The Hemp Connection [Search results for dietitian] 

Today, my post is devoted to a special project promoting registered dietitians. I am cohosting, with dietitian Renata Mangrum, the first-ever Registered Dietitian blogfest, aimed at showcasing to the Internet-surfing public the many things dietitians do and can do to help you with your quest for help. Listed below my entry is a list of links to other blogs written by other dietitians that you can visit to see the many things my friends and colleagues do within this profession.

inCYST was created precisely because I realized there was so much misinformation about polycystic ovary syndrome. Not only was it not HELPING women with PCOS to get better, some of the information seemed to have potential to actually HURT those women.

So I started this network as a means of putting together a team of professionals whose mission and knowledge was evidence-based and cohesive.

What has developed out of that has been far more than I ever could have envisioned when I sat down to do this. Several of our network members have PCOS themselves. Several others have gone through their own issues with infertility. Others have family members with mental health diagnoses, whose treatments for those diagnoses have affected their hormone function.

So as we grow, we are becoming a network of practitioners who happen to be people first, and practitioners second. I love that, because it means we've been there, we know how it can feel to have PCOS and its many associated problems, and we're committed to helping provide accurate information wrapped in a compassionate package.

I can't think of anything better I could be devoting my work and my career to. I hope you enjoy our blog…and I hope you enjoy getting to know some of the many colleagues participating in our blogfest today!

Warmest regards,

Monika M. Woolsey, MS, RD
Founder, inCYST Network for Women with PCOS

Beyond Prenatals — Food vs. Supplements and Real Advice vs. Fake Advice
Annette Colby — No More Diets! A Registered Dietitian Shares 9 Secrets to Real and Lasting Weight Loss
Ashley Colpaart — Dietitians working in food policy, a new frontier
Diana Dyer — There and Back Again: Celebration of National Dietitian Day 2009
Marjorie Geiser — RD Showcase for National Registered Dietitian Day — What we do
Cheryl Harris — Me, a Gluten Free RD!
Marilyn Jess — National Registered Dietitian Day--RD Blogfest
Julie Lanford — Antioxidants for Cancer Prevention
Renata Mangrum — What I'm doing as I grow up…
Liz Marr — Fruits and Veggies for Registered Dietian Day: Two Poems
Meal Makeover Moms' Kitchen — Family Nutrition … It's our"Beat"
Jill Nussinow — The Registered Dietitian Lens I Look Through
Wendy Jo Petersen — March 11 is our day to shine!
Diane Preves — Registered Dietitians and the White House Forum on Health Reform
Andy Sarjahani — Dr. Seuss Tribute continued: Green Eggs and Ham and a Sustainable Food System
Rebecca Scritchfield — Big Tips from a"Big Loser"
Anthony Sepe — RD Showcase: Registered Dietitian Day, March 11, 2009
Kathy Shattler — RD Showcase for Nutri-Care Consultation
UNL-Extension, Douglas/Sarpy County — Nutrition Know How — Making Your Life Easier
Jane Zingaro — My life as a Registered Dietitian
http://workinggreenmom.blogspot.com/2009/03/my-life-as-registered-dietitian.html

I've been a dietitian for 26 years now. I've seen, at this point, thousands of clients for dozens of reasons. And despite all of the new information available, medical advances, and my own experience, one thing has not changed.

Meal plans do not solve medical problems, they do not cause weight loss, and they do not improve your fertility.

If I had a dollar for every time someone called me, asked for an appointment, politely listened to everything I had to say, then changed the subject and asked for a meal plan, I wouldn't have to write this blog to earn a living.

Face it. If a meal plan was what you needed, you could buy one for $15 at Borders. Better yet, you could get it for free at the public library. By the time you likely asked for help, you'd probably tried several meal plans…and none of them worked.

Or, you tried the meal plan, and it worked, but you quit using it. And started looking for another meal plan.

The definition of insanity is trying the same thing over and over and over and over and over and over again…and expecting a different result.

If you are bouncing from meal plan to meal plan, and either not trying them long enough to see them work, or not following a meal plan that works and hoping that dropping money on a consultation with a nutritonist will produce results that you didn't get the last time you didn't try something…

…you are participating in insanity.

So for the benefit of women everywhere looking for help with their PCOS, here is a list of considerations. If you are honestly (and I mean honestly) looking to learn how to eat better, here is a list of what meal plans can and cannot do.

1. A meal plan can help you to get a handle on realistic portion sizes. No dietitian out there expects you to weigh and measure your food for the rest of your life, but our estimation of portion sizes tends to creep up over time. Getting back on track with portion sizes can be useful.

2. A meal plan can remind you to eat from a variety of food groups. My experience is that people eat best when they focus on what they CAN eat, rather than on what they CAN'T. Most people who are not eating well are not eating fruits and vegetables. A meal plan can remind them to get enough of these important foods, and most people who DO are full enough to not be hungry for foods that get them into trouble.

3. A meal plan can encourage you to try foods you weren't hungry for when your carbohydrate cravings were in control. This is an important one. Many women with PCOS are clueless when it comes what to eat, because they have spent so much time trying to satisfy cravings that originate from their hormone imbalance. Once those cravings are corrected, which our program is very good at doing, a meal plan can teach you what normal eating is like.

Now, here's what meal plans WON'T do.

1. Meal plans won't cause weight loss. Following a meal plan can correct a calorie imbalance and encourage weight loss. But you have to follow it. Buying one from a bookstore or a dietitian and letting it collect dust on your desk, won't give you results.

2. Meal plans won't make babies. We're pretty good at correcting hormone imbalances, but even so, we cannot make guarantees. We do know that women who have the ability to make changes over an extended period of time are more successful at correcting hormone imbalances that make it hard to have a baby. But the keywords in that last sentence are make changes and over an extended period of time. Buying a meal plan is not making changes. Following a meal plan is making changes. One week is not an extended period of time.

3. Meal plans won't teach you how to recognize hunger and fullness, and how to distinguish hunger from cravings. A dietitian, if you trust him/her, can guide you through that process. But you have to look up from your meal plan and listen…and try…what they're excited about teaching you.

