The Hemp Connection [Search results for hair] 

I was recently asked my opinion about whether or not biotin supplementation would help hair loss. Here's a bit of commentary, plus information about melatonin, another supplement that has been studied.

As with any supplement, it's only going to help if you are indeed deficient in that particular nutrient. There are many reasons you could be deficient in biotin. One of the most relevant to PCOS, is the use of medications valproic acid and carbamazepine. These are seizure medications, also used to treat bipolar disorder and migraine headaches, that have been reported to cause or exacerbate PCOS. So if you've ever been on those medications, you may want to consider supplementation.

If your diet has been out of balance in any way (severe dieting, overeating, eating disorder, cutting out entire categories of food (gluten-free, paleo, vegan, etc.) with a focus on what to eliminate rather than on how to be complete, you may be at risk for biotin deficiency.

It's certainly not going to hurt, and it might help. The dose reported in the literature is 5 to 10 mg per day. However, keep in mind, if your hair loss is primarily related to high testosterone levels and you do not adhere to your complete recommended protocol, biotin will not fix what those problems are causing. It's not a miracle cure.

The best food source of biotin is Swiss chard. Which I was happy about because one of my favorite quick meals is a Swiss chard frittata…I actually planned on making one tonight before knowing this. Nice coincidence!

The other supplement I'm a little more versed in, is melatonin. You all know I'm a big fan of sleep, almost more than diet, for its power to heal. About a year ago, I was poking around in PubMed and found the abstract below, specifically looking at using melatonin to treat androgenic alopecia, which is specifically the type of hair loss you all have. I was coming out of a pretty stressful personal period myself, and had started to notice that my hairline was receding…not fun to look at! So I figured I'd try it myself before writing about it. What I do, is take a melatonin pill, dissolve it in my hand with a few drops of water, and then massage it into my skin with coconut oil. Simply using water didn't work, it needed a carrier. I've noticed that my hair is gradually starting to grow in again. It's not thick and lush, by any means, but it IS growing some hair back.

A caveat here, it won't happen in a week, and you have to be consistent with application. If you're going to flake out about it…don't bother even starting. It's taken almost a year to see a difference. But if you're committed and willing to be persistent, it's definitely worth a try.

Here's the article.
Fischer TW, Burmeister G, Schmidt HW, Elsner P. Melatonin increases anagen hair rate in women with androgenetic alopecia or diffuse alopecia: results of a pilot randomized controlled trial. Br J Dermatol. 2004 Feb;150(2):341-5.

BACKGROUND: In addition to the well-known hormonal influences of testosterone and dihydrotestosterone on the hair cycle, melatonin has been reported to have a beneficial effect on hair growth in animals. The effect of melatonin on hair growth in humans has not been investigated so far.

OBJECTIVES: To examine whether topically applied melatonin influences anagen and telogen hair rate in women with androgenetic or diffuse hair loss.
METHODS: A double-blind, randomized, placebo-controlled study was conducted in 40 women suffering from diffuse alopecia or androgenetic alopecia. A 0.1% melatonin or a placebo solution was applied on the scalp once daily for 6 months and trichograms were performed to assess anagen and telogen hair rate. To monitor effects of treatment on physiological melatonin levels, blood samples were taken over the whole study period.

RESULTS: Melatonin led to a significantly increased anagen hair rate in occipital hair in women with androgenetic hair loss compared with placebo (n=12; P=0.012). For frontal hair, melatonin gave a significant increase in the group with diffuse alopecia (n=28; P=0.046). The occipital hair samples of patients with diffuse alopecia and the frontal hair counts of those with androgenetic alopecia also showed an increase of anagen hair, but differences were not significant. Plasma melatonin levels increased under treatment with melatonin, but did not exceed the physiological night peak.

CONCLUSIONS: To the authors' knowledge, this pilot study is the first to show that topically applied melatonin might influence hair growth in humans in vivo. The mode of action is not known, but the effect might result from an induction of anagen phase.

Castro-Gag M, Pérez-Gay L, Gómez-Lado C, Castiñeiras-Ramos DE, Otero-Martínez S, Rodríguez-Segade S. The influence of valproic Acid and carbamazepine treatment on serum biotin and zinc levels and on biotinidase activity. J Child Neurol. 2011 Dec;26(12):1522-4. Epub 2011 Jun 3.

Wolf B. EditorsIn: Pagon RA, Bird TD, Dolan CR, Stephens K, editors. Biotinidase Deficiency. SourceGeneReviews [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2000 Mar 24 [updated 2011 Mar 15].

Zempleni J, Hassan YI, Wijeratne SS. Biotin and biotinidase deficiency. Expert Rev Endocrinol Metab. 2008 Nov 1;3(6):715-724.

I spent some time with Susan Van Dyke, MD, yesterday, a board certified dermatologist interested in PCOS, who will soon be in our network. She demonstrated a new laser hair removal technique, LightSheer DUET, which is quicker and less painful than older laser techniques.

I know virtually nothing about what dermatologists do; in fact, the only thing I knew about laser treatments before yesterday was that people I know who have had them hated them because they were so painful. So I was curious to find out what this new procedure offered to inCYSTERs.

The pain from laser treatments comes from the heat in the laser beams. The earlier machines apparently had small surface areas, meaning quite a few laser shots had to be applied in order to cover a skin area. The newer"gun" is quite a bit larger, meaning far fewer"shots" need to be applied in order to do the job. In addition, the older machines were not as precise at hitting their target (the hair follicle), so a lot of the laser heat didn't hit the target and was wasted on surrounding tissue. The newer, more precise technique zaps pretty much what only needs to be zapped, meaning less skin heat…therefore far less pain.

