sexual confidence, and confidence often leads to making investments in appearance, the willingness to make or accept sexual advances, and a boost in self-esteem that comes from knowing you’re doing your best to take care of yourself. I’m talking about the obvious stuff – the best diet you can mange (90% healthy/10% naughty), regular exercise (not the hard-body-oriented, workout until you’re half-dead stuff), a little yoga or meditation when you can, and some focused attention on how you present your body to the world everyday. Exercise alone will dramatically improve your confidence, and your belief in your body’s abilities. Just the experience of exposing your body to the world and not getting laughed out of the gym is a real confidence booster.
You will learn that the rest of the world isn’t really paying that much attention to the excess abdominal fat you loathe so much. You will learn that you actually like good food, and it makes your body feel more energetic. You will learn that there are a lot of clever ways to deal with the cosmetic issues associated with PCOS, and not all of them are painful or cost a fortune. And when you learn all of these things, through your own proactive experience of them, you may find that lack of sexual desire is a thing of the past. If it’s not, however, and you’ve tried to improve it, don’t be afraid to seek additional help from your physician or a counselor. You deserve a healthy, fully functioning level of sexual desire, whether you choose to use it or not!
If you follow our radio show, you know we recently interviewed Stacy Citron, participant in Bravo's television show, Thintervention.
In the process of working with Stacy, I had the opportunity to become acquainted with Craig Ramsay, one of the trainers she worked with on the show. We sat down recently in Los Angeles and chatted about Stacy's PCOS, and PCOS in general. I left our brief meeting realizing PCOS had a genuine and enthusiastic ally in Craig, and we've become friends in past months.
I'll be interviewing Craig on Monday, November 15, at noon Eastern time. Please join us live or download the recorded version later at www.blogtalkradio.com/incystforhormones
In the meantime, I asked Craig to answer a few questions to help our audience get acquainted with him.
I'm so looking forward to Monday!
1. What did you know about PCOS before you began your work with Stacy?
My only knowledge of PCOS prior to working with Stacy on Thintervention was from my Broadway co-worker/friend Haviland Stillwell. Her journey with it was private. (My note: Haviland has since spoken publicly about her PCOS; her interview is in our show's archives.) All I knew of the disease was that it affects a woman's hormone levels and fertility.
2. As a trainer, what was the most challenging aspect of working with someone with PCOS?
As a trainer working on a time crunch of a fitness show, and the added responsibilities of 7 other clients, I found working with someone with PCOS was very time consuming. Not because that person is difficult, but because I had to take a great deal of time to learn about the condition for myself. Stacy knew little of the disease, so tackling it together was the hardest part, as well as getting our questions answered. 3. You have expressed a strong interest in reaching out to women with PCOS. What is it about the syndrome that has inspired you?
My mother has Fibromyalgia. I have a sensitivity to her, and other women, who struggle with such health obstacles that get in their way of feeling and looking their best. Like Fibromyalgia, PCOS sufferers have a difficult time getting answers and respect from Doctors. It frustrates me that the medical field hasn't spent more time discovering answers to their vital questions.
I have experience working with many women that have gained control of their PCOS, and with great success!
I'm thrilled to share my experiences to help others. 4. Have you developed any different strategies for working with future PCOS clients?
I advise my PCOS women to start with their diet. Get control over their sugar levels, introduce a high protein diet, and make sure they are eating the proper foods and eating at the proper times. This will improve their energy levels, sleep and therefore their ability to properly workout to intensity.
This is the place I start with all my PSOC women. 5. Do you have any words of encouragement for frustrated women watching your series who can relate to Stacy's journey?
Frustrated women watching at home please know that you are not alone. What used to work for you"back in the day" will not work anymore. The answers are out there, don't compare yourself with others, make it your own journey.
OK! We've cruised past the candy corn…mastered the Thanksgiving pie…what is it about these nasty carbohydrate cravings that make it so darn hard to keep a respectful distance from all of these holiday sweets?!?!?
You may not be imagining things. And you may not be a nutrition wimp. Your body chemistry actually changes with the seasons.
Did you know, for example, cholesterol is actually higher on average midwinter than it is midsummer? Yup, so if you have your annual physical midwinter, get a high reading, and go on medications, the drop in your followup may not be entirely due to medication. It's just how nature does things.