4. Meal plans won't stop you from emotional eating or binge eating. If you have a history of yo-yo dieting and binge eating, a meal plan may actually set you off. You may rebel against it. But why? The only person you rebel against, when you rebel against a diet…is yourself. A meal plan is an attempt to impose superficial structure over chaos. Not all that different from putting a shiny new paint job on a rusted out old beater, hoping no one will notice the inside. And when you fail, you end up reinforcing with yourself that you do not deserve to succeed. A dietitian can help you succeed. But only when that is what you are ready to do.

Next time you ask a dietitian for a meal plan, be sure you have been able to verbalize, out loud, just what it is that you expect the meal plan to do for you. Better yet, go into your bathroom, look yourself in the eye in the mirror, and say out loud,"I would like a meal plan because it will help me with __________________. I commit to following the meal plan for __________ weeks before I determine that it is not working. And before I quit, I will ask the dietitian I asked to give me a meal plan for help in problem solving why it didn't work. I will ask her how to help me succeed."

Then write your commitment to yourself on two pieces of paper. Post one on your refrigerator and the other on your bathroom mirror.

If the thought of doing this leaves you feeling uncomfortable, it's time to be honest with yourself. Maybe a meal plan is not what you're looking for.

Just wanted to welcome Lesli Bitel-Koskela to the inCYST Network. She is a dietitian practicing in Long Grove, Illinois.

Lesli Koskela. RD, LDN is a registered dietitian/licensed nutritionist and the owner of the private practice and nutrition consulting business, Harmonic Nutrition & Wellness, LLC. She provides medical nutrition therapy and lifestyle coaching services to individuals, families and corporations with a focus on long-term behavior change.
In her work, Lesli takes a highly personalized, integrative and non-diet approach to designed to empower her clients in achieving a balanced and healthy relationship with eating and exercise.

Lesli uses a variety of nutrition intervention and coaching strategies designed to support her clients in meeting their goals. She is a certified food sensitivity and food allergy therapist, lifestyle and wellness coach, weight management specialist and mindful eating expert. Additionally, Lesli has earned an advanced certification in Weight Management in Children and Adolescents through The American Dietetic Association.

Lesli has been a registered dietitian for over twenty two years and draws upon a wide range of experience in several health care settings. She was a clinical dietitian at Northwestern Memorial Hospital in Chicago with an emphasis on corporate wellness, eating disorders, oncology & spinal cord injury nutrition and as a business director within the pharmaceutical industry.

I know Lesli and our other Chicago contact, Anna Ahlborn, have met to discuss how they can be of service to women in their area who could benefit from their expertise.

Please contact Lesli if you would like to start on an individualized nutrition program that can help you on the path toward better hormone balance…and feeling better!

Harmonic Nutrition and Wellness, LLC
847-381-5947

I make Tuesday nights my housecleaning nights so I can watch this show and keep up with what my clients are learning about weight, nutrition, and exercise. This is the 6th season…and it wasn't until recently, while reading a colleague's blog, that I learned that this show even had a dietitian.

Never once have I seen this dietitian interact with the contestants. Never once have I seen her be given credit for any of the meal plans the contestants follow. In fact, I've seen an ad on the program about supplementary nutrition material viewers can purchase that is credited to the show's physicians. And you know what? She's not only a dietitian…she's a professional chef!!! Why is Rocco getting more air time?

I think Bob and Jillian, the trainers, are great trainers. But every single time they start to talk about food…it's a product placement opportunity. Watch for that next time around. Tonight it was about jello and milk, which turned out to be program sponsors.

Has the dietitian been silenced because she'd talk about all foods and not just the ones financially supporting the show?

It just doesn't seem fair, as much as the show is about nutrition, that the nutrition expert has been relegated to be completely off camera and not be given credit for much of the work she apparently does.

I wish this person would get the credit she deserves. Maybe if she did, the food information would feel less like poor attempts at sneaking more advertising time into the show and more like information that has some scientific basis.

Cheryl, I hope some day you get to come in front of the cameras and be rightfully acknowledged for everything you clearly do.

We're accumulating quite a team of exercise experts here, and I wanted to be sure you knew who you could go to for help with your own fitness program. It was when working on my master's degree in exercise physiology that I developed my own interest in hormones, so it's always been important to me to have great go-to people in this area for our fans.

Here they are!

Stacey Frattinger is a registered dietitian with two bachelor's degrees, one in psychology, the other in clinical dietetics. She is also a Certified Health Fitness Specialist. Stacey also lives with PCOS, and understands the struggles associated with nutrition and physical fitness that the diagnosis brings. If you are interested in working with Stacey (she is located in Reno, Nevada), visit her website for more information on the services offered.

Sally Hara, of Kirkland, Washington, is a registered dietitian, exercise physiologist, and certified diabetes educator. She is a contributing author to the American Dietetic Association’s 4th edition Sports Nutrition; A Guide for the Professionals Working with Active People, the official Sports Dietitian and Diabetes Educator to the type 1 diabetic athletes of the Sports and Diabetes Group NW, and the official nutrition coach for AdventX, an outdoor adventure fitness training company in Seattle. She will soon be doing a training webinar for inCYST on the topic of Sports Nutrition for PCOS. Personally, Sally enjoys endurance bicycling and has completed the Seattle to Portland bike ride 4 times (and counting) as well as several century rides. I opted for an action shot because as I write this, Sally is on a training ride, wth her local Juvenile Diabetes Research Foundation (JDRF), in the pouring rain, for the upcoming Tour de Tucson. Here is her website for more information about how to contact her.

Sarah Jones started out as inCYST's very first intern, has completed the inCYST training, and is our network's very first registered yoga teacher. She has been teaching the yoga component of our current workshop series at Metta Yoga. Sarah is currently completing her nutrition studies at Arizona State University. If you'd like to practice yoga with Sarah, please visit Meta Yoga's website for her current schedule. Sarah is helping me put together a special inCYST training for registered yoga instructors. Stay tuned!

Christine Marquette has a Bachelor of Science Degree in Dietetics with a major in Nutrition from the University of Texas and is also a registered dietitian and certified Health Fitness Specialist (HFS). Christine walks the walk (or should I say runs the run)! She is a practicing vegan and an avid runner, having completed over 6 marathons and dozens of 5Ks, 10Ks, half marathons, and other distance races; and is an assistant coach with Austin Fit marathon training program. She is also a sprint distance triathlete. Christine's practice is in Austin, Texas.

