The Hemp Connection [Search results for diarrhea] 

Before the bathroom humor starts popping into your head, I want to say that I’m quite serious about this one. As a psychologist, over time, it is typical for people to feel quite comfortable telling me virtually anything that might be perceived as shameful, embarrassing, or humiliating. Confidentiality and acceptance are key to successful therapy, and creating an atmosphere that invites disclosure is important – if I don’t know what’s REALLY going on, how can I help you?

As a health and medical psychologist, I gather more than the usual amount of medical information from my clients. Many of them are dealing with PCOS, infertility, diabetes, and other endocrine conditions that can result in bowel irregularities. Anxiety often results in diarrhea, as do irritable bowel syndrome, Crohn’s disease, and related conditions. Thyroid disorders also alter bowel functioning. Cancer treatments affect regularity. And the list goes on and on.

What I usually hear is a client bringing up the issue by saying, “Um, you probably don’t want to really hear about this, but, um, I’m having this um, problem with, um, diarrhea… ” As they trail off, I reassure them that I’m used to hearing this stuff, and I actually want to hear it. Truly, I have heard it all in this department. This is an enormous relief to the client, who has often been too embarrassed to tell one of her doctors about it. Because I see the client weekly, there’s a much higher level of trust than with a doctor whom she seems every few months.

This information is helpful to me diagnostically, because I instantly know a great deal more about what’s driving stress and anxiety (if you’re prone to sudden loose stools, it can contribute to social anxiety and fear of leaving the house, for example). It helps me normalize certain behaviors or symptoms, and be alert to other things that might be troubling the client. Quite often, we are so used to having irregularities in our bodies – food cravings, random menstrual cycles and the like – that bowel irregularities get overlooked. When you can’t get pregnant, you’re generally not overly concerned with chronic constipation, right?

When a client is able to trust me with this type of information, I actually feel honored. I’m not a medical doctor; I can’t perform diagnostic procedures or prescribe medication to remedy the problem. But I truly do want to know every aspect of my clients, up to and including the quality and frequency of their bowel movements. I can make referrals to medical doctors who can help. And there are psychological treatments that are effective for bowel disorders, and of course for reducing stress and anxiety.

On a more interesting note, there’s a strong gut/bowel and brain connection. A significant percentage of our neuro-transmitters are produced in the gut – around 85% of the serotonin, for example. So, if you’re experiencing cramping, bloating, diarrhea, or constipation, not only may you have a medical disorder, but it may be contributing to depression, anxiety, or other psychological conditions. In a nutshell, that’s why I want the full scoop on your poop – so I can help you as comprehensively as possible!

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.

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

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

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

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

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

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

Reference:

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

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

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

It’s normal to have some anxiety from time to time. Everyone experiences anxiety as a normal reaction to threatening, dangerous, uncertain, or important situations. When you’re taking a test, going on a trip, or meeting your prospective in-laws for the first time, you’re going to have anxiety. Psychologists classify anxiety as normal or pathological. Normal anxiety can enhance your function, motivation, and productivity, such as the person who works well under pressure.

But there’s a larger problem called Generalized Anxiety Disorder (GAD), and it affects an estimated five to seven million Americans. People with GAD experience pathological anxiety, which is excessive, chronic, and typically interferes with their ability to function in normal daily activities. GAD patients are about 60%women/40% men, and women with PCOS are affected by anxiety disorders more often than other people, just as we’re more affected by depressive disorders.

There are biological and environmental risk factors for GAD, which include the following:

• Environmental stressors (e.g., work, school, relationships)

• Genetics (Research has shown a 20% risk for GAD in blood relatives of people with the disorder and a 10% risk among relatives of people with depression.)

• Sleep deprivation, sleep inconsistency

Stress in the following areas can intensify symptoms:

• Financial concerns

• Health

• Relationships

• School problems

• Work problems

Symptoms include trembling, general nervousness or tension, shortness of breath, diarrhea, hot flashes, feeling worried or agitated, trouble falling asleep, poor concentration, tingling, sweating, rapid heartbeat, frequent urination, and dizziness. A panic attack, which is an extreme manifestation of anxiety, may feel like a heart attack, and sends many patients to the emergency room. If you’re having these types of symptoms, you should definitely make sure you’ve seen a physician to rule out medical conditions.