One of the toughest seasonal changes is mood. Back in the days when we were more exposed to the elements, it probably made sense to want to be more sluggish and a little heavier. No need to waste body heat on exercise when we need it for warmth. And a little extra fat for insulation was more than welcome.
Nowadays, we prefer to have our weight be as stable as possible, and this time of year it can be hard to achieve that. About 20% of the population (and 4 times more women than men) experience such a radical shift in mood, hormones, and biochemistry, that they qualify for an official diagnosis of seasonal affective disorder (SAD). Symptoms include: tiredness, depression, crying spells, irritability, trouble concentrating, physical aches, decreased sex drive, trouble sleeping, less desire to be physically active, increased appetite (especially for carbohydrates), and weight gain.
I'm guessing that a pretty high percentage of the audience reading this is thinking,"But this is how I feel all the time!". If you have PCOS, that may be true, but it may become more intense…progressing to out of control…in the dark of winter. Here are some strategies to try to help you get through the winter solstice. Remember, from December 22 on…it's all uphill!
1. Check your vitamin D levels. Low vitamin D may be part of the problem. If it is, be sure to supplement.
2. Do your best to get outside. It's hard with short days and cold temperatures, but even a few minutes a day can make a difference. Even on a cloudy day! Ultraviolet rays are present even with cloud cover. Take advantage of them.
3. Consider phototherapy. I have recommended light devices for clients living in places like Seattle and Alaska, and they can work wonders. All they do is bring sunshine indoors. Working, studying, or reading the mail in the presence of one on a regular basis can help to promote a biochemistry similar to what you naturally experience in the summer.
4. If your SAD progresses to where the symptoms are incapacitating or dangerous, antidepressant therapy has also been found to be helpful. Ask your physician for a discussion about your options.
5. Of course, you know I'm going to say this…prioritize diet. Take advantage of comfort foody crockpot meals like chili, and lentil soup, to help keep your blood glucose stable. Don't forget the protein. It's easy to forget about protein in the mountain of Christmas candy and cookies we're about to tread through, but a little packet of Justin's Nut Butter or string cheese stashed in your purse or briefcase can work wonders for staving off those carbohydrate demons.
6. Don't panic. If you've noticed over the years that your weight naturally fluctuates 5, even 10 pounds between winter and summer, and it naturally self-corrects without radical dieting, you are simply in tune with Mother Nature. Appreciate the fact that you can get by with fewer bulky sweaters and scarves to stay warm, and don't get caught up in unhealthy eating and exercise habits to try and"fix" what is likely a completely natural phenomenon.
Golden, R.N., B.N. Gaynes, R.D. Ekstrom, et al."The Efficacy of Light Therapy in the Treatment of Mood Disorders: A Review and Meta-analysis of the Evidence." Am J Psychiatry 162 (2005): 656-662.
• Leaping over tall buildings in a single bound! • Flying without mechanical assistance! • X-ray vision! • Breathing for extended periods under water! • Becoming invisible!
When I was a child, the superpower I wanted most was to be able to shrink down to about one inch tall, so that I could observe the world without being observed. Although that would still be fun, if I had a superpower now, I would want it to be wiping people clean of mental and physical illness and disease. I wish I had a magical capacity to briefly join energetic forces with my clients, and quickly relieve them of what ails them.
And yet, I am a mere human, so I have to deal with my very human limitations. Since I don’t have a superpower, I apply the capacities I do have – empathy, understanding, relating, connecting, validating, offering technical and scientific education, and utilizing my intuition, among other tools – to the practice of psychotherapy. Although remarkable changes can occur quite quickly in therapy, in reality, it’s not magic, and it’s a process that can take months or even years.
The superpower I have as a therapist though is one that you can use yourself. It’s called reframing, and it’s the practice of taking a negative statement and changing it around into something positive, containing elements of optimism. For example:
• “I have really bad hypoglycemia, and now I have to use this stupid glucose monitor to check my sugars and make sure they’re not too low” BECOMES “I have a special machine that allows me to track my sugars and prevent hypoglycemia, so I feel really good most of the time.”
• “I have to go the doctor every three months for tests related to my PCOS, and I hate going to the doctor!” BECOMES “I have the opportunity to monitor my health closely, and prevent complications.”
