The Hemp Connection [Search results for hormones] 

I've had two different clients share a similar observation in the last couple of weeks, and I thought I'd write about it since it's not uncommon to feel this way in early recovery.

First of all, I want to share with you an article on depression that was recently in the Boston Globe.

This article presents the argument that depression is not about a deficiency of neurotransmitters that need to be balanced with medication, but rather, a condition in which neurons are dying a slow death and gradually losing their function. I've had this premise for awhile; it is the basis of my treatment philosophy for PCOS. Fish oil is the best compound nature has for restoring life to neurons, and when you put it into your diet, the brain begins to function again.

My two clients have both observed that as they began taking fish oil, they felt more alert and their memory and concentration seemed to be better. Signs that Elvis is back in the building!

These two clients also observed, though, that they were feeling more emotional. Not all emotions, especially anger and sadness, are easy to feel. So when you begin to feel these emotions, it can feel like things are getting"worse", not better.

Keep in mind, when neurons are malnourished, that means ALL neurons stop functioning, not just the ones affecting memory. The ones affecting emotion, the ones affecting appetite, and the ones affecting hormones.

If you've had PCOS, your hormones have not been functioning as they should, perhaps for a very long time. And that means you've not had the experience other women have, of fluctuating energy, emotions, you name it. Those fluctuations are normal!

So I often get the question,"What can I do?" The most important advice I can give is, be patient with yourself. Become used to what it means to truly cycle. Get to know what a healthy body feels like. It means it is normal to feel bloated, even constipated, just before your period. Your weight might fluctuate. The cycle should be around 28 days when you're back on track, and every single day within that 28 days may feel different. There may be no such thing as getting on the scale and weighing the same thing every single day.

With regard to your emotions, perhaps as your brain becomes more aware, this is an opportunity to experience what emotions might be about. Emotions are messages from the brain, telling you how you are with regard to balance, and what you need to do to restore balance if it isn't there. Anger is often a clue that a boundary has been violated. Loneliness means you need to seek companionship of some sort. Fear suggests that you need to remove yourself from danger. If they didn't feel uncomfortable, you would not be motivated to engage in behaviors that keep you healthy and safe. So rather than running from emotions, embrace them! They're telling you that your health is returning and things are getting back to normal.

PCOS is so hormone driven that emotions end up on the back burner. Excesses of androgens and stress hormones put anxiety and anger in control. But if you find that these feelings are persistent and do not wane after time, or that they seem to be there even when nothing in your life can explain them, they may be signs of hormone excesses and not really environmentally or event-stimulated emotions. When your hormones have you constantly revved up, it can feel strange to not have that kind of energy rush.

I couldn't figure out why, when I first started recommending yoga to clients, they would come back after one class and tell me they hated it. I figured out eventually, that yoga slowed their bodies down but their heads were still spinning. And being pinned to the floor in a yoga pose while your head is thinking angry thoughts can be a very uncomfortable place to be. Those clients got the same advice I'm giving you. Give the new changes some time. Don't abandon your new lifestyle because it initially feels uncomfortable. It's been a long time since your body has felt normal. Be gentle with your self and get to know/understand that"normal" involves hourly, daily, weekly, and monthly cycles. There is no such thing as being the same weight, temperature, size, or temperament every single minute of every single day.

Our philosophy is a little different than what many physicians will have you do. We're not trying to control your hormones, your weight, or even your diet. We're not trying to force a cycle, a pregnancy, or a clothing size. We're guiding you toward healthy choices that allow your body to be in balance. Sometimes giving up control, and letting the body speak to you instead of the other way around, is the absolute best way to get there.

So if things seem a little chaotic and you feel like you're charting uncharted territory, welcome to the world of female physiology! Ask questions, observe, and embrace the wonderful lesson you're learning, that your body will heal if you let it. There is no such thing as being past the point of no return or"stuck" where you are.

Last month I had the opportunity to spend a week with 5 women with PCOS at Green Mountain at Fox Run's first ever PCOS week. I learned a tremendous amount from them, maybe even more than I went to teach to them, about the syndrome.