I actually observed a procedure (which happened to be a man's back), a large surface area. The patient was relaxed and talked to us throughout the entire treatment, and a half hour later, had hardly any red skin. A very different experience than what friends of mine have described with the old technique.

When I tweeted yesterday that I was going to observe this procedure, an inCYSTER responded that laser hair removal was a useless exercise, because the hair grows back. That's likely true, if that's all you do! Laser hair reduction is permanent hair removal for currently existing hair, but there is still a need to work to balance hormones in order to alter the environment that promotes hair growth. What Dr. Van Dyke and I would like to do, is work together in a way that hair that is already there is removed with her DUET procedure, and then help these women learn new lifestyle choices that help to discourage the appearance of future hair.

It's going to be fun to work together, as I know this is a very distressing aspect of PCOS that affects self esteem, mood, etc…and that can lead to binge eating, which can only worsen the hair growth. The possibility that a simple dermatological procedure can help break this vicious cycle and jump start PCOS management in a positive direction, is very exciting.

You can learn more about Dr. Van Dyke at this link.

You ever have one of those days where everything just seems to come together in the right way? Your hair looks good, your face is clear and bright, your outfit is colorful and flattering, and people are just responding to you in a good way. You’re looking good, and you know it! You FEEL good.

On the flip side, thought, PCOS is there to drag you down when it comes to appearance. We’ve got moustaches, partial and full beards, hair loss, hair in inappropriate places, excess weight (or sometimes not enough weight), acne, skin darkening, skin tags, and other cosmetic indignities galore. How on earth are you supposed to feel good in this body when it’s presenting you with these problems on a daily basis?! Moustaches and muffin tops, indeed!

And that’s just the external stuff. Inside, there are the imbalances that lead to mood swings, depression, and even thoughts of suicide. Insulin resistance, thyroid problems, and other health concerns lurk in the background. All of this can be physically and emotionally exhausting. And when you’re exhausted, it’s easy to give up on appearance. One thing I’ve learned about PCOS is that, although it threatens your physical appearance with masculinizing and unflattering characteristics, you can use positive attention to your appearance to lift your mood.

Part of what I always focus on with my clients is self-care. This may be emotional, spiritual, or physical in nature. I’ve observed that taking time to tend to your appearance as much as reasonably possible (because we don’t want the opposite problem of busting out your budget on shopping, or spending all of your play time at the salon!) results in feeling better. The American Cancer Society sponsors a program called “Look Good, Feel Better,” for women with cancer – it’s a day of make-up application instruction, wig and other hair tricks, and so on – sounds trivial in the face of cancer, but it’s miraculous in how the women respond.

PCOS isn’t cancer, to be sure, but the principles are the same – look good, feel better! I won’t go so far as to say that I “prescribe” pedicures, but maybe I should, and I have in fact recommended them, along with shopping days and other beauty services. Well-tended toes, a pretty top, or some dangly earrings will spark up the girly-girl in most women. For women with PCOS, this is a place that needs a little extra attention. You deserve it.

If there’s something you’ve been neglecting – a haircut, shopping for new bras (yes, you in the stretched out ultra-comfy bra that you haven’t replaced since last year – the one that isn’t doing your breasts any justice at all — I’m talking to you!), doing a wardrobe clean-out and ditching all the unflattering items – it’s a great time to do it. Right now, this very moment. Call your stylist, grab a bag to be filled and donated to Goodwill, or make a call to find out about laser hair removal in your area. Whatever it is, the action will make you feel better.

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.

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 at www.drhousemd.com, or e-mail her at Gretchen@drhousemd.com.

Reprint permission granted by RESOLVE: The National Infertility Association, 2009. www.resolve.org.

I’ve recently been amused by a list of weird, wacky, and unusual holidays. Whole days, weeks, and months are devoted to the oddest things, and I’ll be writing about a few of them this month. Tomorrow, July 3, 2012, is National Compliment Your Mirror Day. I don’t really know or care about the origins of Compliment Your Mirror Day, but I’m going to tell you why I like the concept.

When you’ve got PCOS, when you think of the mirror, you’ve probably got negative associations. For many of you, your physical appearance fixations are typically:

• Being too heavy/problems losing weight
• Acne and other skin problems
• Hair loss
• Hair growing in strange places, with abundance

The mirror is not your friend; the mirror is your enemy. Mirrors may have become something to dread, a way to facilitate getting down on yourself, or even a way to practice some really damaging things, like skin picking or cutting (those are both mental health issues, by the way). Many of you avoid the mirror at all costs, even to the point of not having a mirror in your house except where it’s unavoidable, like on the medicine cabinet in the bathroom.

You may dress to hide your body, or your hairy arms. You may wear hats or sunglasses to distract from hair loss, or wear scarves to hide akanthosis nigricans on your neck. You avoid shopping, except online, where you don’t have to be tortured by the multiple mirrors in badly lit dressing rooms. You spend a fortune on potions to fix your skin, dermatologist visits, and special machines that are guaranteed to sweep everything clean. It’s exhausting having PCOS, and doing all of what’s required, if you really commit to it, to look “okay,” “acceptable,” or “normal.”