This type of anxiety is obviously more severe than normal anxiety, and can even be quite disabling. There might be a tendency to expect the worst without clear evidence, with particular worries about health, finances, job, and family. Individuals often can’t relax, sleep or concentrate on the task at hand. This disorder affects the quality of work and home life. You may know that your worry is excessive, but don’t feel like you can do anything about it. There are also some cultural issues — many people in the United States who are diagnosed with GAD claim to have been nervous or anxious their whole lives. Eastern societies, on the other hand, perceive and treat anxiety differently, as something associated with pain. So anxiety may be seen as normal in one setting, and pathological in another setting.

GAD is associated with irregular levels of neurotransmitters in the brain. Neurotransmitters are chemicals that carry signals across nerve endings. Neurotransmitters that seem to involve anxiety include norepinephrine, GABA (gamma-aminobutyric acid), and serotonin. Anxiety may result in part from defects in serotonin neurotransmission, and drugs that augment this activity may be useful in the treatment of anxiety disorders. However, many therapists believe that GAD is a behavioral condition and should not be treated with medication. Further, some believe GAD is more closely related to depression than to anxiety. I tend to believe that there’s a spectrum, and usually, if you’ve got depression, you’ve got some anxiety, and vice versa. There also seems to be a correlation between GAD and other psychiatric disorders, including depression, phobia disorder, and panic disorder. Anxiety is a risk factor for sleep disorders such as insomnia.

If you have numerous symptoms of anxiety, it’s important to be evaluated by a mental health professional who can help you identify the causes of your anxiety, and teach you ways to manage your anxiety. Many forms of therapy are effective, and I see great results in my anxiety clients who practice yoga or meditation (or both!). If that’s not enough, you can be evaluated by a psychiatrist and try some of the highly effective anxiety-reduction medications.

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.

I'm looking to our readers to help us out.

If you experience at least three of the symptoms listed below in conjunction with your PCOS, would you please let us know which ones? It's part of a research project. I'll explain in detail in a future post, but I don't want to skew your answers with too much information.

Also, if you have ever experienced migraine headaches, do they ever occur in conjunction with any of the symptoms below, or are they separate events?

Thanks!

diarrhea
nausea
vomiting
food cravings
loss of appetite
thirst
increased urination
chills
fatigue
confusion
irritability
euphoria
wavy or jagged lines in your vision
flashing lights
dots or spots in your vision
blind spots
tunnel vision
disruptions in hearing
auditory hallucinations
distortions in smell or taste
numbness, a pins-and-needles feeling, or other unusual body sensations
difficulty remembering or saying a word
other language difficulties

The tennis world was all aflutter this week over an article in the Wall Street Journal about professional tennis player Novak Djokovich's rise in the tennis ranks in the year following his switch to a gluten-free diet. While there may be a correlation, relatively little in the article directly addressed the direct connection between gluten-free eating and a phenomenal tennis season.

So here are some facts for all of you tennis players looking for an edge, as well as those of you courtside who may wonder if gluten is affecting your hormone balance.

What is gluten?

Gluten is the protein found in many grains, especially barley, oats, rye, and wheat. Statistically, 1 in every 133 individuals is gluten intolerant or experiencing celiac disease. In this condition, gluten irritates the lining of the intestines to the point where the absorptive surface erodes away and can no longer absorb food. It is painful, it causes malnutrition, and it. This photo, courtesy of http://www.sensibleceliac.com/, shows how the"fingers" of the intestine, where nutrients are absorbed, gradually shrink in size and disappear.

Symptoms of true celiac disease are related to malabsorption: diarrhea, gas, bloating, fatty stools are common. However, they do not occur in everyone. Other symptoms are related to the nutrient deficiencies resulting from malabsorption and can include: weight loss, fluid retention, anemia, easy bruising, nerve pain, muscle weakness, and…yes…infertility.

A full workup to confirm celiac disease includes blood testing, intestinal biopsy, and a challenge with a gluten-free diet to see if the body responds in a healing way. Because the symptoms of celiac disease can also be symptoms of other serious disorders, it is important to not self-diagnose and treat yourself.

It is possible to be gluten sensitive even if you do not have celiac disease. Many women reading this blog may have a gluten sensitivity, and it can be the source of the inflammatory process that is triggering PCOS. Many of our inCYSTer providers have completed LEAP training, which allows them to help you diagnose and treat food sensitivities in a way that is precise and direct. It is a way to shorten the process of figuring out what is truly causing your symptoms, rather than randomly eliminating a food and hoping it will help you to feel better.