One of the most important insights I gained, was why it can be so difficult to lose weight once you've decided to change your eating and exercise habits.

Insulin has a lot to do with it.

Your body is constantly taking in data, recording the temperature, the light level, energy levels, etc., and adjusting itself to be able to meet the demands of the situations it's recording. When it comes to hormones, it often records and hangs on to information from weeks before. It's as if it wants to be sure it's ready to handle the worst case scenario it's going to have to be asked to deal with. So…if you've been binge eating, and you've changed your habits, information it's taken in about that binge, if it occurred in your recent past, is still in the database. Your body is likely to want to make more insulin than it currently needs, just in case it's asked to have to handle a binge session like one it remembers you engaged in.

If you continue your new eating habits, consistently, that will register positively, your body will trust that it needs to make less insulin, and your lab values will improve.

The challenging part is being patient with your body while the new data has a chance to be recorded and acted on.

If you've got high insulin levels and all of a sudden you decide to go on a diet, or exercise at high levels, the insulin levels won't automatically adjust. It can be very easy to create a hypoglycemic state if you take on too much too soon. And, as your blood sugar levels drop, your hunger and carbohydrate cravings are likely going to be triggered to correct the situation.

Hypoglycemia is a stressful situation for the body, so when this scenario kicks in, it also triggers the release of stress hormones. Cortisol, one of the major stress hormones, is made with cholesterol. As are estrogen, testosterone, and progesterone. If choices you are making are demanding of the body that it makes more cortisol, it's going to be hard for it to make the other three hormones in the proper proportions.

The other thing that is common with PCOS is an intelligent, driven, all-or-nothing tending personality. When you decide to take on diet and exercise, it can be in an extreme fashion. When weight doesn't come off as planned, you can be very hard on yourself, raising your stress levels, possibly bingeing out of frustration.

And thus the cycle starts, all over again.

Hence the title of this post. How do you back yourself out of such a situation?

Ohhhh…you all are going to hate this, but the key word is"moderation". Be gentle with yourself. Rather than taking on an extreme exercise plan and a rigid diet, focus on small simple changes and working to turn them into habits. Be patient. Understand that the changes you're implementing on the outside take time to be registered by your internal hormone control systems.

Probably key? Remember this: THE DAYS YOU FEEL THE LEAST LIKE STICKING WITH YOUR NEW HABITS ARE THE DAYS IT IS MOST IMPORTANT TO DO JUST THAT. It's tempting to blame a bad day on something you've done, to take it personally, rather than let your body do what it does best when it's not interfered with. By bingeing and not exercising on a day you feel badly, you prolong the time it's going to take to get things back into balance.

We've gotten a whole lot of traffic from people coming to learn about Amber. And I'm guessing, more than a few came to see what diet I put her on.

We'll eventually get to the food stuff, but there was something else going on with Amber that caught my attention and seemed like the more important priority. I say that, because it holds the potential to undermine any kind of nutrition advice I might give. Because of that, it needs to be addressed and corrected first, so that any type of nutrition changes we pursue have a better chance of catching and taking hold.

Amber doesn't sleep well. She shared with me that she often gets up in the middle of the night, she wakes up unrefreshed, as if she hasn't slept at all, she's exhausted most of the day, and she has memory problems.

Does that sound to you, like someone who's going to do well with a diet and exercise problem?
--She's going to have a hard time finding the energy to exercise. For those of you who have labelled yourselves"lazy" because you're not sleeping well…stop it. You're exhausted.
--She's going to have a hard time choosing productive foods, because all she's going to care about is quick energy to get through the next 10 minutes.
--She's not going to be able to organize her day to accommodate exercise because she's too tired to think about how to do that.

What it really sounds like Amber might be doing…is something called MICROSLEEPING. It's something sleep-deprived people do, kind of going through life in a subconscious haze, never really sleeping, never really being fully conscious. It's hugely stressful on the brain, and it tends to chomp away at neurons so they can't function. It's also quite dangerous, as you can see in this video, if you're spending any part of your day at all operating some sort of machinery.