• “This disease makes me miserable” BECOMES “I have a chronic condition, AND I can manage it effectively.”
See how the first statement in each example contains elements of negativity, fatalism, pessimism, and victimhood? The counter-statements – the reframes – cite a benefit or positive outcome, and take an assertive stance about owning the quality of your life.
Reframing isn’t useful just for therapists, or women with PCOS, or people with chronic medical conditions. It’s useful in all aspects of your life. Once you start reshaping your language, your thoughts will change, and so will your actions. So it’s not exactly a superpower… I'm okay with that, because it’s a highly effective tool to incorporate into your life.
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.
Unless you've been living under a rock, you know our comrades in the gay community have taken some major hits in past weeks. Many of my Facebook friends posted the video by Ellen DeGeneres. One asked,"What are YOU going to do?"
Later that day, I was spending the evening with friends. The theme of conversation turned to bad doctor experiences. Luisa, a lesbian woman with PCOS, shared that during an appointment she had made for her annual gynecological physical, her physician told her she didn't need to have these physicals, because she was not having sex with men.
There is concrete evidence that lesbian women have a higher incidence of PCOS, and therefore a GREATER need to be in more frequent with reproductive specialists. Whether or not they are in a relationship, and whoever that relationship may be with. If my friend had been heterosexual, and not in a relationship, I'm willing to bet that is not the advice she would have received from that physician.
I was floored, but I was grateful for the inspiration. What I was going to DO, as my Facebook friend encouraged us to think about, was use this blog advocate for equal access to quality healthcare for homosexuals.
Over the years, I've witnessed attitudes and heard comments that should never have existed.
In my last job, at an eating disorder treatment center, my supervisor pulled me aside after a meeting and asked me what I thought about the possibility that a treatment center for men would be added to our organization. I thought it was a great idea. At the time, there really was no place for men with eating disorders to go.
She acted surprised."But you know what that means, don't you?"
"Um…that men who couldn't get help before can be helped?"
She hesitated."Well, yeah, but…"
I was in the dark."But…?"
"We'll have to start treating gays."
I didn't work long for that company. I couldn't work in a place where an attitude prevailed, that some people are more deserving of help than others.
Now I am realizing that not only do I have an obligation to not work for an employer who would foster such attitudes, I need to speak out to my fellow healthcare professionals and not request, but demand, that you treat all of your patients with equal respect and offer them equality of service, regardless of their religious, political, cultural, or gender orientation.
If we were in a pathology lab, and I asked you to pick out the Republican spleen, or the Methodist pineal gland, or the Icelandic aorta, or the lesbian wisdom tooth…you couldn't do it. Because on the inside, we are all alike.
If I asked you, however, to point out the PCOS liver (likely to be fatty), or ovary (containing cysts), you would be able to do so, in a moment. THAT is what we were trained to do. Help our patients with the things that may not be working so well, while being blind to what kind of packaging they come in. As helping professionals, we don't have the luxury of categorizing our patients in ways that give us reasons not to care. We do our work because we DO care.
One of my very first inCYST success stories was actually a lesbian couple. A young woman helped me to organize a class, and I noticed that she was more engaged and took more notes than anyone else who attended. I stayed after class and learned that she and her partner had been, unsuccessfully, trying to conceive. She realized in the class she had many of the symptoms of PCOS, but no one had ever worked her up for it.
We had a most enlightening discussion about what it is like to be lesbian and to be seeking reproductive services. About how much thought this couple put into who they would even trust to ask for help. About how it felt to sit in the waiting room of the doctor and know that the couple across the way is looking at you the way they are for reasons that aren't so compassionate.
It opened my eyes to how much, as a Caucasian, heterosexual, Christian woman, I take for granted when I pick up the phone and make a physician appointment. I simply pick up the phone, set the date, show up, and get what I came for. I don't have to research who to go to, emotionally gear up, deal with bizarre responses, or leave without what I came for because someone thought I didn't need or deserve it.