But the mirror, like the scale, is merely an inanimate object. It doesn’t have the power to make you miserable, or to dictate your behavior. Only you have the power to decide what your mood is, or what your behavior is. Next time you catch yourself starting a litany of denigration because you caught a glance of yourself in the mirror, turn it around (it’s all about reflection) and force yourself to say something positive. It may take time and practice. You may have to really push some boundaries, but you can find something. So instead of focusing on the thinness of your hair, focus on the fact that it’s actually kind of a nice color. Instead of focusing on your hairiness, focus on the beauty of your eyes. Instead of focusing on a roll of fat, take note of how good the color you’re wearing looks on you. Try hard. Be honest. Don’t just default to the garbage you’ve been telling yourself for years. Don’t give up.

If this seems like a real push, start by just exposing yourself to some mirror time. Set a timer on your phone if need be. Start with 15 or 20 seconds. Just look at yourself without judgment. Practice for 30 seconds, then a minute. Work your way up to two or three minutes of just looking at yourself calmly, examining what is, not wishing for what isn’t. Then you can move up to giving the mirror itself a compliment: “you reflect me so well,” “I like the way you cast light on my face,” and maybe, just maybe, you can actually give yourself a compliment. The mirror is a facilitator of self-love. With increased self-love comes increased self-care, and that’s what we’re all about here at inCYST.

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.

This abstract caught my eye because finasteride is sometimes used to treat the hirsutism (hair growth in women) that PCOS often causes. It has now been observed to have antipsychotic properties and is being proposed as a treatment for psychosis.

Antipsychotics are increasingly being used to treat depression, and at least 85% of women with PCOS have some kind of anxiety, depression, or other mood disorder associated with this diagnosis. If you have PCOS, please do not jump to the assumption that I am saying you are psychotic. What I am trying to point out here is that there is a huge mind-body connection in the syndrome that is often ignored. Physicians can be so compartmentalized with their treatments that they focus on the acne, the hair, the infertility…and completely ignore the moods, the mood swings, the associated disrupted eating patterns…and then they and their patients wonder why treatment is not successful.

I am posting this abstract to challenge anyone who treats PCOS to figure out what is going on in the brain of the woman with PCOS since it is, after all, the brain that controls hormones. Rather than mess with hormones and create even more problems, why aren't we going to the source and looking THERE for potential solutions? Let's make this the day we shift our thinking.

Bortolato M, Frau R, Orrù M, Bourov Y, Marrosu F, Mereu G, Devoto P, Gessa GL. Antipsychotic-like properties of 5-alpha-reductase inhibitors. Neuropsychopharmacology. 2008 Dec;33(13):3146-56. Epub 2008 Mar 19.

I chose the photo I did not to be funny, demeaning, or hurtful. I did it for the benefit of those who truly do not understand what many women go through because of their PCOS. Hair growth can be devastating and lead to horrible issues with self-image. Long ago it was often called"diabetes of the bearded ladies". If you can imagine what it's like to look in the mirror and feel as though you're losing your femininity, often at a time when you're trying to conceive and desiring to be attractive to your partner…it's a situation deserving of much more attention than it often gets by physicians.

The more I read about melatonin the more I think I should have majored in sleep instead of nutrition. Just ran across a research abstract reviewing the many effects melatonin, our sleep hormone, has on hair health.

In addition to being a potent antioxidant, which means it destroys compounds that promote the many symptoms of PCOS, melatonin reduces apoptosis, a process which kills cells in the body.

It's really important to value your sleep. Not getting it is not a sign of drive…or superiority…or success…or a glamorous lifestyle…losing sleep is something you do that accelerates aging and promotes all the nasty things you've come to hate about PCOS. Those of you who are losing hair to your PCOS…should take this very seriously!!!

Fischer TW, Slominski A, Tobin DJ, Paus R. Melatonin and the hair follicle. J Pineal Res. 2008 Jan;44(1):1-15.

Source: Uploaded by user via Monika on Pinterest

“Dysmorphia” may not be part of your everyday vocabulary, but if I tell you that lots of people thought the late Michael Jackson suffered from it, you’ll probably know what I’m talking about. Body Dysmorphic Disorder (BDD, for short), is a complex psychological problem that results in obsessions with imagined defects in your personal appearance.

It drives people to exercise excessively, engage in extreme dieting, reshape their bodies through weight-lifting, get cosmetic procedures including plastic surgery, change their clothes often, engage in approval-seeking behaviors, and dress oddly in order to disguise imagined defects. It may also result in avoidance of mirrors, failure to seek medical help when necessary, refusal to participate in sports, sex, or other social activities, excessive beauty practices such as permanent make-up, dangerous chemical hair straightening, and the like. Many if not most of us have engaged in some of these behaviors at some point in our PCOS journeys.

In a group of people who have anxiety or depression, you’ll find BDD as an additional diagnosis in about 5 – 40%. This is quite a range, to be sure, but I think we’d find an even higher rate of BDD among women with PCOS. BDD is more common among women, actually, since we’ve already got a culture that is fixated on our likes as a central factor in our value. And, we’ve already got a much higher incidence of depressive and anxiety disorders, and our symptoms, while both internal and external, have particularly disturbing external manifestations. It can definitely reach an obsessive level of preoccupation when a woman is losing her hair, covered with excess hair in all the wrong places, erupting in acne, or dealing with stubborn, unbudgeable abdominal fat. The desire to be rid of THE PROBLEM can take an astonishing amount of time and energy.

I have clients who do all of the above, and more. If they’re not tackling the problem head-on (all discretionary funds go towards laser or electrolysis, they will not have sex unless and until they lose 50 pounds, they consider themselves complete failures at managing their bodies and tell themselves so regularly), they’re in avoidance mode. The avoidance usually affects social relationships, and further exacerbates depression – or being forced into a social situation will bring up anxiety.