Should You Go Gluten-Free?  In the last five years, gluten-free eating has become somewhat trendy. Please don't misunderstand my comment. I know many of you truly ARE gluten-intolerant and gluten-sensitive. But many of you are not. Something that can happen if your primary sources of gluten were baked and processed foods, and you cut those out, you tend to decrease your caloric intake and improve your ratio of carbohydrates to protein. You improve your chances of improving insulin resistance, which may have nothing to do with gluten issues even though gluten intake was altered with your dietary choices.

In addition, inCYSTer and LEAP guru Michal Hogan recently shared with me that if you are NOT gluten sensitive, and you restrict gluten, you can create an sensitivity where none previously existed. So it is really important to make this dietary adjustment only if it is necessary and in an informed way, not because you think it might help when nothing else has.

It's also important to understand that a gluten-free diet is NOT automatically healthier! I belong to several gluten-free discussion groups and have seen chats literally obsessing about ways to keep eating sweets and calorically dense/nutritionally inferior foods while getting around the gluten issue. It's important to understand that whole grains, even those containing gluten, contain other important nutrients such as magnesium and
B vitamins, that will need to be included in other fashions if you eliminate a major category of foods.

For those of you who ARE in need of gluten-free eating, we encourage you to become familiar with Zing Bars, who you've seen us blog about before, who we've interviewed on our radio show, and whose bars are all gluten-free. Zing has also been generous with the PCOS community and their product is one that is insulin as well as gluten-friendly. It's not just a candy bar that's easy on the intestines, as some products pan out to be.

If your first name is Roger or Rafael, you play tennis, and you're wondering if you might make some dietary adjustments to better keep up with that guy on the other side of the net…Zing Bars certainly will help to keep your energy levels stable for good coordination and focus through the longest of matches. But before you switch out a major staple and completely change your diet, be sure to ascertain that it genuinely has potential to help you.

If you're not sure if gluten is your problem, and you'd like to work with someone who can help you know for sure, for a list of inCYSTers who are also LEAP-certified who would be happy to help you work through the maze of information and to do it productively…visit www.afterthediet.com/pcoshelp.htm and look for"CLT" behind the provider's name.

Many of you already know you're insulin resistant, and are receiving medical attention for that. Here are the basic nutrition and lifestyle actions you can take to further help minimize the impact of that issue on your pregnancy success.

1. Move! I'm a distance runner. As much as I love running, however, I have a lot of other activities I love to do. Having a variety of activities to rotate through prevents boredom, and it involves different muscle groups in exercise. I learned to vary after a ski injury that sidelined my running for a year. You don't want that to happen, to become so dependent on one activity that you set yourself up to lose activity completely. These days I run, but I also walk, rollerblade, garden, hike, golf, swim and do yoga. (Ivonne recently talked me into trying a tango class. I think dancing is my new favorite!) Any little thing you can do that tells your body it needs to get better at moving glucose into muscle cells…is what you need to do.

2. Commit yourself to better sleeping habits. Poor sleep, either few hours or bad quality, interferes with insulin function. The clients I work with who prioritize better sleep are the ones who notice feeling better the soonest. It can be a hard one if you love the late night shows, easily get lost in the Internet, or don't set good boundaries with others. But good sleep is one of the most important things you can give yourself. If you search"sleep" in this blog there is a lot of information about how to achieve this.

3. Watch the caffeine. This goes hand in hand with #2. Caffeine in coffee, tea (it's in green tea, too, so be aware), chocolate…it all challenges healthy sleep. It's something you are best to live without during pregnancy anyway, so why not get used to decaffeinated life now if that's where you want to be?

4. Be aware of glycemic index. Foods with a low glycemic index are foods that don't challenge your insulin function as much as other foods. It's not that high glycemic foods are"bad", it's just that they should not be eaten as often. In order to make a MEAL lower-glycemic, be sure you have a good balance of carbs, fats, and proteins. People eating on the run tend to challenge glycemic function either by eating large quantities of fast food or nibbling all day long on carbs without making time for protein.