It makes better sense, rather than imposing a self-defeating program onto an exhausted, stressed out system, to pull that system back into balance so it has the energy to pursue healthy living.

Here's what I think microsleeping does to hormones and how it may be affecting Amber.

1. When you're hyperinsulinemic, and you go long periods of time without eating, your blood sugar is likely to get low. That's not something your body really likes to see, so when that happens, it releases cortisol in order to get blood sugar back up. If that happens in the middle of the night, when stress hormones aren't supposed to be circulating, it prevents you from cruising through normal stages of sleep. So you wake up feeling as if you haven't slept.

2. When your stress hormones have been working during the night, you're likely to wake up in the morning not feeling hungry. Plus, it's likely that you overslept, finally having fallen asleep just before the alarm went off, so you hurry out the door without breakfast.

3. High insulin levels and empty stomachs are not really the greatest combination, so at some point, mid-morning, hunger appears…with a vengeance. If you're tired and haven't really planned your eating, you're highly likely to seek out caffeine and sugar to fix the problem.

4. And thus, the vicious cycle begins.

But how in the world do you begin to break it? Here are the things I suggested to Amber.

1. Eat a protein-containing snack about a half hour before bedtime. It should contain at least 8 grams of protein. It will help stabilize blood glucose through the night. I don't care if it's an energy bar, string cheese, or a slice of turkey. I like to have Greek yogurt with nuts, myself. (I don't even have PCOS but I find that it helps me to sleep better if I do this.)

2. Spend at least a half hour outdoors each day. Amber lives in a hot, desert, climate, and we're closing out our"winter" in the desert, meaning her body is likely really needing a hormonal reset. UV light exposure really helps to improve melatonin (and serotonin) metabolism. So she's been eating breakfast outside.

3. Define breakfast as something that contains protein and is consumed before 10 am. If she's not hungry at 7 am, I don't want to force her to eat, but I do want to be sure she's keeping blood sugar levels stable. I told her that a good sign we're resetting hormones is if she starts to feel hungrier, earlier in the day. Within a couple of days she emailed to tell me that she was.

4. Take a dose of fish oil equivalent to 1000 mg DHA (not total omega-3's, specifically DHA) per day. Not sleeping well is one of the quickest ways to oxidize and destroy brain cells so we need to rebuild them. And, because memory is an issue, we had a pretty detailed discussion about what needed to happen in order to make sure this happened every single day, without fail.

5. Eat at least 5 servings of vegetables per day. Research has shown that people who do this, have higher melatonin levels, which means they also sleep better.

6. Keep doing Craig's exercises, because they would help her be ready to fall asleep at bedtime.

Fortunately, she started feeling better almost immediately, so now we're looking at her food patterns to see what we can productively layer on this foundation.

In the meantime, Amber's discovered she's a bit dependent on soda, likely for the caffeine. So I wrote an article for my Examiner gig about some substitutions that at least give her some fizz.

We'll get back to you with more food information in future posts, but I wanted to be sure those of you who were disappointed to not see some sort of magic diet or supplement in our program, understood why you didn't find it.

Our approach at inCYST is very different. It feels a bit counterintuitive, I know, but those who trust it and use it, do see results. I hope this series is helping you, too.

The topic for this blog post was suggested by a reader. I figured it was likely important, since many of you struggle with depression and arthritis or some sort of chronic pain, and you're self-medicating. The effects of THC, the active ingredient in marijuana, on hormones, is quite extensive. I am summarizing the findings reported in the reference I list at the end. Bottom line, it's probably not the greatest idea to be regularly introducing marijuana into your system if your hormones are out of balance and you're trying to correct that problem. Even if you're not trying to become pregnant but you're sexually active. The effects outside of your own self are potentially significant.