It’s a complex condition that merits more than passing, gossipy attention from the media. It ruins lives. If you think you may suffer from BDD, please seek professional consultation to see how you can be helped. PCOS is complicated enough, without the extra layer of problems caused by BDD.

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.

Three different clients in the last two weeks have expressed the same inspiration independently of each other, so I figured I'd let them inspire me on this blog topic.

Each of these women expressed that once they stopped mentally fighting with themselves over their diagnosis, stopped focusing on how badly they're feeling, and started prioritizing their self-care, they began to lose weight and feel better.

Up until the point that they had this moment of inspiration, they were fighting against the disease, feeling sad and angry because of the diagnosis, and much of the time, interfering with their own potential to succeed at feeling better.

Here's the deal.

1. Your PCOS is not going to go away. You can fight with it for the rest of your life. You can draft an encyclopedia's worth of reasons why you shouldn't have to be asked to make different food choices, get out and walk on your lunch break, go to bed a little earlier, set boundaries with your husband. You can even complain about the dozen doctors who don't get it. But the whole time, you'll be stuck in a body that is even more tired, frustrated, and depressed than it already is. Unfortunately, you can't just go jump into a newer, upgraded model. The model you have to learn to work with…is the one that you were given.

2. Accepting that you have PCOS is ABSOLUTELY NOT accepting defeat. I hear in a lot of comments that many of you feel that by accepting your diagnosis, you're failing, that somehow being stubborn and fighting back, and demanding more money be devoted to research and the development of a cure…is the most productive path you can take. Have you considered the psychology of this argument? That until a cure is found, you've committed yourself to not taking care of yourself and unloading choices that make it even harder for you to function normally and enjoy TODAY? It seems to me that now that you've discovered you have PCOS, you have an extra special reason to be treating yourself a little more proactively, so that if and when that day of a cure does arrive, your body is in the absolute best condition it can be in, ready to respond to this new treatment.

Acceptance is actually a stage in the grieving process. If you've ever lost a loved one, you likely know how sometimes you fight to keep the memory of that loved one in your presence out of fear that if you stop fighting, stop feeling sad, stop wrapping your day around the sad thoughts, you've let go and lost the person forever. It's not really that way. When you accept the loss, you just put them in a place in your heart and spirit where they still have your love, but you have room for new and different experiences that they do not share with you.

Accepting that you have PCOS is a lot like learning that if you have curly hair, you need a different kind of hair conditioner than someone with straight hair. Now that you know how your body works, what makes it feel badly, what helps it to feel better, you have an opportunity to make choices that drive you more often toward feeling better.

You can still be a PCOS advocate, you can still fight for more and better research, you can still research your disease. Only you're feeling a whole lot more energetic in the process.

Oh, by the way, I'm willling to bet…even if a cure is found, it's not going to be any kind of vaccination that allows you to eat Fritos and Twinkies ad lib without consequence. You're still going to have to prioritize self-care in order to see progress. Just sayin': )

I encourage you to think about whether or not fighting against yourself and pushing away all of the possible choices that could help you to feel better isn't part of why you're not feeling better?

It's ok to accept. A diagnosis. Help. Support.

Thanks for coming and using this blog as a part of your personal PCOS acceptance plan.

Hello everyone!

The last two clients I evaluated are struggling with acne. And recently, we were linked to an acne care website that is bringing in a whole new audience. So I thought it might be a good time to talk a little bit more about this topic.

First of all, thanks to Fran Kerr for linking to Susan Dopart's testimonial about flax and fish oil! It was a great way for our two organizations to become connected. I am going to put Fran's blog (http://www.highonhealth.org/) in our resource list because she has so much great information to offer. Not just on skin, but on living healthy in general.

Secondly, for those of you who are coming to us from Fran's blog/website, I'd like to ask you if you have ever heard about polycystic ovary syndrome (PCOS). It's the focus of this website, and many women find out they have it when they seek help for their acne. And…many women don't get that assessment. I actually had a dermatologist tell me she'd rather just give her patients birth control pills and end the appointment rather than get into it because it's such a complicated diagnosis.

A very common scenario is just that. A young girl goes to the dermatologist for her acne, gets birth control pills, takes them for 10 years or so, goes off them, tries to get pregnant…and can't. What happened was that the birth control pills treated the symptom…but essentially shoved the problem under the rug…where it continued to fester and create havoc elsewhere in the body.

So I want to take a moment to list the symptoms of PCOS for those of you who might have had this experience but either didn't have a doctor who wanted to deal with it, or who had a doctor who thought if you just"got your act together" you wouldn't have the problem.

Symptoms of PCOS include:
A family history of infertility, irregular periods, or diabetes
Being of an ethnic heritage that tends to have a high rate of diabetes
A history of early puberty (first period at 11 years or younger)
A history of taking medication for depression, bipolar disorder, seizure disorder, epilepsy, or migraine?
A history of gestational diabetes in any of your pregnancies.
An android ("apple shaped") body type (measure your waist to hip ratio; greater than.8)
Irregular periods (or none at all)
Dark velvety patches of skin on you neck, groin, or in your armpits
Hair loss or male balding spots
Difficulty losing weight
Intense cravings for carbohydrates or sweets
Problems conceiving
Decreased sex drive
Excess hair growth on your face, like a mustache or beard
Excess hair on your chest or back
Acne on your face, chest or back

If you see yourself painted in this symptom set, please print this out with your symptoms marked and show them to your physician. Ten percent of all women who have this syndrome will be diabetic by age 40, and with diabetes comes a whole other list of problems.