PCOS sort of followed me, it wasn't the other way around. But now that it has become my life's work, I want every woman who knows about inCYST to understand, and trust, that no matter who you are, where you came from, how different your life may be from mine, that there is information and support for you here. You are special, and you are important, and if the information we have is pertinent to your situation, it is our honor to use it to create a healthy path for your journey through life. Agrawal R, Sharma S, Bekir J, Conway G, Bailey J, Balen AH, Prelevic G. Prevalence of polycystic ovaries and polycystic ovary syndrome in lesbian women compared with heterosexual women. Fertil Steril. 2004 Nov;82(5):1352-7.
I was recently graciously shipped a jar of Tropical Traditions Gold Label Standard Virgin coconut oil for review. First of all, thank you to Tropical Traditions for their generosity! I use coconut oil twice a day on my skin and I love the noticeable difference it makes. I'm also learning to cook with it, and am happy to have this to work with.
This is a long, drawn out post. I'm putting my conclusion at the very beginning so you can decide if you want to sit through the rest:
I love coconut oil, I use it myself, both in cooking and on my skin. I love this particular brand and product, and it's clear that the company is very proud of the attention they devote to quality and sustainable practices. If you choose to incorporate coconut oil into your cooking, and I hope that you do, please consider supporting a company that works so hard on behalf of integrity.
My intention is to encourage more people to use coconut oil than currently do. It wasn't long ago that we discouraged coconut oil consumption and I still encounter people who think it's unhealthy. I'd also like to encourage those who may be creating problems with excessive use, to understand why that may not be a good choice.
My only reservation is that there is somewhat of a health halo hanging over coconut oil that encourages its use in quantities that potentially do not support improved health.
I'll be addressing those issues in this post. A little bit of feedback on the coconut oil information I found on the website.
In the FAQ section, there is no peer-reviewed reference provided to support the following statement:
The benefits of coconut oil are mainly from the nutrient value of medium chain fatty acids (MCFAs). The best comparison in nature as to the percentage of MCFAs being consumed in a diet is human breast milk. To equal the amount of MCFAs a nursing infant would receive in one day, an adult would need to consume about 3.5 tablespoons of coconut oil a day according to researchers.
1. With regards to fat, what an infant needs, nutritionally, is far different from what an adult needs.
For example, nutrition experts recommend 2% milk for children up to to years of age, then a drop to 1% or skim. The reason for this recommendation is that the extra fat is needed during the first 2 years of life to help fuel the rapid growth occurring during that time. As growth and development slow, so do needs for dietary fat.
Arachidonic acid (ARA) is an essential fatty acid for infants. The only place they can get it is milk, so if an infant is formula fed, ARA needs to be added to that formula. When that infant is weaned, however, and can get this fatty acid elsewhere, it no longer needs to be added to the diet.
It simply has not been proven that nutritional needs for infants are the same as nutritional needs for adults. Or that what you would feed an infant is even healthy for an adult. So I'm not entirely convinced that the extrapolation from an infant's saturated fat intake in breast milk, to a recommendation for adults of 3.5 tablespoons per day is a logical or healthy leap. (I am happy to adjust my stance if peer-reviewed research supporting the higher level becomes available. Our readers are in large part pursuing fertility and possibly in the midst of infertility treatment. I owe it to these high-risk situations to lean toward the skeptical and conservative. I don't want to heap more expense, stress, and/or disappointment on women who take our advice so seriously.)
Fat is fat, no matter where it comes from, it still contains calories, and the recommendations are still to keep saturated fat intake to about 10% of total calories. Regardless of the source of the saturated fat.
I did a long blog post calculating dietary amounts for different calorie levels that this translates to not too long ago if you want more specifics. I do think that when possible, saturated fat from coconut oil is better than saturated fat from meat, so the focus needs to be learning how to make that switch. (See the recipes I posted below.)
2. In moderate quantities, coconut oil can definitely be beneficial. A 2009 Brazilian study providing 1 tbsp per day of coconut oil to a group of women with abdominal obesity found that compared to 1 tbsp of soybean oil, the coconut oil group had higher HDL, a lower LDL/HDL ratio, and a reduced waist circumference. It cannot be determined from this study design if the change was due to the absence of soybean oil, the presence of coconut oil, or a little of both, but it does illustrate that when used in moderation, coconut oil can be part of a hormone-friendly eating program.