Interestingly, improving your omega-6 to omega-3 dietary ratio helps to correct some of your own human cannabinoid levels, which may help to decrease the desire to get them from an external source. It may also alleviate the depression and joint pain that you may be using marijuana for in the first place. Some experts suggest that this imbalance of our "natural THC" may be one reason women with PCOS have strong carbohydrate cravings--it's another form of the munchies!

Reduced FSH and LH levels.
Suppressed prolactin, thyroid, growth hormone
Provokes cortisol release and reduces production of adrenal steroids, which makes it hard to maintain hormone levels.
Interferes with ovarian prostaglandin synthesis.

HCG-stimulated and FSH-stimulated progesterone secretion is inhibited.
Inhibits estradiol release.

Inhibits cholesterol esterase manufacture, and cholesterol is the building block for many reproductive hormones.
Hyperplasia and hypertrophy of the uterus
Changes in vaginal cell thickness, character and mucoid presentation
Reduced uterine weight
Suppresses thyroid function.

A dose of LH that routinely caused ovulation in normal rats was only able to induce ovulation in 40% of the rats exposed to THC.
Two to fourfold greater doses of LH were required to restore ovulation in THC-exposed rats.

The equivalent of one marijuana cigarette per day interfered with cell division and embryonic growth in fertlized eggs. It also reduced intrauterine weight gain by the fetus.

Offspring of rats exposed to THC had abnormal eggs, meaning the fertility of future generations was also affected.

Prevents reuptake of serotonin, dopamine, norepinephrine into the brain, increasing, not decreasing, depression over the long term.

Braude MC, Ludford MP, eds. Marijuana: Effects on the Endocrine Reproductive Systems. 1984

The findings in this study are probably not news to you if you have PCOS, but it's nice to see your emotional PCOS finally validated with a scientific study.

480 women with PCOS participated in the psychological evaluation portion of this study.

Women who were not menstruating were more likely to have lower self-esteem, and to have a greater fear of being negatively viewed with regard to their appearance. These women also appeared to have an earlier onset of maturity.

High androgen levels and acne were associated with poorer body satisfaction. The greater the degree of hirsutism and BMI (body size), the lower the scores on psychological tests.

The obvious social explanations for these findings have been covered elsewhere. I believe that hormones have a huge part to play in these tendencies…I've worked in eating disorders and I've seen literally thousands of women lose the weight and remove the hair…and STILL be unhappy. Women with PCOS need help in understanding how hormones affect mood (and that hormones ARE mood) and to have access to qualified professionals who can help with that aspect of PCOS.

It's why I'm so happy Gretchen Kubacky and Anna Ahlborn are in the inCYST Network. They are here to help us better understand these conditions and what can be done to minimize any potentially negative influence they may have on your quality of life.: )

de Niet JE, de Koning CM, Pastoor H, Duivenvoorden HJ, Valkenburg O, Ramakers MJ, Passchier J, de Klerk C, Laven JS. Psychological well-being and sexarche in women with polycystic ovary syndrome. Hum Reprod. 2010 Mar 31. [Epub ahead of print]

Our blog statistics have shown over time, that we get quite a bit of regular traffic from the other side of the world. I have to admit, my advice is hemisphere-centric, since I've never been south of the Equator. So I invited a friend from Australia, Olwen Anderson, who works with PCOS in her part of the world, to share a little bit of advice. Here's hoping for our Aussie readers, it introduces you to someone close to you who can help you, and that what Olwen has to say, is helpful!

Legumes are a girl’s best friend… when you have PCOS

Olwen Anderson is an Australian Nutritionist-Naturopath who specialises in treatment of hormone imbalances and gut disorders. Her blog contains lots of PCOS-friendly recipes: Visit www.olwenanderson.com.au

Been diagnosed with PCOS? Meet your new nutritional “best friend” – legumes.

When you think about food as medicine, legumes should almost be a compulsory prescription for good health. These amazing little vegetables are packed to the brim with nutrition that can help moderate your hormones. They taste great; and once you learn how to prepare and use them, they will open up a whole new culinary world for you.