And keep checking back here. There are lots of ways to manage PCOS that do not involve medication, and we'd love to help you learn about them. In fact, the list of practitioners at the right is a list of registered dietitians who have taken the time to complete a 20 hour course in the management of PCOS. They are just waiting to hear from you.

For more information, please visit my web page on the topic: http://www.afterthediet.com/polycystic.htm

Have a wonderful week, it's a short one with the upcoming holiday!

I'm posting inCYST's symptom checklist, developed by Mia Elwood, LCSW, of Healthy Futures in Scottsdale, Arizona. Mia's lecture on mood disorders and PCOS is part of the inCYST professional training. I like Mia's list because it addresses many of the food and mood aspects of PCOS that are not often written about. And in my opinion, when moods are not taken into consideration, their imbalances can generate many of the behaviors that make it hard to manage PCOS.

If you're new to this blog, or if you haven't seen this, take a moment and run through the symptoms. If this sounds like you, one of our inCYST providers is happy to help you figure out your personal action plan. You can also print this out and show your medical caregiver to give them a more complete picture of the issues you need help with.

If you wish to duplicate this for any reason, please include the copyright information at the bottom as Mia deserves credit for her original work. Thanks!

If you feel this profile describes you, stick around and read more! Pay particular attention to Ellen Reiss Goldfarb's post on lab tests you can get to monitor how your diet, exercise, sleep, and lifestyle changes are helping you to get back into balance.

Screening for Polycystic Ovary Syndrome and Other Hormonal Contributors
Name ________________________ Date _______________ Current Age _____

*Code answer with a YES(Y), NO(N), MAYBE(M), NOT APPLICABLE(NA), or HAVEN’T PAID ATTENTION(HPA).

Sometimes, hormones contribute to our symptoms. These questions help to explore whether hormones may be contributing to any of your symptoms.

When was your first period? Age ___ When was your last menstrual period? ___ What is your current height? ___ What is your current weight? ___

___Do you believe that you are perimenopausal or in menopause? If so, what symptoms are you experiencing that lead you to believe this?

___Have you had regular periods consistently throughout your life? Explain:

___Do your symptoms (that you are here for) change in any way according to your cycle? If yes, how do they change and when in your cycle do you notice a change?

___Has your menstrual flow become lighter/much heavier than usual for you?

___Have you ever gone more than two months without a period?

___Do you have skin that is dark or thick, especially on the neck, groin, underarms, or skin folds? ________

___Has your menstrual flow become lighter/much heavier than usual for you?

___Do you have any skin tags, teardrop-sized pieces of skin usually found in the neck area and/or armpits?

___Have you or any family members had bipolar disorder, an eating disorder, epilepsy, or migraines?

___Do you take any psychotropic medications? (antidepressants, mood stabilizers, etc.)

___Have you ever had trouble getting pregnant?

___Has your sex drive decreased?

___Do you feel you have excess hair growth? ___ Where? ___face ___back ___chest ___other____________

___Do you feel more irritable than usual?

___Have you lost/gained weight recently without your eating/exercise habits changing? _________________

___Is it hard for you to lose weight or maintain a genetically healthy weight?

___Do you have more mood swings than you used to?

___Do you have severe acne? (if adolescent) or adult acne?

___Is your waist to hip ratio greater than 0.8? Ratio _________

___Have you noticed your hair thinning or hair loss?

___Do you have strong cravings for sweets or carbohydrates?

___Do you or any family members have a history of PCOS, insulin resistance, diabetes, hypoglycemia, gestational diabetes? Who?

___Are you experiencing any other symptoms (emotional,physical, cognitive) that you feel may be related to hormones or your cycle (or lack of one)? Describe

Created by Mia Elwood, MSW/Healthy Futures-MSE, LLC, 2004/www.healthy-futures.com

If you want to learn the latest about hair removal, don't miss this interview with Dr. Susan Van Dyke, a board certified dermatologist!

Here is a video demonstrating Light Sheer Duet, a newer, faster, less painful laser hair removal treatment that was discusssed in the interview.

Hirsutism is such a devastating condition, worthy of understanding and treatment. Here are some explanations about how to get started and how to find the best practitioner to help 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.

Fenugreek you say? What the heck is fenugreek? It's a spice popular in India, northern Africa, and the Middle East that has multiple benefits for PCOS:

--it can lower your lipids
--it can help to control blood sugar
--it can help improve milk production in women who have trouble breastfeeding
--antioxidant action in the face of high blood glucose

In women struggling with lactation, fenugreek tea (made with the leaves of the plant) has been found to be beneficial. The Fenugreek spice has been added to flour to provide functional properties and it has found to be beneficial in this format as well.

And since we're on the topic of hair loss this week, here's an Ayurvedic remedy using Fenugreek:

Mix ground fenugreed seeds with water and yogurt to make a paste. Rub into hair and wash after 30 minutes.

I'm giving you two recipes, the first one from India, and the second one from Ethiopia. If you like spicy foods, you're going to love adding this herb/spice to your culinary creations!