5. Pay attention to your fats. One reason I push the fish oil so much is that it really helps to improve insulin function."S" and"C" oils--safflower, sunflower, soybean, corn, cottonseed…tend to worsen glycemic function. They're found in processed foods, baked goods, and salad dressings. One reason I love teaching my classes at Whole Foods is that their entire deli uses only olive and canola (the only"C" exception) and you can literally choose what you want without ingredient anxiety.

6. Add a little cinnamon to your low-glycemic oatmeal. It has been found to improve insulin function…and it's tasty!

A word about metformin. Some women complain about digestive disturbances with this medication. A physician once shared that if you eat a lot of carbs (particularly sweets) while on the medication, it can cause diarrhea. So be forewarned, taking the medication is not a license to eat what you want, assuming metformin is going to do all the work. Metformin is most effective if you use it in conjunction with the guidelines in this post.

Next progesterone post we'll talk about poor nutrition. It is very important!

Fluctuating hormones, limited research, and dietary recommendations that are all over the place (ranging from vegan to Paleo) are all things that characterize PCOS. Given the vagaries of PCOS treatment (really, how many divergent opinions can we extract from a gynecologist, an endocrinologist, a reproductive gynecologist, and a dietician or two?!) and the limited success that treatments often have, it can be really tempting to think about abandoning western (allopathic, traditional) medicine and going in search of alternative care.

Alternative care includes, but is not limited to, homeopathy, meditation, nutritional coaching or consultation with unlicensed individuals, muscle testing, psychological counseling from unlicensed individuals, yoga, spiritual counseling, reiki, and EFT. We often think of acupuncture, chiropractic, osteopathy, massage, and naturopathy as part of the alternative spectrum, but in fact they’re generally well-regulated, licensed professions, and many of them have been studied extensively, and received acceptance from both traditional and alternative practitioners.

I’ve been through hundreds of treatments myself, both traditional and alternative. I’m highly sympathetic to your frustration and feelings of hopelessness. And while I’m personally all for exploring the alternatives, I’m also cautious. Just because something is “natural” doesn’t mean it’s safe. I, for example, actually believed the “dietician” some years ago who told me that, if I just gave them a good trial of a couple of weeks, I’d ultimately have no problem digesting the nuts to which I’d been told I was allergic (and the swelling in my throat when I ate them seemed to verify that, but I had faith!). Nuts are great, so I dutifully tried all sorts of tree nuts, and had a bad enough reaction to walnuts that my allergist thought I’d better keep an Epi-Pen with me at all times. As in, I could have a potentially fatal allergic reaction to them, so I’d better be prepared. Epic fail on the natural/alternative nutrition approach, in other words.

HCG injections that back-fire and result in more weight gain; poorly regulated, excessive, and/or inappropriate supplements; homeopathic treatments that result in unmitigated symptoms, up to and including depression-inducing insomnia; diarrhea, constipation, and other digestive disturbances; unnoticeable impacts from treatments or supplements that a practitioner swears are working, but just taking time; malnutrition; exercise-induced damage of all sorts; allergic reactions – the list of problems is endless. This is not to say that western medicine doesn’t have most of the same potential side effects, not to mention quite a few that are equally if not moreacute, but I think it’s important to know what you’re dealing with.

What I worry about from the mental health side of things is:

-Not wanting to take prescription medication for depression when it’s clearly indicated may be fatal;

-The pursuit of hope – and subsequent failure to achieve the desired results – can result in a sharper drop-off of hope – right into hopelessness, which is a predictor for suicidality;

--Wasting money, time, and other resources can contribute further to feelings of hopelessness;

--Unknown/unstudied impacts on the brain, mood, and our future health;

--Shame or embarrassment about not trusting one’s doctor enough, leading to keeping the alternative care a secret, which can impair your M.D.’s ability to provide appropriate treatment;

--The endless pursuit of alternatives may impair the process of reaching acceptance about your condition, its permanence, and it’s long-term health implications; and

--Information overload is already prevalent in our society; unfortunately, the alternative care world is full of even more phenomenal amounts of inaccurate, misleading, and anecdotal evidence than the world of Western medicine.

I want you to be empowered, educated, and make informed decisions. I want you to know your options, both Western/allopathic and alternative. I want you to take charge of your health, and use your health care dollars wisely. I want you to use your time and energy and hope in ways that have a meaningful impact on your health. I want you to be well.

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 AskDrGretchen@gmail.com. You can also follow her on Twitter @askdrhousemd.