Me (Monika Woolsey) I have degrees in both nutrition and exercise physiology. I managed the exercise testing laboratory my final year of graduate school, and I've worked in fitness centers at Apple Computer and Stanford University. I've also consulted with Olympic and professional athetes. My interest in hormones got started when I researched menstrual cycle abnormalities in elite female figure skaters; that study was the foundation for my work with PCOS. I am an eclectic athlete, not necessarily competetive in any one sport, but I love to move! That wasn't always so, as I struggled with weight as a child and it wasn't until college that I realized I had athletic ability. My photo montage shows me on top of a 14,000 foot peak n Colorado, cross country skiing, finishing a half marathon training run, and getting my butt kicked by Craig in his bootcamp fundraiser. Looking forward to taking tennis lessons very soon! I practice in Phoenix, AZ and Santa Monica, CA, and can be contacted at monika at afterthediet dot com for consultations.

As you can see, our team has a breadth and depth of knowledge and experience with all kinds of exercise. Please take advantage!

I am super excited to share a brand-new book about PCOS with our readers and fans, it is hot off the presses, today! The name of the book is The PCOS Diet Plan: A Natural Approach to Health for Women with Polycystic Ovary Syndrome, by Hillary Wright, MEd, RD.

There are two reasons this book is so special:

1. It is written by a dietitian.
2. Hillary Wright, this dietitian, actually works in a fertility practice, Boston IVF. Infertility doctors and dietitians rarely work in the same place, and it is wonderful to see this team working together on behalf of their patients.

Hillary has also experienced infertility herself, so she has some personal experience with the emotional aspect of what many of her readers have gone through.

I told Hillary, as soon as I got the book, I immediately opened to the omega-3 section to see what she had written. And, seeing that it was primarily consistent with what our own network providers teach, I felt encouraged that the rest of the book would be valuable.

And I wasn't disappointed.

Hillary has a very readable style. I could practically envision her in a session, presenting the hard science, then stopping, taking a breath, noticing her client's hesitation, and gently nudging that client into not just knowing the science, but understanding why they needed to act on it. It's not so much that the science she presents is new, but she has a great cadence to her writing style, as if she wants to be absolutely sure this book is not written for women with PCOS, but personally for you. As if she genuinely wants to know you're going to do something with the information she is taking the time to explain to you.

It is not condescending at all, however. It is clearly the voice of someone who has worked with many, many, many women with PCOS, and she knows exactly where in the conversation they are likely to take the breath and start to launch on the reasons why the information is not going to work or why they don't want to try it. And she gently calls each and every one of them on their stuff, encouraging them to be empowered, rather than held captive, by their diagnosis.

Hillary is clearly a professional who understands what you're going through, and who acknowledges the disappointment, fear, skepticism, and trust issues you may have with your body, nutrition, and nutrition professionals. But she'd rather show you the way out of that darkness than encourage you to wallow in it.

For those of you who want meal plans, food options, etc., the examples are plentiful. You really should have no issue with the nuts and bolts of your diet if you read this book with good attentin.

Before you spend money on a PCOS consultation of any kind, invest in this book and take the time to read it cover to cover. It will prepare you well for the next step and give you a more concrete basis on which to structure your conversation with anyone you pay to help you with your diagnosis.

If you're a dietitian and you do not fully specialize in PCOS, this book is a great one to refer your clients to or to keep in your lending library to provide the information you may not have on the tip of your tongue during a counseling conversation.

If this book goes into its second edition, and I really hope it does, I'd love to see a little bit more information on a few topics: (1) eating disorders, (2) what to do if you're lean with PCOS, and (3) supplements. Those are all areas that are hotly discussed on our fan page, are some of the most common searches bringing traffic to our blog, and clearly not well researched or written about. If you're looking for information in these areas, you may not find the book to feel complete…to offer more information in these areas would only add to its value.

This book is available in both a paperback edition and a Kindle edition that I've linked to here for your convenience.

Thank you, Hillary, for taking the time to write this book. You are surely helping many women feel as though PCOS is something they can live with and have a productive, fulfilling, life.

Dear blog readers,

I received a comment over the weekend, questioning my lack of enthusiasm for high fructose corn syrup that ended with,"My RD would be proud of me." It sounded like our reader was feeling a little bit caught between two different dietitians with two different ways of interpreting information. No one looking for help with their PCOS should ever feel like they need to choose between one advice giver or another. No one reading this blog has to do anything for us. We're just here to provide information in a way we hope is helpful. As long as we get blog hits, we figure that is exactly what we're doing.

I figured it was best to clarify why I do what I do and how you're best going to benefit from visits to this blog.

1. I am a pretty obsessive reader of research. When I read research, I find a lot of information that either has not been presented to women with PCOS at all, or it's not been presented in a way that benefits women with PCOS. So I compose my conclusions and post them here, in hopes of helping people who haven't had access to that viewpoint. It's my viewpoint, and my viewpoint only. It's not ever going to be anything that makes 100% of people who read this blog happy. I never set out to do that. But what I do provide, when possible, is references from peer-reviewed research that shows you where I got my facts and how I connected the dots.

2. If you've read my writing, and you've also connected dots in a different way, I respect and support that. Like I said, I'm not here to make you think like me or do like me. I'm hoping to encourage you to do your own critical thinking and come to conclusions and choices that work best for YOU. You have enough personal and corporate interests trying to make you think one way or another. I don't want to make you think anything. I want to encourage you to think independently.

3. If you're working with another dietitian, I respect that. Any time anyone has EVER come to an inCYST event who has not been working with an inCYST network member, I make it absolutely clear from the beginning that we aim to enhance the experience with the other professional. We're not out to steal clients or make anyone look bad.

4. If for some reason you've brought any of our information in to your non-inCYST dietitian and the discussion has left you feeling caught in the middle, I don't want you to feel that way. All we're doing is presenting information that we have found to be helpful. And recently, we've grown into a fundraising entity designed to invest in scientific studies that can help add credibility to the paradigm we've been developing. It's super important at inCYST that we don't grow into a place where we just spout off about ideas, but that we pursue the ones we feel are valid, on behalf of women who live a life with less quality than they deserve. Even with that commitment, we know our way of doing things is not the only way of doing things. It's just our way of doing things. We work very hard to make it credible and verifiable. If it works for you, great, please benefit. If it's not consistent with what your dietitian is telling you, my biggest hope is that you would be empowered enough to be able to take the best of both sets of advice and chart your own course. If nothing that we offer here works for you, that's ok too. There are many paths to the same destination. Your best nutrition coach is not us, or anyone else, it is YOU.