Methi Murgh (fenugreek chicken) from allrecipes.com

Ingredients
1/4 cup cooking oil
1 (4 to 6 pound) whole chicken, cut into 8 pieces (skin removed and discarded)
1 teaspoon cumin seeds
1 cinnamon stick
1 black cardamom pod
4 whole cloves
1 large onion, sliced thin
1 tablespoon ginger-garlic paste
4 green chile peppers, halved lengthwise
1/2 cup chopped fresh spinach
1/2 cup chopped fresh fenugreek leaves
1 tablespoon dried fenugreek leaves
1/2 teaspoon ground turmeric
1/2 teaspoon ground red pepper
salt to taste
1 cup water
1/2 teaspoon garam masala

Directions

1.Heat the oil in a pressure cooker over medium heat; brown the chicken pieces evenly on all sides, about 5 minutes. Remove from cooker and set aside. Add the cumin seeds, cinnamon stick, cardamom pod, cloves, onion slices, ginger-garlic paste, and green chile peppers to the pressure cooker and cook until the onions are golden brown, 5 to 7 minutes. Stir the spinach, fresh fenugreek leaves, dried fenugreek leaves, turmeric, red pepper, and salt into the mixture and cook until the spinach and fenugreek leaves begin to wilt and darken in color, about 5 minutes. Pour the water over the mixture and return the chicken pieces to the pressure cooker; bring to a boil for 2 to 3 minutes.

2.Fasten the lid on the pressure cooker; cook until the chicken is tender, about 30 minutes. Release pressure fully and remove the lid; sprinkle the garam masala over the dish. Cook and stir until the liquid thickens, 3 to 5 minutes. Serve hot.

Berbere — spiced lentil stew from Sundays at Moosewood Restaurant

Berbere

2 teaspoons cumin seeds
4 whole cloves
3/4 teaspoons cardamom seeds
1/2 teaspoon whole black peppercorns
1/4 teaspoon fenugreek seeds
1/2 teaspoon coriander seeds
8 — 10 small dried red chiles
1/2 teaspoon grated fresh ginger root (1 teaspoon dried)
1/4 teaspoon turmeric
1 teaspoon salt
2 1/2 tablespoons sweet Hungarian paprika
1/8 teaspoon cinnamon
1/8 teaspoon ground cloves

In a small frying pan, on medium-low heat, toast the cumin, whole cloves, cardamom, peppercorns, allspice, fenugreek, and coriander for about 2 minutes, stirring constantly. Remove the pan from the heat and cool for 5 minutes.

Discard the stems from the chiles. In a spice grinder or wtih a mortar and pestle, finely grind together the toasted spices and the chiles. Mix in the remaining ingredients.

Store Berbere refrigerated in a well-sealed jar or a tightly closed plastic bag.

Yemiser W'et (Spicy Lentil Stew)

1 cup dried brown lentils
1 cup finely chopped onions
2 garlic cloves, minced or pressed
1/4 clarified butter
1 tablespoon Berbere
1 teaspoon ground cumin seeds
1 tablespoon sweet Hungarian paprika
2 cups finely chopped tomatoes
1/4 cup tomato paste
1 cup vegetable stock
1 cup green peas, fresh or frozen
salt and freshly ground black pepper to taste
plain yogurt or cottage cheese

Rinse and cook the lentils.

Meanwhile, saute the onions and garlic in the clarified butter, until the onions are just translucent. Add the berbere, cumin, and paprika and saute for a few minutes more, stirring occasionally to prevent burning. Mix in the chopped tomatoes and tomato paste and simmer for another 5 to 10 minutes. Add 1 cup of vegetable stock and continue simmering.

When the lentils are cooked, drain them and mix them into the saute. Add the green peas and cook for another 5 mintues. Add salt and black pepper to taste.

Roberts KT. The Potential of Fenugreek (Trigonella foenum-graecum) as a Functional Food and Nutraceutical and Its Effects on Glycemia and Lipidemia. J Med Food. 2011 Aug 23. [Epub ahead of print]
Middha SK, Bhattacharjee B, Saini D, Baliga MS, Nagaveni MB, Usha T. Protective role of Trigonella foenum graceum extract against oxidative stress in hyperglycemic rats. Eur Rev Med Pharmacol Sci. 2011 Apr;15(4):427-35.
Turkyılmaz C, Onal E, Hirfanoglu IM, Turan O, Koç E, Ergenekon E, Atalay Y. The effect of galactagogue herbal tea on breast milk production and short-term catch-up of birth weight in the first week of life. J Altern Complement Med. 2011 Feb;17(2):139-42. Epub 2011 Jan 24.

Christine Cassano's interview was jam-packed with information about how to clean up your work, home, and beauty environment.

Here are some of her recommendations for products and companies who can help you do the same.

Art Supplies
American Clay Plaster: http://www.americanclay.com/

Clay Paints etc
http://www.bioshieldpaint.com/index.php?main_page=products&cPath=93
Environmentally safe paints, sealers, etc
http://www.afmsafecoat.com/

Soy Based Sealers & Stains http://www.ecoprocote.com/

Local (Phoenix) Vegan [and super-awesome!] Soaps & Lotions
Strawberry Hedgehog — http://strawberryhedgehog.com/

Hair Dye: Hennas
http://www.light-mountain-hair-color.com/#Story

Soaps & Lotions
http://www.drbronner.com/

Shampoos & Makeup
http://www.aubrey-organics.com/default.aspx
Cleaning Products
DIY: http://www.thedailygreen.com/green-homes/latest/green-cleaning-spring-cleaning-460303
Shaklee: http://www.shaklee.com/products_home.shtml
Seventh Generation: http://www.seventhgeneration.com/

General Resource Links
EWG: the most comprehensive environmental consumer advocacy group: http://www.ewg.org/
Understanding the risk of everyday beauty products 101: http://www.safecosmetics.org/
Beauty Products Chemical Database [by EWG]: http://www.cosmeticsdatabase.com/

Christine also mentioned a company called AKA Green. While they no longer have a store front, they do have a blog.

And our own co-host, designer Michael Keele, is devoted to finding and selling similar products. Check him out at http://www.centralslope.com/.