Legumes include chick peas (or garbanzo beans), black eyed beans, haricot, lima beans, kidney beans, soy beans and many other dried beans that are a staple food in many countries. In fact, legumes are one of the powerful plant foods common in countries where people routinely live happy, productive lives to 100 plus.

Phytoestrogens and fibre are two outstanding features of legumes that will benefit you. Phytoestrogens are naturally occurring plant chemicals that have a molecular shape similar to estrogen. When digested, they ‘latch on’ to the estrogen receptors of cell membranes, and effectively block real estrogen molecules from connecting with the cell. This means that when you have plenty of the right fibre in your diet, you’re automatically reducing the effects of excess circulating estrogen.

Its good bacteria in your intestines that convert plant phytoestrogens to their active form. These good bacteria feed and breed on soluble and insoluble dietary fibre. Fortunately legumes are packed with fibre, so your intestinal bacteria will love them. When there’s plenty of fibre in your diet, your body produces more sex hormone binding globulin. This transporter molecule travels through your bloodstream, picking up and removing excess hormones, including excessive androgen hormones like testosterone. Exactly what you want to happen in your body.

Even better, legumes are packed with nutrients: Some protein, a little of the good fats, and complex carbohydrates. They’ll take ages to digest, resulting in smoother blood glucose management; and they’re packed with minerals too.

But won’t they make me flatulent?

Many women worry that if they start enjoying legumes, they will become windy. To prevent this, start with small quantities (about one tablespoon) and build up over a few days to half a cup so your intestinal bacteria have a chance to adjust.

It’s easy to incorporate legumes into your diet every day:

- Sprinkle chick peas (garbanzo beans) through your salad

- Enjoy some home made baked beans for breakfast with poached salmon

- Fresh broad beans, steamed and mashed, make a great vegetable side dish

- Include legumes in your stews, casseroles and soups. Like minestrone soup; or lentil stew.

You can buy legumes canned; but the dried variety, cooked, taste so much better. (Also, avoiding canned food helps you avoid suspected endocrine-disrupting chemicals like BPA). Buy dried legumes, soak for a few hours, boil until cooked, (firm but not crisp), then freeze in portion size containers.

I always keep containers of cooked legumes meal-ready in the freezer. Then, if I want a quick meal, I can take one out, stir-fry in a hot pan with garlic, spices, some kangaroo fillet, a few baby tomatoes and a handful of baby spinach leaves. Fast, healthy, one-pot cooking.

Looking for recipe inspiration to enjoy legumes?

- Visit my web site at www.olwenanderson.com.au (recipes tag on the blog)

- Look at recipe books for cultures where legumes are part of the daily diet: South American, Mediterranean, Indian.

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.

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

The topic for this blog post was suggested by a reader. I figured it was likely important, since many of you struggle with depression and arthritis or some sort of chronic pain, and you're self-medicating. The effects of THC, the active ingredient in marijuana, on hormones, is quite extensive. I am summarizing the findings reported in the reference I list at the end. Bottom line, it's probably not the greatest idea to be regularly introducing marijuana into your system if your hormones are out of balance and you're trying to correct that problem. Even if you're not trying to become pregnant but you're sexually active. The effects outside of your own self are potentially significant.

Interestingly, improving your omega-6 to omega-3 dietary ratio helps to correct some of your own human cannabinoid levels, which may help to decrease the desire to get them from an external source. It may also alleviate the depression and joint pain that you may be using marijuana for in the first place. Some experts suggest that this imbalance of our "natural THC" may be one reason women with PCOS have strong carbohydrate cravings--it's another form of the munchies!

Reduced FSH and LH levels.
Suppressed prolactin, thyroid, growth hormone
Provokes cortisol release and reduces production of adrenal steroids, which makes it hard to maintain hormone levels.
Interferes with ovarian prostaglandin synthesis.

HCG-stimulated and FSH-stimulated progesterone secretion is inhibited.
Inhibits estradiol release.