5. We can respect the differences in philosophy that exist in the world of health care, but our primary focus with inCYST is to develop the paradigm and provide information to those who DO benefit from our information. It's not to defend ourselves with those who disagree. We respect the disagreement and hope that you achieve success with the information and choices that work best for you.

6. I believe our team does excellent work, but just because someone is not in our network, it doesn't mean we think they don't as well. The purpose of having a network is so that if you come to this blog and you like what you see, we have a team of people in a variety of places that you know you can go to, who will give you the same sort of approach one-on-one as you got here. You guys waste enough money trying do that on your own, and we wanted to stop the unproductive cash flow. We are very good at what we do, but we do not intend to say that others are not. That would be untrue, not to mention completely arrogant.

Thank you for visiting the blog, and I hope that once in awhile, it does provide information and inspiration that's helped you along your PCOS path.

Rachel Brandeis is a dietitian in our network, practicing in the Atlanta area. She is well respected in the reproductive medicine world, and well versed in PCOS. The other day, in a phone conversation, she mentioned that one of the aspects of her work that doesn't always allow her to be as productive and helpful to her clients, is when they come unprepared and unready to get down to work. She sent me a great list of bullet points that you can use to prepare for working with your own dietitian.

Keep in mind, we tend to ask a lot of questions and stick to business! It's not because we don't care about you or your story. But since you're spending time and money to work with us, we tend to be focused on the task at hand. We also understand that a lot is riding on our advice, so we want to be sure there is time in the appointment to get our information across.

Here is what Rachel suggests:

1.Be prepared to give an accurate diet history — foods and beverages that you commonly consume; it may be helpful to keep a detailed food record for a week (including a weekend).

2. Be honest when discussing what/how/when you eat — you are paying us to help you, not to judge you!

3. Be prepared to also give an in depth weight history and past dieting attempts (both successful and unsuccessful).

4. Know what medications you are taking and the dosage of each medication

5. Bring your most recent lab work with you

6. Keep an exercise diary — we need to know how frequently you exercise, how long and how intensely.

7. Be prepared to answer"what would you like to get out of this consult"

8. Understand that we don't have a"magic wand"

9. Come back for follow-up appointments! Change does not happen with one consult!

10. Have realistic expectations.

If you'd like to contact Rachel about an appointment, visit her website.

This is a great question!

PCOS, because of the word"ovary" in its name, is often thought of as a gynecological disorder. However, it has symptoms affecting quite a few organ systems, many of which gynecologists may not be specially trained to treat.

Before you ask for help with your PCOS, be sure you know exactly what it is that you are wanting from that person.

Are you trying to become pregnant? Then a gynecologist is your best bet. Do you have acne or facial hair? A dermatologist is most likely to know the latest and best PCOS-friendly treatment options. Family history of diabetes? Consider a diabetes-specialized endocrinologist. Keep in mind, a specialist is trained to see your condition through a very finely tuned set of lenses, and that means the possible answers they provide will have some bias. Medline published a study a few years ago illustrating this bias, reporting that a gynecologist and an internist would have very different ways of diagnosing--and treating the same PCOS. So it is important to know what your goals are, before choosing the best person to help you reach them.

Despite those recommendations I just gave, consider that you may not actually need a"specialist". Some of the best physicians I've worked with on behalf of clients have simply been good listeners and willing to look for solutions even if they didn't have them, themselves. That person could be a country doctor, if you live in a rural area, or a family practitioner who has been your primary caregiver for a very long time. What matters most is that you get solutions in a respectful fashion!

I am biased because I am a dietitian and not a physician, but I strongly encourage you to find a physician who values a well-trained dietitian as part of your treatment. Nutrition is one of those topics everyone knows a little about. But it is also one of those things a lot of people think they know more about than they really do. I've encountered a lot of nutrition advice for PCOS given by health professionals that actually could have been counterproductive. It is important for each person taking care of you to excel in the part of your treatment they are trained to excel in…but also to refer out to others who excel in their own part of the picture. No one can possibly know everything about everything!

A strong nutrition program can often do the job that medications are prescribed to do. So making extra sure that nutrition and lifestyle are in good order before jumping into medications, surgeries, and treatments, can save a lot of time and frustration. Even if it turns out that medication and other treatments are needed in addition to medications and procedures, you may not need as much medication, and you may have better tolerance for and success with, the treatments your physician provides for you.

On that note, qualified naturopathic physicians and acupuncturists may have treatment options that work well for your individual situation. I have seen several of my own clients do very well with a team that included medical doctors IN ADDITION to specialists in these areas. What made it work, was a willingness on the part of each of these professionals, to work together with the other professionals.

One of the most important responsibilities you have, once you ask for help from a medical professional, is to follow their advice. And to follow it long enough to give it a chance to work. A very common tendency I see, unfortunately, is for a person to try advice, but not long enough for it to actually work. And then they blame the physician. Or, to spend more time on the Internet looking for reasons to NOT follow the doctor's or dietitian's advice than actually giving it a chance in real life. If you are asked to take medication, take it consistently. If you are advised to exercise, then exercise. It is not the physician's fault if the medication s/he prescribed was not used as advised!

Once you've found the person you feel fits you best, remember that a lot of the answers to the syndrome are about changes YOU can make for yourself. Doctors, dietitians, acupuncturists…can guide you toward those changes, but they cannot make them for you. It's important to remember how much of the responsibility for your success comes from other people, and how much of it actually lies within YOU.

I actually came into working with PCOS through the back door, as someone who had specialized in eating disorders treatment first. I'd left my work at a treatment center, launched an eating disorder website, and women started calling me saying,"I used to have an eating disorder, now I have something called PCOS…do you know anything about it?"

It happened enough times that I started researching the syndrome, realized there was not a lot of good, standardized information about PCOS, saw the niche that needed filling…and there you have it, the Cliff's Notes version behind the inception of inCYST.