If you'd like to see Christine's art, here are three opportunities:
http://www.christinecassano.com/
http://www.monorchid.com/
http://www.practicalart.com/

If you missed the interview, you can find it in our archives at http://www.blogtalkradio.com/incystforhormones/2010/11/03/how-pcos-influenced-my-life-and-my-passion-artist-christine-cassano

A friend of mine is a two-time survivor of breast cancer. She is a single woman, diagnosed at age 40, who chose a double mastectomy and reconstructive surgery. Along the way, she’s had a lot of challenging medical procedures, fears, and unpleasant side effects. After dealing with the immediate medical issues, she realized she was depressed, and turned to the internet for help.

She found numerous online resources for cancer, and breast cancer specifically. She was steeped in depression, lethargic at best, but that’s when she got angry! Her anger pleased me as a therapist, by the way, because getting angry often leads to action, and she needed to take some serious action to get out of her depression. She found that there were a lot of people saying “Why me?” about cancer. (As an aside, there are two very helpful organizations online called www.whyme.org for pediatric cancer and www.y-me.org for breast cancer.). But what she said to me is “Why NOT me?! Who am I to be so special that I escape a very common disease?” She found “why-ing” to be pointless and actually an impediment to her getting well. And here I’d been thinking that it was a perfectly reasonable question!

I’d venture a guess that you’ve said “Why me?” more than a few times when it comes to your PCOS. I know I have. There are many questions and thoughts that come along with that first thought, and all of them have the underlying subtext of “THIS IS SO UNFAIR”:

• Why do other women get to go on a diet and lose weight with relative ease?
• Why do other women get pregnant by accident, and I tried for a decade and it never happened?
• Why do I have to shave my face every day (or spend thousands of dollars on laser hair removal and electrolysis)?
• Who is ever going to love me/want to have sex with me when I look like this?
• Why do I have to take all these supplements?
• Why can’t I eat carbs like normal people?
• WHAT is happening with my hair?
• Why do I need an endocrinologist? And a cardiologist? And, and, and…

It IS unfair. It’s expensive, inconvenient, awkward, uncomfortable, scary, humiliating, enraging, and a whole lot of other things. And yet, the reality is, 10 – 20% of women have PCOS. You are fortunate enough to know that you’ve got it, so you can start dealing with it proactively. You found this blog, and hopefully some other resources. As http://en.wikipedia.org/wiki/Wilhelm_von_Humboldt Karl Wilhelm von Humboldt says, “How a person masters his fate is more important than what his fate is.”

So your fate is PCOS. I know it’s a hard thing to accept. But once you can move to acceptance you can take action. Mastery of your fate means taking control, and making choices that support your good health. It means understanding that, although genetics dealt you a bad hand, there are many things you can do to positively affect the daily quality of your life, and your long-term health, well-being, and longevity.

Instead of saying “Why Me?” (and really, it IS okay to say it every now and then – you’re not perfect, you’re human, and a little self-pity may be a necessary step along the road to further and fuller acceptance), see if you can feel a shift in your mental landscape by saying “Why not me? Yeah, why not me?” Then move forward from there with something more productive.

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.

A client recently handed me a supplement called"DIM" and told me her physician gave it to her. The physician said it would help her hyperestrogenemia. She had stopped taking it, and asked if I thought she should resume with it.

Here's the lowdown on DIM, which is the abbreviation for diindolylmethane.

DIM occurs naturally in cruciferous vegetables, such as cabbage, cauliflower, and Brussels sprouts. It was first researched for its cancer-fighting properties; we all know that these vegetables have this quality.

Soon after that, it was discovered that DIM influences estrogen metabolism, promoting the creation of estradiol, or beneficial estrogen (E2) and inhibiting the creation of estrone, or cancer-related estrogen (E1).

DIM may also be an anti-androgen. Although the research I was able to find looked at DIM in the prostate, not in women with PCOS, there is much information on websites selling DIM promoting it as a natural way to reduce facial hair.

If you are considering taking a DIM supplement, be sure to consider the following warnings found on the WebMD website:
Special Precautions & Warnings:

Pregnancy and breast-feeding: Diindolylmethane is safe when consumed in the small amounts found in foods. But don’t take larger amounts. Not enough is known about the safety of larger amounts during pregnancy and breast-feeding.

Hormone-sensitive conditions such as breast cancer, uterine cancer, ovarian cancer, endometriosis, or uterine fibroids: Diindolylmethane might act like estrogen, so there is some concern that it might make hormone-sensitive conditions worse. These conditions include breast, uterine, and ovarian cancer; endometriosis; and uterine fibroids. However, developing research also suggests that diindolylmethane might work against estrogen and could possibly be protective against hormone-dependent cancers. But stay on the safe side. Until more is known, don’t use diindolylmethane if you have a hormone-sensitive condition.

The client who asked the question feels the supplement may actually have helped her facial hair. Note, this is a one-person observation and a testimonial only, it is NOT an endorsement of the supplement.

What I would recommend to this client, and to others who are interested in using DIM:

1. Start with your diet: eat more cabbage, cauliflower, brussels sprouts, and broccoli. (Click here for a cauliflower curry recipe).

2. Be sure your diet contains adequate omega-3 fatty acids and is not high in omega-6 fatty acids (discussed many times in other posts on this blog). Omega-3 fatty acids found in both fish and flax have similar effects on estrogen metabolism.

3. Be scientific about the supplement use. Have your hormone levels measured for a baseline, and have them remeasured 6 months after consistent use of the supplement. Too many times, supplements are recommended without any way to evaluate whether or not they are having any effect. In the case of my client, the supplement was sold to her by her physician and there was never any followup scheduled to evaluate how well it was working. (You'd never do that with a blood pressure medication or antipsychotic, would you?!?!?)