Inhibits cholesterol esterase manufacture, and cholesterol is the building block for many reproductive hormones.
Hyperplasia and hypertrophy of the uterus
Changes in vaginal cell thickness, character and mucoid presentation
Reduced uterine weight
Suppresses thyroid function.

A dose of LH that routinely caused ovulation in normal rats was only able to induce ovulation in 40% of the rats exposed to THC.
Two to fourfold greater doses of LH were required to restore ovulation in THC-exposed rats.

The equivalent of one marijuana cigarette per day interfered with cell division and embryonic growth in fertlized eggs. It also reduced intrauterine weight gain by the fetus.

Offspring of rats exposed to THC had abnormal eggs, meaning the fertility of future generations was also affected.

Prevents reuptake of serotonin, dopamine, norepinephrine into the brain, increasing, not decreasing, depression over the long term.

Braude MC, Ludford MP, eds. Marijuana: Effects on the Endocrine Reproductive Systems. 1984

I dedicate this post to Susan Dopart and Jeffrey Batchelor. Susan is a contributor to this blog…her post about the power of fish oil and flaxseed oil combination has been pretty widely read around the Internet.

Susan and Jeffrey e-mailed me from a recent trip to Switzerland where they were going ga-ga over the wonderful food. I mentioned that Emmenthaler Swiss cheese has been found to have a higher content of omega-3's than the average cheese, and Susan recently mentioned that she's found a store at home in Santa Monica, where she can special order the stuff she loved so much in Switzerland.

So today I walked over to the grocery store to get my lunch and it turned out it was cheese sampling day. Kara, the local Cheese Goddess, happened to be there and since she is so knowledgeable about cheese I call her the Human Cheese Rolodex, I pulled her aside and picked her brain about what might be some fun options for healthy cheese.

Her recommendations were based on the following criteria I gave her:
--grass fed (corn fed cows turn out like corn fed people, too much inflammatory
fat in their tissue)
--organic (hormones are very chemically similar to estrogen and can disrupt
hormone balance

She gave me a list of some options. She told me that artisan cheeses, made by smaller dairies, tend to grass feed over grain feeding, but that is not always so. You need to ask.

Point Reyes Bleu Cheese
Cypress Grove
Winchester Dairy
Sierra Nevada Organic Dairy
Rouge et Noir
Bravo Farms
Fiscalini Cheese
Rumiano
Gioia
Bellwether Farms
Maytag Dairy
Carr Valley
Black Goat Dairy
Beecher's Cheese

Most of these come from California, hence the Happy California Cow picture.

The most interesting cheese Kara told me about was Beemster cheese from Holland. These cows graze on pesticide-free grass in pastures that lie below sea level. These pastures are located on top of a former sea lagoon, and their soil is made of a blue sea clay, and the combination of how this clay nourishes the grass these cows eat, produces cheese with 20% less sodium than the average cheese. I am curious whether this pasture history means somehow there are some omega-3's getting into this cheese…but I couldn't find anything online to answer that question.

If you are a true cheese aficionado and must have Beemster cheese…there is a little bad news…only 2000 wheels are made each year, in the springtime. The good news is, that could be an extremely fun pilgrimage.

http://www.beemster.us/the-cheeses/the-taste/

Now some science to round out Kara's trivia.

Cheese has its good qualities, when eaten in moderation.
--It's high in protein and calcium
--It contains CLA, an omega-3 intermediate which may help with weight control
--It's convenient
--If it's the right kind, it contains omega-3's
--If you are like me, whose first language was German, there is no life without cheese.

Moderation is the key, for several reasons
--Cheese is a good source of saturated fat
--Cheese is one of the few nonprocessed foods that contains trans fats
--Cheese has calories

Susan and Jeffrey and I will be at the first Fertile Intentions Couples Infertility Day Spa on October 25, 2008. Along with our co-hosts, we will be discussing cheese as well as many other great things about food, health, stress management, and environmental awareness as they pertain to balancing hormones and fertility.

Please join us if you can!