The correlation between the two conditions is so strong that I often wonder if it isn't the exact same problem being given a different name and treatment, depending on whether or not a physician or a mental health professional makes the initial diagnosis.

Because diagnosis and treatment can start in two completely different environments, there can be problems with outcome.

--Physicians accustomed to other diagnoses that respond to a simple medication or surgical procedure, may not have the interest in considering the emotional aspects of PCOS. A dermatologist actually said to me once,"I just want to take care of skin cancer. I really don't want to deal with all of those emotions."

--Even dietitians who work with diabetes and can assume they have expertise with PCOS, may not have the patience to delve through the layers of hormones and emotions and reactions to imbalances between the two, to help a client understand how all of these pieces fit together.

--Psychiatrists may be prescribing medications that exacerbate hormone imbalances and PCOS, and not consider that the weight gain and other side effects are a huge reason for medication noncompliance.

--Psychologists may not understand that anger, even rage, and depression, is very strongly affected by hormone imbalances, not entirely based on what's going on in a person's world. They also need to understand that a client can be absolutely, completely, 100% compliant with every single assignment they're given…and STILL have cravings and not lose weight. They need to not project that disappointment on the client, but take it as a cue that they may be missing an important part of what's going on.

--Eating disorder specialists I've worked with seem to be much more comfortable working with"thin" women with eating disorders. I remember when I worked in the treatment center, the women with binge eating disorder never seemed to get the same sort of attention. There seemed to be a size discrimination even coming from professionals who were supposed to be advocating for the opposite.

--Body image specialists may not completely understand that with PCOS, there are genuine and valid body image issues that are not distorted thoughts. There is facial hair. Acne scarring. Hair loss. And the cysts on the ovaries can create a feeling of bloating that is valid, not imagined.

My personal feeling is that you cannot effectively and successfully treat PCOS unless you are helping both mind and body.

If you're a physician, you need to be sure that your client has adequate emotional support rather and not just increase a medication dosage because you're not seeing progress on lab reports that you'd like to see.

If you're a dietitian, you need to have access to a size-neutral psychologist who understands the syndrome and not be afraid to refer and work together as a team.

If you're a mental health professional, you need to understand that just because your client has a disease with a physiological basis, your place in their treatment is not threatened…in fact, it is more important.

You just need to enhance the number and type of issues you can help them with.

All of us need to stop attaching symptoms and needs to a certain weight. To assume that if we get down to a certain weight the syndrome magically goes away. It's there no matter what. I just had an enlightening conversation with a dietitian who has gone through my training, is embarking on her PhD, is normal weight, and teaching at the university level. Even though she's doing all the right things, she says she STILL has times when her appetite is out of control and it completely frustrates her.

The link between eating disorders and PCOS is very, very strong. We need to embrace it and study it so we can help women tackle both and accomplish great things in their course of managing the syndrome. All of us are going to have to step outside of our personal comfort zones as professionals to be effective, and to stop thinking we can help women with PCOS all on our own outside of the structure of a team. inCYST would like to make that a rewarding risk for anyone who chooses to take it.

So 2011 has been designated inCYST's year of eating disorder outreach. We've got two learning opportunities for you who are interested in learning more.

This coming Monday, at 12:30 pm Eastern time, inCYST dietitian Janenie Wade and her business partner Ellen Shuman will be on our radio show sharing more about their collaboration with A Weigh Out, an online and phone coaching program specifically designed to help women with binge eating disorder and able to account for the presence of PCOS. Come tune in and get your toes wet, and see what they're doing! Maybe it will inspire you to want to do more as well.

This spring, in Scottsdale, Arizona, the Binge Eating Disorder Association is holding its annual conference. It's a great place to start learning more (in a beautiful climate, I have to add!).

Of course, we're always looking for mental health professionals to join us at inCYST as well. Our training is open to anyone who would like to take this on. Just let me know if you're interested.

Hello everyone,

I had a wonderful time in Michigan getting to know some new inCYSTERs in our training. I wanted to highlight them in this post, plus mention some new names you will be seeing more often here on the blog.

JACKIE SMIERTKA is a nurse who specializes in bariatric medicine. She has worked in that field for many, many years, and she recognized that PCOS was coming through her door. She was my initial Detroit contact, and she hosted my training. She is passionate, not to mention compassionate. She owns the Quality of Life Center, a one-stop center for people who have needs associated with their bariatric surgery. That center now has the ability to help women with PCOS who are either contemplating such a surgery or who have had one and would like to work with someone who understands PCOS.

SALLY MYERS is the dietitian who introduced me to Jackie! She is currently in Herndon, Virginia, she is well known as a bariatric nutrition specialist, and I am really excited to have her in the network as a resource on nutrition for bariatric surgery when PCOS is an associated condition. Sally is also a competetive racewalker! I enjoyed learning more about that sport during our lunch breaks.

TERRIE HOLIEWINSKI is a dietitian at the University of Michigan at Ann Arbor, who specializes in working with cardiovascular issues and PCOS. She is passionate about this work, and loves working with PCOS!

IVONNE BERKOWITZ officially finished her inCYST training this past Sunday. She is a certified wellness coach and she loves to write. I hope you enjoyed her post on labels, her style is very"tell it exactly like it is without pulling punches," and she's got some great ideas that can help you with the practical application of what you see on the blog.
I am adding links and contact information as I have them…please seek these professionals out if they are in your area! The amount of work they have put into learning about PCOS and their passion for wanting to help is a fabulous combination just waiting for you to take advantage of!

OK, they finally had a dietitian tonight! And she was fun to watch. Not some sterile woman counting out food portions. No finger shaking. No weird, nasally voice. No"I'm-recovering-from-my-own-eating-disorder-and-don't-even-look-healthy" appearance, or overly perky personality. Just a normal person who knows about food…and who wants other people to enjoy food, too.

I think my favorite thing she did was the food taste test. It's the first time, in all of the seasons of this entire show, that someone actually talked about ENJOYING food. Well, food that is healthy. It tends to be so much about what you should and shouldn't eat. But…if you don't like the food you're eating, then you aren't going to stick with the plan.

She also talked about alcohol, another first. That was a nice piece to add.