4. Don't assume that once you start taking the supplement you do not need to follow a healthy diet. Supplements usually seem to work better in a healthy body where the biochemistry promotes their effectiveness.

5. Even though eating these foods has never been found to be dangerous to pregnant women, because the supplemental form is much more concentrated than what is found in food, it is strongly recommended not to take this supplement if you are trying to conceive or if you are pregnant. As it's been with us since we've been in existence, we are of the opinion that it is not appropriate to be treating hirsutism while you are trying to conceive. There is time for that later.: )

Wattenberg LW, Loub WD, Lam LK, Speier JL. Dietary constituents altering the responses to chemical carcinogens. Fed Proc. 1976 May 1;35(6):1327-31.
Jellinck PH, Makin HL, Sepkovic DW, Bradlow HL. Influence of indole carbinols and growth hormone on the metabolism of 4-androstenedione by rat liver microsomes. J Steroid Biochem Mol Biol. 1993 Dec;46(6):791-8.

Chen I, McDougal A, Wang F, Safe S. Aryl hydrocarbon receptor-mediated antiestrogenic and antitumorigenic activity of diindolylmethane. Carcinogenesis. 1998 Sep;19(9):1631-9.

Lord RS, Bongiovanni B, Bralley JA. Estrogen metabolism and the diet-cancer connection: rationale for assessing the ratio of urinary hydroxylated estrogen metabolites. Altern Med Rev. 2002 Apr;7(2):112-29.

Le HT, Schaldach CM, Firestone GL, Bjeldanes LF. Plant-derived 3,3'-Diindolylmethane is a strong androgen antagonist in human prostate cancer cells. J Biol Chem. 2003 Jun 6;278(23):21136-45. Epub 2003 Mar 27.

Tadi K, Chang Y, Ashok BT, Chen Y, Moscatello A, Schaefer SD, Schantz SP, Policastro AJ, Geliebter J, Tiwari RK. 3,3'-Diindolylmethane, a cruciferous vegetable derived synthetic anti-proliferative compound in thyroid disease. Biochem Biophys Res Commun. 2005 Nov 25;337(3):1019-25. Epub 2005 Oct 3.

I cannot reinforce how important it is for you ladies to get out and advocate for yourselves. If you think Susan G. Komen got to where it is because women with breast cancer sat on the couch, felt sorry for themselves, and wished people would give them money, you are dead wrong.

Women with no hair, women whose bodies are forever changed from surgery, women who were exhausted from rounds of chemo, banded together, and walked. And ran. And advocated. And showed the world that they were worth caring about.

Power Up for PCOS has the exact same potential. But only if YOU, yes the one reading this, assuming someone else will do it for you and who feels a little bit uncomfortable because you realize I just called you for passing the buck…yes, YOU, the woman with PCOS who wants a cure for the disorder, raises money to help us do that.

What are you waiting for? Here's the information on how to participate.

http://www.powerupforpcos.com/5k

Dear Doctors,

I've been studying PCOS for about 10 years now. In that time, I've seen the standard dose of metformin double. As the dosage has slowly crept up, I have, more often, heard women complain that the side effects of metformin are so horrible that they stop taking it completely.

There are several ways you can look at this problem.

1. You can continue to prescribe the bigger dose of metformin because the lower dose isn't working, you have a limited amount of time to talk to your patient, and you want to feel like you did something. And you can continue to fail at adequately managing the process.

2. You can blame the problem on the patient. You can tell her she simply needs to hang in there for several months and be nauseous and miserable for 3 months while she waits for, with great hope, the side effects to subside.

I can't tell you what to do. But I can tell you, women who are not following their medication prescriptions are telling you something very important. That is, that increasing the dose of a medication they are not taking, is not the answer to the problem.

Have you considered what happens when your client does not eat in order to try to tolerate her medication without throwing up? She likely binge eats later in the day. There goes self-esteem, calorie control, and blood glucose management.

Have you considered what happens when she gives up on trying to follow your recommendations because she's too sick anymore to try? She stops coming in for checkups, providing ample opportunity for that inflammatory process to affect her brain, her nervous system, her ovaries, and her arteries, to name a few. She potentially shortens the duration, not to mention the quality of, her life.

Have you considered that when a woman takes a half a day off to sit in your office, waiting to see you, and patiently sits there even though you're running an hour behind, that the last thing she needs to hear from you is that she just needs to take her medicine, eat less, and exercise more? If that had worked, she would not have put herself out there like that in an effort to reach out for help that was going to work.

If you have not taken the time to refer your PCOS patient to a dietitian who can help normalize eating, reduce stress eating and binge eating, and identify other barriers to success that may help that patient succeed with you on a much lower dose of metformin, you may be missing the point. You may also be sending some of your business to someone who"gets it".

Please consider referring to one of our team. We're not trying to be argumentative by pointing this out in this blog post, just sending a friendly reminder that in our world of health care, the definition of insanity just might be prescribing larger and larger doses of a medication that didn't work the first time around…and expecting a different response.

We understand the health care system is set up to keep you from having a lot of time to talk to your patient about what's really going on, like how she's bingeing every time she has a negative pregnancy test, or looks in the mirror and sees new hair growth. We even understand that you're trained to look at numbers and not feelings. That's ok. That's why we started inCYST, so we could attend to the parts of the picture you cannot or do not wish to address. Please think of us as your support staff.

Thanks for hearing me out, and we look forward to helping guide you and your PCOS patients to treatment success.

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.