As I mentioned in the first part of this series, vitex has its strongest effect on four hormones: estrogen, progesteron, luteinizing hormone (LH), and the one this post is dedicated to, prolactin.

Prolactin is primarily associated with lactation. It is also important for sexual arousal, sensing orgasms, and libido. So it's safe to say, you have to have good prolactin metabolism in order to successfully conceive and carry a pregnancy through to nursing!

One of the most important, and often overlooked, influences on prolactin function, is medication. I am most familiar with psychotropic medications because of my specialty, and I believe, with the very high incidence of anxiety, depression, and sleep disorders in women with PCOS, it is incredibly important to use these medications with discretion in order to not interfere with fertility, or successful PCOS management in women who are not in pursuit of conception.

Before considering any supplement, make a list of all the medications you've ever been prescribed and show them to a registered pharmacist. Ask them if any of those medications have any potential for disrupting prolactin function. And if you come up with a"yes" for any of them, ask for a list of alternatives that you and your prescribing physician can use to adjust your treatment plan.

When prolactin is out of balance, funny things can happen. You can produce milk when you're not supposed to (I once had a male client who started to lactate, and it turned out to be a symptom of a pituitary tumor.)

You might not be able to produce milk when you want to. Many, many, many women with PCOS find, much to their dismay, that they get pregnant, and cannot feed their babies. I am shocked at how many medical colleagues with PCOS write me to share that until they heard us mention this at inCYST…they never knew it could be a problem. And they themselves could not nurse their babies!!!

This lack of awareness and the incredible importance of healthy prolactin function to the overall health of mother and baby, is precisely why, our first outreach outside of dietitians, with inCYST, has been with lactation consultants. They understand this physiology best, and they are the most likely to pick up on problems as soon as they become apparent.

Bottom line, PCOS is not just about infertility. It is about successful reproduction, which includes being able to successfully create the next generation of healthy people.

But I digress. Back to prolactin.

Prolactin is controlled by the hypothalamus, the part of the brain we at inCYST are obsessed with learning and teaching about. The hypothalamus also regulates estrogen, progesterone, testosterone, cortisol, thyroid, and growth hormone. You can see why it's your BFF as a woman with PCOS. If you have problems with one of those, you likely have problems with more than one.

Most medical treatments address each of those hormone imbalances as if they are separate, requiring a separate medical treatment…better yet…a separate medication. So by the time you've made the specialist rounds, you've been given a birth control pill, an antidepressant, a sleep medication, a lipid lowering medication (since some of these hormones are made of cholesterol, when they're out of balance…cholesterol will be, too).

We like to think we start where the problem starts. Giving the hypothalamus what it needs to work efficiently. And the number one chemical you can focus on, which should help all of these functions, which I call our"Recipe for a Happy Hypothalamus (SM)"…is DHA, one of the fish oils.

1. DHA makes it harder for the hypothalamus to feel stress. Stress is a very selfish thing. It steals energy away from other things your body might need it for. With enough DHA in the system, the hypothalamus can put its energy into healing the functions that are NOT related to stress, mainly reproduction, sleep, and mood.

2. DHA increases dopamine receptor density. Prolactin is dopamine-controlled, meaning the more receptors there are to communicate with the dopamine that is there, the less prolactin your body needs to make.

An interesting aside--dopamine imbalance is common in people who crave and/or binge on sugar. So if you've got cravings AND your prolactin levels are not right…you just might be DHA-deficient.

I have one more post coming on chaste tree berry that will summarize important findings and recommendations.

But, with regards to prolactin, what I will say is that two very important things you can, and should, do, to move yourself back into balance, are:

1. Make sure your medications are not the source of the problem, and
2. Make sure your food choices are promoting healthy dopamine function.

Even if you DO decide to try an herbal formula, it is much more likely to work for you, if you provide it with an environment that allows it to do what it does best.