I wish they'd delve a little more into the things that can be hard to talk about, but which get you into a situation where you apply to compete on a show like this. Such as binges. Eating in private. Tricks people use to make it look like they're eating less than they really are. Painful topics, I know…but it's the kind of thing that every viewer on my side of the screen with an eating problem can relate to and would love to hear some dialogue about.

I'm even willing to bet, if the producers of this program included a little bit more of that…they would still get ratings without Jillian yelling or exercising contestants until they vomit.

Overall, this was one of the best episodes in all seasons combined. Of course I'm biased because I'm a dietitian. But then this show in large part is about food and to not have that food person be an integral part of the program is like having Law and Order without any attorneys.

I just received a review copy of Living With PCOS by Angela Boss and Evelina Sterling. I actually sold the original edition of this book in my bookstore for a time, so I was interested to see the new version.

Before I review, I want to qualify, I went into reviewing this book a little differently than many readers would. I am a dietitian who believes in the power of nutrition to help women with PCOS. In the process of building the inCYST network, I've also had the honor and pleasure of meeting and working with colleagues who use many different (and evidence-based) approaches to PCOS management that expand past what a medical doctor might offer. So I am most likely to connect with experts on the topic with a similar perspective.

What this book is very good at:
--putting the readers in the frustrated and invalidated shoes of a woman with this diagnosis, and advocating for better identification and syndrome management.
--providing a laundry list of qualities to look for in a primary care physician.
--summarizing lab values typically used to develop a woman's treatment plan.
--explaining medications typically prescribed for PCOS management.
--including an entire chapter on depression, an aspect of PCOS that medical professionals seem to not want to acknowledge, but which is very, very prevalent.

What this book could have been better at:
--advocating for as much discretion when choosing a nutrition professional as choosing a physician. Many dietitians say they treat PCOS when they haven't even pursued specialized training for the diagnosis.
--advocating for as much discretion when choosing an alternative care provider as choosing a physician. Again, there are many people who view women with this diagnosis as a revenue stream, not women who deserve evidence-based, ethical treatment.
--explaining why breastfeeding can be problematic in PCOS.
--describing and evaluating alternative therapies, supplements, and herbs. A very high percentage of women with PCOS are so desperate for help they are doing a lot of self-treating and self-medicating, which can be helpful…or very dangerous.
--broaching the topic of emotional eating, binge eating, and eating disorders. It's rampant in this population, it needs to be validated, explained, and destigmatized, as much as the rest of the symptoms do.

I was not entirely comfortable with the section on low carbohydrate diets. Even though it acknowledged that these diets are restrictive and difficult to maintain, it went on to make some general recommendations about how to pursue one. One of the most common problems we encounter at inCYST in our individual counseling, is a blanket carbohydrate restriction that eventually ends up with a binge. It's a noble goal, to reduce carbohydrates, but there are ways to do it that do not promote disordered eating. Perhaps including a dietitian in a future version of this book could help promote healthier eating patterns that are evidence-based.

Because I've been working with Dr. Van Dyke to better understand laser treatment for hirsutism, I was interested on the section regarding laser hair removal. There were some important facts about this treatment that were not included.

In general, for someone who is new to the diagnosis, it's a helpful rundown of what to expect when working with a medical doctor, but the slant is toward that relationship. If you have chosen, in your own personal situation, to prioritize medical treatment without using nutrition, naturopathy, acupuncture, or other complementary treatments, it is a good resource. However, if your treatment team includes other approachess, you will not find information in this book to enlighten you or guide you with regard to those issues.

Click here for more information on the book.

This past week I was watching The Biggest Loser. Not because I endorse their methods for weight loss, but because so many of you watch that show, it's almost required viewing for my job, to know what's being said and how to address it should it come up in our Facebook group.

I was appalled to watch one of the trainers, while a participant was doing situps, dropping a medicine ball on the poor guy's stomach. Nothing about that segment modeled respect for self or others, in my opinion, and it could have done serious damage to the participant. But that is what seems to happen in the world of weight loss. Once your weight exceeds what is deemed medically and culturally acceptable, the rest of the world seems to act as if they automatically have a license to decide how to"fix" you. The behaviors can range from looks into your grocery basket when you're shopping, suggestions that you're somehow not"doing enough" if your weight loss is not linear and predictable (as illustrated by the closeups of the shocked looks of the Biggest Loser trainers when someone does not lose, or…God forbid…gains weight, the assumption that if things are not going the way the trainer needs them to go in order to be the"good trainer"), that the participant must be the one to blame.

PCOS creates an even more frustrating scenario for physicians, dietitians, trainers, family members, everyone watching on as a woman decides she's going to lose weight. We've learned over the years that in many ways PCOS is counterintuitive. When you diet too strictly, weight goes on. When you exercise too much, weight goes on. It seems to be the"canary in the coalmine," so to speak, of imbalances in your life that need to be addressed. And, unfortunately, if you're a person of extremes, and you resort to fixing one extreme with another extreme, you're likely going to find yourself in a place where you plateau, gain weight, etc., with at least a half-dozen people looking on, with a million suggestions for"fixing" the problem.

Years ago I was a dietitian in an eating disorder treatment center. I was literally responsible for the weight gains of anorexics, the weight loss of women with binge eating disorder, and to be sure that bulimics who had been abusing laxatives did not gain too much weight during their withdrawal from those drugs.

Take the scenario I described above and multiply it by 36, which was the census of the treatment center. I absolutely hated Monday and Thursday mornings because those were staff meetings. I had to meet for three hours each morning with all of the therapists, physicians, etc., and discuss the progress of all of the women we were helping. If, God forbid, the weight of one person was not EXACTLY what I'd projected, I was put on the spot to (1) explain why and (2) come up with a remedy. Suggesting that healing from dietary imbalances of any kind was complex and that we were not in charge of all of the parts of the solution was not an option. Much of the rest of the week was spent with patients, family members, and insurance case managers, having the same conversations. In one case it was an attorney of a beauty queen who insisted she'd been promised prior to admission that she would not gain weight despite needing to withdraw from her box-a-day laxative habit and since her temporary fluid gain was in the double digits, I was to blame.

Can you tell how much I thought this job sucked?