3. What IS showing up in the literature is that too much coconut oil can be metabolically deleterious. Individuals at risk for diabetes (and if you have PCOS that means you) need to use coconut oil with care. One recent study in particular (done with calves) compared coconut oil to a non-medium-chain triglyceride (MCT) diet as well as to another MCT, caprylate oil. The coconut oil-fed calves weighed pretty much the same at the end of the study, contradicting claims that coconut oil promotes weight loss. In addition, the coconut oil calves had heavier, fattier livers and contained 15% more fat than the livers of the other calves.
Bottom line, used respectfully, coconut oil has many health benefits and I do encourage its use. What I DO discourage, is using this product indiscriminately with the belief that it has any kind of magical quality that counteracts dietary indiscretions or which somehow allows you to ignore other important rules of nutritional balance.
4. I spent a long time on the company's companion website, http://www.freecoconutrecipes.com/ to see how others were using coconut oil in cooking. Most of the recipes were for baked goods and sweets, the use of which, due to the insulin resistance issue the readers of this blog deal with, should be limited. Cakes, cookies, etc., are not nutritionally dense and cannot be eaten in large quantities just because of the oil they were made with.
I did find a great recipe for coconut oil vinaigrette coleslaw, which nicely combines the concept I've been writing about recently, consuming a bit of vinegar before meals, with a nice, moderate use of coconut oil. I would so love to see more savory recipes like this, as it would help the readers inCYST most often works with, to use this oil to their benefit.
I did my best to walk the walk, as well, and asked the members of our Facebook fan page to share any savory recipes they might have using coconut oil. Here are a few provided by culinary school graduate Alyssa Fritts.
Coconut Green Beans Blanch fresh green beans by dumping them in boiling water for about 20-30 seconds. Strain them out and put them in ice water to s top the cooking. Melt a tsp or less of coconut oil in a pan. Add 1/2 clove of garlic and the strained green beans, toss around a few times. Add chopped almonds and salt and pepper to taste.
Coconut Pork Chops Put a little bit of coconut oil in a pan, salt and pepper pork chop with all fat trimmed Brown on both sides. Remove chop, add garlic, and chopped onion. Saute until garlic is fragrant. Add veggie or chicken stock and a LITTLE bit of apple jui ce. Put chop back in and let it reduce down by about half. Remove chop and place on plate. Add a scoop of stone ground mustard, and a sprig of fresh rosemary. Let it thicken. Finish with a swirl of coconut oil to give it the smooth fullness butter would. Pour over your chop.
Miso-Ginger Salmon 1/2 tsp coconut oil 1 clove minced garlic 1/8 in piece peeled ginger in matchsticks 1 tbs chopped onion 1 tsp miso paste 1/4 cup white wine 1/4 cup veggie stock or water 1/4 tsp coconut oil
Melt 1/2 tsp coconut oil in pan. Salt and pepper salmon. Place in pan skin side up. Brown on both sides. Set aside on a plate. If needed as a tiny bit more coconut oil. Add ginger and garlic. Add onion and sautee for a few seconds. Add wine and stock. Add salmon back to pan and cook for about 5 min. Remove salmon and turn heat up to high. Add miso and reduce down until thick. Swirl in a tiny bit (up to 1/4 tsp) of coconut oil and pour over salmon.
What Alyssa is illustrating, beautifully, is that one of the best ways to use coconut oil is to switch out other oils for coconut oil in your regular cooking, being careful with quantities just as you would any other fat. It adds a nice flavor while it helps your metabolism.
If any of you use Tropical Traditions Coconut Oil, and you've developed some savory, hormone-friendly recipes you'd like to share with our friends at Tropical Traditions, I would love if you would do that. I'd like their customers to see just how much potential this oil can have in the kitchen. I'd really love to see this company, which clearly has a heart for wanting to do something good, succeed at that goal. I'm in love with the creativity of inCYST fans, and encourage you all to step up and share it in a way that can have benefit far outside of this blog post.
Bottom line: Used intelligently and respectfully, Tropical Traditions gets a thumbs up. Stay tuned, as tomorrow we're going to announce a giveaway encouraging you to think about and incorporate the concepts presented in this blog post!
Assunção ML, Ferreira HS, dos Santos AF, Cabral CR Jr, Florêncio TM. Effects of dietary coconut oil on the biochemical and anthropometric profiles of women presenting abdominal obesity. Lipids. 2009 Jul;44(7):593-601. Epub 2009 May 13. Talbott, Shawn M. and Kerry Hughes. (2006). The Health Professional's Guide to Dietary Supplements. Lippincott Williams & Wilkins. pp. 60–63. ISBN 9780781746724.