The piece de resistance came during one stretch, when we had an overload of laxative abusers in the house (no pun intended) and my boss, desperate to be able to show good weight progress to insurance companies and keep her own"success" record high, asked me to come up with a solution. This was in the days before the Internet, and so I asked to be able to take a day in the local medical library researching intestinal health and dietary strategies. My request was denied. Instead, I was asked to create some type of"cocktail" that would"clean out or speed up the 'progress'" of the constipated individuals.

I looked at my boss and said,"I am a dietitian. I am not a plumber."

As you can guess, it was the beginning of the end of that job, which I actually eventually walked off of, because that particular situation was merely one of many I was expected to endorse that in good conscience I could not.

I learned humility in that job. An Ivy League degree and a master's degree plus stints at Stanford, Apple Computer, and the professional sports world, could not fix what was broken in these women. Only time, self-nurturing, and patience. Every single time I watch The Biggest Loser, I am reminded of that job. And how so many people I worked with based their own success on a patient's numbers recorded in a medical chart. Not on how well she was asserting herself, or sleeping, or challenging herself to eat salad dressing. It was all about the number. That it wasn't about the healers at all, but about empowering our patients to have the confidence to take care of themselves so well that they could fire us because they didn't need us anymore, was completely forgotten.

I guess I was inspired to write this piece because ever since I saw that medicine ball, I've been thinking how badly I wanted the poor guy on the floor to just stand up, tell the trainer to bite it, and walk off the ranch. Because he was being taught that somehow, because of the position he'd found himself in, needing to lose weight, he deserved to be punished and humiliated in the process of regaining his self-esteem. Yup, he had to be humiliated in order to develop self-esteem.

Don't ever let anyone, and I mean ANYONE — a medical professional, coach, or loved one, cause you to believe that they know better than you, what you need for yourself. Or that because your weight is not changing at a rate that THEY have determined is appropriate, that you're somehow doing something wrong. Or that what they have to say about your health supercedes what you believe about your health.

As Eleanor Roosevelt once said,"No one can take away your self-respect, unless you allow them to."

Meet Robyn Priebe, RD, CD, registered dietitian and Director of Nutrition at Green Mountain at Fox Run in Ludlow, Vermont.

Robyn just completed the inCYST training, and she is on site full time as a resource for women with PCOS. Double the learning…double the fun!

I had a great time working with Robyn the first PCOS week and am really excited to team up with her to provide a great program for those of you who come join us.

There is still time to register, for more information, visit www.fitwoman.com.

In the meantime, get to know Robyn!

I am a registered dietitian working at an all-women’s health and fitness resort in Ludlow, VT, called Green Mountain at Fox Run. At Green Mountain, we focus on helping our participants make healthy changes in their lifestyle. Our philosophy is non-diet & permission-based. Our goal is to help our participants practice intuitive eating in order to get their bodies back in balance. We strongly believe that each individual has different nutrition needs and different obstacles to meeting those needs. We strive to guide our participants towards the changes in their eating and exercise habits that would meet their specific needs/goals.

Personal Interests:

Stained glass, glass fusing, playing piano, attending concerts, running, animal rescue, vegetarian cooking, sewing, painting, gardening/foraging

Hello inCYST Readers,

It has been brought to my attention that the Corn Refiners Association has launched an advertising campaign promoting high-fructose corn syrup. On their home page, there is a statement that reads, in part:

High fructose corn syrup provides many important characteristics, such as texture, flavor and freshness, to your favorite foods and beverages. It is nutritionally the same as table sugar and has the same number of calories, too. As many dietitians agree, sweeteners should be enjoyed in moderation.

In response to the advertising campaign and this statement, I would like to clarify:

1. I am a registered dietitian.
2. I do promote foods in moderation.
3. I do not promote the use of high fructose corn syrup.
4. I am not one of the dietitians this campaign or this web page is attempting to connect their product with.
5. Just as I am exercising my freedom of expression by posting this statement to this blog, I respect the right of the Corn Refiners Association to promote their product. I simply wish to clarify that I have no professional association with their statement or their association.
6. If anyone reading this blog chooses to consume high-fructose corn syrup, it is their personal choice and freedom of expression. It is not a choice based on any perceived endorsement related to the fact that I am a registered dietitian that may have been insinuated based on the wording of these advertisements and the Corn Refiners Association web page.

Respectfully,

Monika M. Woolsey, MS, RD

Graphic courtesy of Renata Mangrum, MPH, RD

This post is part of the Women's Health Blogfest. Please click on the links below to read more from other contributors! And thanks to everyone who took the time to participate!

In the almost 10 years I have been studying PCOS, I've learned much about what drives a woman's motivation to seek out information. The top reasons women find this blog are:

1. to improve their fertility,
2. to more effectively manage their weight, and
3. to feel and look better

As I've read and met women with the syndrome, I've learned that PCOS is about a whole lot more.

1. A woman's breastfeeding practices seem to significantly influence her child's hormonal health. Many women I've worked with were formula fed at a time when baby formula did not contain essential nutrients.
2. Whether or not you as a woman with PCOS were born to term, and potentially whether or not you were part of a multiple birth, seem to be red flags for PCOS risk later in life.
3. Just because you're a teenager, too young to want to conceive, or a woman who has already had her children, doesn't mean PCOS isn't something to be concerned about. It can mess with your mood, and in turn your energy level and relationships. It can provoke eating disorders. It can elevate your cholesterol. And…through its link to diabetes, it may increase your risk for Alzheimer's disease.

A blog attempting to tackle a syndrome with such widespread effects is not easy to manage. I've been working since we've started to find experts in areas outside of nutrition to complement what I as a dietitian can discuss and promote. I'm really excited to be partnering with lactation consultants to address breastfeeding issues specific to PCOS, and to have Gretchen Kubacky, PsyD, on board, to help us understand what PCOS can do to thinking, mood, and energy. We have one dietitian, Karen Siegel, who is also an acupuncturist, and another acupuncturist will soon be contributing her insight as well.

For the very first time, we are collaborating with Green Mountain at Fox Run in Ludlow, Vermont, to offer PCOS Program weeks this coming September! It's been a dream of mine to see this kind of program and there is no better place where it could be launched. Green Mountain is also participating in this blogfest, if you'd like to learn even more, be sure to read their contribution.