Mills JK, Ross DA, Van Amburgh ME. The effects of feeding medium-chain triglycerides on the growth, insulin responsiveness, and body composition of Holstein calves from birth to 85 kg of body weight. J Dairy Sci. 2010 Sep;93(9):4262-73.
Last month I had the opportunity to spend a week with 5 women with PCOS at Green Mountain at Fox Run's first ever PCOS week. I learned a tremendous amount from them, maybe even more than I went to teach to them, about the syndrome.
One of the most important insights I gained, was why it can be so difficult to lose weight once you've decided to change your eating and exercise habits.
Insulin has a lot to do with it.
Your body is constantly taking in data, recording the temperature, the light level, energy levels, etc., and adjusting itself to be able to meet the demands of the situations it's recording. When it comes to hormones, it often records and hangs on to information from weeks before. It's as if it wants to be sure it's ready to handle the worst case scenario it's going to have to be asked to deal with. So…if you've been binge eating, and you've changed your habits, information it's taken in about that binge, if it occurred in your recent past, is still in the database. Your body is likely to want to make more insulin than it currently needs, just in case it's asked to have to handle a binge session like one it remembers you engaged in.
If you continue your new eating habits, consistently, that will register positively, your body will trust that it needs to make less insulin, and your lab values will improve.
The challenging part is being patient with your body while the new data has a chance to be recorded and acted on.
If you've got high insulin levels and all of a sudden you decide to go on a diet, or exercise at high levels, the insulin levels won't automatically adjust. It can be very easy to create a hypoglycemic state if you take on too much too soon. And, as your blood sugar levels drop, your hunger and carbohydrate cravings are likely going to be triggered to correct the situation.
Hypoglycemia is a stressful situation for the body, so when this scenario kicks in, it also triggers the release of stress hormones. Cortisol, one of the major stress hormones, is made with cholesterol. As are estrogen, testosterone, and progesterone. If choices you are making are demanding of the body that it makes more cortisol, it's going to be hard for it to make the other three hormones in the proper proportions.
The other thing that is common with PCOS is an intelligent, driven, all-or-nothing tending personality. When you decide to take on diet and exercise, it can be in an extreme fashion. When weight doesn't come off as planned, you can be very hard on yourself, raising your stress levels, possibly bingeing out of frustration.
And thus the cycle starts, all over again.
Hence the title of this post. How do you back yourself out of such a situation?
Ohhhh…you all are going to hate this, but the key word is"moderation". Be gentle with yourself. Rather than taking on an extreme exercise plan and a rigid diet, focus on small simple changes and working to turn them into habits. Be patient. Understand that the changes you're implementing on the outside take time to be registered by your internal hormone control systems.
Probably key? Remember this: THE DAYS YOU FEEL THE LEAST LIKE STICKING WITH YOUR NEW HABITS ARE THE DAYS IT IS MOST IMPORTANT TO DO JUST THAT. It's tempting to blame a bad day on something you've done, to take it personally, rather than let your body do what it does best when it's not interfered with. By bingeing and not exercising on a day you feel badly, you prolong the time it's going to take to get things back into balance.
If you don't know me, you should know I'm very picky about who I collaborate with in business. I actually turn down more opportunities to advertise than I accept. It's made the business a little more slower-growing than average, but the reward for being such a tortoise is that the business that DOES come our way is loyal business.
If you do know me, you know I'm very big on omega-3's. (I spent Christmas with a neighbor's family, and she told her kids that when it came to fish oil…I was like the guy in"My Big Fat Greek Wedding" who thought Windex cured everything!) OK, Marilyn, I'm not THAT fanatic, but I do believe omega-3's are incredibly important to overall health.
I like to believe that because I AM so cautious about where my name lands, that credibility is added to the products I DO associate with.
The company you will find at the other end of the link to the right, Omega 3 Brain Booster, was the first one to support my work, and they have been wonderful to be involved with. It is an honor and a pleasure to tell people about their business. They have created a product that can be used in your own cooking, which eliminates the need to take a capsule and deal with fishy burps.