We don't just care about your ovaries. We care about all of you, from birth through retirement, and we hope that as we grow and diversify, the expert opinions you will see expressed here on this blog will address the many important ways we can keep our hormones working positively for us.

Thanks for stopping by our contribution to the Women's Health blogfest. If you enjoyed us, you can follow us with the signups you see here on the blog, through our Facebook inCYST group, or through Twitter, via @incyst.

For more information on women's health:

Angela White at Blisstree’s Breastfeeding 1-2-3 – Helpful Skills of Breastfeeding Counselors
Angie Tillman, RD, LDN, CDE – You Are Beautiful Today
Anthony J. Sepe – Women's Health and Migraines
Ashley Colpaart – Women's health through women
Charisse McElwaine – Spending too much time on the"throne?
Danielle Omar – Yoga, Mindful Eating and Food Confidence
Diane Preves M.S.,R.D – Balance for Health
Joan Sather A Woman's Healthy Choices Affect More Than Herself
Laura Wittke – Fibro Study Recruits Participants
Liz Marr, MS, RD – Reflecting on Family Food Ways and Women's Work
Marjorie Geiser, MBA, RD, NSCA-CPT – Healthy Women, Healthy Business: How Your Health Impacts a Powerful Business
Marsha Hudnall – Breakfast Protein Helps Light Eaters Feel Full
Michelle Loy, MPH, MS, RD – A Nutritionista’s Super Foods for Super Skin
Motherwear Breastfeeding Blog – How breastfeeding helps you, too
Rebecca Scritchfield, MA, RD, LD – Four Keys to Wellness, Just for Women
Renata Mangrum, MPH, RD – The busy busy woman
Robin Plotkin, RD, LD – Feeding the Appetites of the Culinary, Epicurious and Nutrition Worlds-One Bite at a Time
Sharon Salomon, MS, RD – Calories, longevity and do I care
Terri L Mozingo, RD, CDN & D. Milton Stokes, MPH, RD, CDN of One Source Nutrition, LLC – Crossing the Line: From Health to Hurt
Wendy Jo Peterson, RD – Watch Your Garden Grow

Hello everyone,

It's great to be back with the new team of PCOS course graduates! I hope you enjoyed Susan Dopart's recipe and that other contributions will be educational and practically useful.

Today I wanted to share some recent findings about the effects of elevated glucose on a developing baby. If you have PCOS and you are pregnant, you are at risk for gestational diabetes. I realized while reading this study that rarely is the effect of hyperglycemia on the fetus ever discussed. You might hear that it can effect your weight and the baby's weight, but can it do anything else? Some researchers think so.

A group of chick eggs were injected with glucose. Significant changes were found in the babies that developed from those eggs, including:
--their own hyperglycemia
--elevated oxidative (degenerative) activity in body and brain tissue
--lower body weight
--lower brain weight
There also seems to be lower levels of DHA in babies exposed to hyperglycemia. This may be due to the elevated oxidative activity destroying any DHA that might be there.

You're likely aware that taking folate is pretty much an across the board recommendation to pregnant women. In this study, hyperglycemia seemed to induce a level of oxidation/inflammation that was not significantly helped with a folate supplement.

Bottom line, it's important to eat well not just to avoid weight gain or to keep your blood sugar low to keep your doctor and dietitian happy, but because your baby's brain and body depend on you to do so.

I did not write this post to scare you, I did it to make you aware. However, if you're feeling as if you now don't know what's right to eat, or you're trying and having a hard time, please take a look at the right hand of this blog screen. There is a whole list of professionals ready and waiting to help you figure it out.

Most of my clients express surprise that healthy eating includes as many tasty foods as it does. So before you write off a visit to the dietitian because you're afraid of what you WON'T be able to eat, consider that it may be your ticket to freedom and guilt relief to work with someone who can introduce you to the many foods that will BENEFIT you and baby!

Cole NW, Weaver KR, Walcher BN, Adams ZF, Miller RR Jr. Hyperglycemia-induced membrane lipid peroxidation and elevated homocysteine levels are poorly attenuated by exogenous folate in embryonic chick brains. Comp Biochem Physiol B Biochem Mol Biol. 2008 Jul;150(3):338-43.

Yesterday I had lunch with a dear friend at a local favorite pizzeria, Pizzeria Bianco. It's hugely popular and until recently the line for a table could last several hours due to limited hours the establishment was open. They extended their hours of business so we decided to check it out. It was a wonderful visit with my friend, and I hugely enjoyed my pizza rosa, a thin crust, cheeseless pizza with red onions and pistachios. (Note: this establishment does not add cheese to their pizza, it was not some kind of"dietitian" request on my part. And I don't choose to eat there because they don't use cheese…I eat there because I adore their pizzas!)

I mentioned on Facebook that I'd had pizza for lunch and a good friend was surprised (I think pleasantly) to know that.

Ahhhh…the dietitian's halo. Of course I eat pizza! And ice cream. And even corn chips on a rare occasion. But I also made calabacitas this week. I've had Greek yogurt muesli with strawberries for breakfast every morning. And I'm trying a new miso eggplant recipe here tomorrow.

I shared with my friend that when I eat pizza, I make sure it's pizza worth eating. I don't eat pizza just because it's there. And even though I do love my Bianco pizza rosa, it did knock me out in the afternoon to eat that much carb without protein to balance it. So I couldn't, and wouldn't, do that every single day. It was a treat.

I'd rather share my normal in's and out's, than try to present a false impression that I eat"perfectly", or that there is even such a thing as"perfect" eating.

I've been thinking for awhile about what I would call the kind of eating I advocate for here, since the term"clean" eating just doesn't sit right with me. I'll share my thoughts tomorrow.

Now it's time to gear up for a Moroccan-themed potluck dinner a friend has organized for tonight. Yup, I do potlucks too, and I'm super excited about this one!

If you enjoy Internet radio, be sure to check out our new program, "Healthy Planet, Healthy Hormones".

In our first broadcast, I interviewed Stacey Frattinger, dietitian and personal trainer, of Reno, Nevada. Stacey shares her perspective as a dietitian with PCOS, working with women with PCOS.

Here is the interview in its entirety. Stay tuned for more chats with inCYST Network members…and other interesting topics related to your hormones!

If you'd like to schedule a live or Internet consultation with Stacey, email her at formulafuel@hotmail.com.