If you're interested in trying it, you can order online. By using the coupon code"neuron", you can receive a 10% discount on your first purchase.
I was just on a website for a local naturopathic physician who specializes in women's health and reproduction. She is well known in our area for her success with challenging conception situations. I love to refer to this particular naturopath because she is so skilled and compassionate.
I'm pasting some excerpts from her testimonials page.
"It was hard to hear from the MD's that I would not have a baby unless it was in-vitro…"
"I was told I was facing early menopause and may need an egg donor to conceive a child. When faced with paying more than $14,000 out of pocket per IVF attempt, which offered a 20% success rate and no guarantees, enough was enough."
"My reproductive endocrinologist told me I had little or no chance of conceiving a child. He told me if I wanted to try to conceive with my eggs, we should do IVF immediately, even though we had less than 10% chance of success."
These are all women who became pregnant when they decided to not listen to that advice and seek help elsewhere.
I hear these stories too. Sometimes I have a very hard time with the reproductive industry, despite the miracles they've created, because they often seem to prey on the desperation that can develop when a baby isn't easily created. They can make you feel like the problem is that something is wrong with YOU.
In many cases, the real problem to the doctor is that you're not giving him/her your money quickly enough!
What other service would you be willing to spend so much money for with so little guarantee of success?
I am so excited about what inCYST is learning and the success stories we've been able to be a part of. But what I'm still trying to understand is the psychology of the infertile woman. I offer classes for $15 apiece. That's about the cost of a copayment. That's a smoking deal compared to an in vitro procedure. Sometimes I even do them free of charge. But women I invite, often politely tell me, thanks but no thanks, I've made an appointment with my fertility doctor. I'll try that first.
One woman recently shared that even though she paid for the class and didn't show, she decided to go through in vitro. She ended up having to quit her job, because she could not manage the stress of the treatment along with her work responsibilities. She's pregnant, now, which is the good news. But she's financially challenged, to the point where she's asking me for free help. I'm not sure if that is success or not? And at that point, whose responsibility it should be that a $15 resource has become too expensive?
If you have two choices for earning money, one being interest in a bank account and the other being money won playing blackjack in Las Vegas…and you politely tell the banker thanks but no thanks, I'll bring you my Vegas winnings and I'll earn interest on that…and you lose your shirt in Vegas…do you think the bank is going to give you money to put in a savings account? Probably not. You have to make good decisions in advance.
It seems to me that the most important time a nutritional tuneup should be considered is precisely WHEN you've decided to invest in IVF. If it were me, I'd want to be absolutely sure that the environment I am giving my physician to work with when being paid to help me, is the healthiest, most balanced, most receptive to successful conception and pregnancy. What better preparation for success could you offer your reproductive system than nutritional health?
I know there is a huge difference between what you'll get in an inCYST consultation vs. what a physician provides. We're definitely going to ask you to make some changes. We're here to support, to encourage, and to point you to ways to make the new changes livable. Unlike a physician's visit, where most of the hard work is done by the doctor, we will ask YOU to do some things. We don't believe anything is wrong with you. We believe that life on planet Earth has its stresses, but if you learn how to manage them, hormones cooperate. Very simple.
We're not an"either-or" kind of choice, at all. We are not the only answer out there, and we are not ever going to eliminate the reproductive endocrinology industry. In fact, I think there are a lot of opportunities, when working together, for us to help increase some of those dismal percentages I quoted so the doctors have higher success rates as well!
Just a note, a friend just e-mailed me to tell me that this very topic was featured on the Today Show today. I Googled the website for the Fertile Soul, the program featured in their segment. Even their fees are high--as much as $12,500 for a couple to attend. I want to reassure anyone coming to this blog looking for help, I want to help people, and I do need to pay my bills, too, but our program is not about depleting anyone financially. Our one day couples spa program is only $350.
It just seems to me like when you have a choice between paying several hundred dollars and several thousand dollars, and you're seeing indications that the least expensive option may actually work, that you'd start low and work up the pay scale, if and only if needed.
I'd love it if this post inspires you to think differently. Sometimes medicine works and sometimes it creates miracles. But sometimes medicine has its limits. Why not try an inCYST provider or class or retreat and see if it gets you going in the right direction?