We focus a lot on the successes our program achieves, but I thought I'd take a blog post to talk about what happens when it doesn't work. I'm not so sure that's the way to describe unexpected results, but since that's how clients often perceive and define it, that's what I'll use for this discussion.

PCOS is a counterintuitive syndrome. It doesn't follow the typical weight loss patterns that most diets address and promote. If you're looking for"x" pounds of weight loss in"x" amount of time, it can set you up for disappointment. In fact, if you've got certain numbers in your head, and you don't get there in a certain timespan, it can set you up to be tempted to cut your calories back too severely, or exercise too intensely. With PCOS, one of your most important mantras needs to be"more is not better and moderation is best."

Are you gentle with yourself? Or do you tend to punish yourself if your body doesn't act exactly the way you wish you could just push-button program it to? One of the worst things you can do is stress out about changes not happening on a certain schedule. Cortisol, a very powerful stress hormone, is one of the hormones you just don't want to add to the mix. Be sure you treat yourself well, every day, even on the days your weight is not what you think it should be, when your pregnancy test is negative, when your blood test didn't show changes you hoped for. Sometimes it takes awhile for changes to blossom, and they have the best chance of doing so if you're consistent with your behavior. (Soon I'm hoping a network member will be sharing her own testimonial about the benefits of slow and steady…it's very motivating and inspiring.)

Are you too"black and white" with your problem solving? If you tried something that someone recommended, and you didn't see results in the time frame you expected…did you toss the idea completely because it"didn't work"? Or did you step outside of yourself and play detective, asking yourself if the change needed adjusting in dose, time, consistency…? Are you looking for the perfect food? Or are you letting yourself gradually introduce new and different ways to change your overall intake? Are you allowing for fun foods, or are you trying to completely eliminate foods you feel are"bad"?

Are you applying the wrong solution to the wrong problem? Of course, this is a nutrition website, and we believe wholeheartedly in the power of nutrition. But nutrition cannot solve everything. Sometimes the driving force behind an eating problem is a mood disorder. If you have bipolar disorder or severe depression, good nutrition can definitely help, but it may not be the most important thing you need to do to restore balance. As much as we believe in nutrition, we believe even more in the mind-body connection. If your mind is out of balance, and not being prioritized…you'll be chasing its cravings with the foods that throw your hormones out of whack. It's important to honor your mental health and ask for help with it if you notice that it's hard to slow down your thoughts or to not be negative.

For the most part, my experience is not that the information isn't working, but rather, that a client hasn't given it time to work.

Remember, slow and steady. Be gentle with yourself. Trust that your body knows what it needs to do to get healthy. When we don't get in the way and make it even harder for it to get there.

So let's say you've landed on this website because you were doing a Google search at 3:30 in the morning.

Or because you're home from work and can't slow your head down enough to relax and enjoy a leisure activity…so you're surfing the Internet to distract yourself.

What's going on?

It could be a lot of things.

1. If your hormones are out of balance, as with PCOS, you may have excess levels of stress hormones such as cortisol that rise more easily than average, and take longer to normalize after a stressful day.

2. If you didn't sleep well last night and used caffeine and sugar to get through your day, you may be experiencing the aftermath of that.

3. If you over-exercised too late in the day, because it's only large amounts of exercise that help to calm your mind, it may have stressed you more than it relaxed you.

4. You may have a mood disorder (anxiety, bipolar disorder, attention-deficit hyperactivity disorder, obsessive-compulsive disorder).

How to know which is which? If you've made major changes in your lifestyle, corrected nutrition choices, worked to prioritize sleep, etc., and your head simply won't slow down, that's a huge red flag that something important lies beneath those behaviors. In fact, the imbalances you adopted, from eating sugar to drinking alcohol to relax, to marathon exercise sessions, may have helped you to"medicate" something more important going on in your nervous system.

Mood disorders are important not to ignore. They can be degenerative, which means, left unchecked, they can prematurely age the brain and nervous system. Your new lifestyle choices are incredibly important in slowing that process down, but you may find that additional help, such as a medication, can be tremendously useful as far as finally bringing you back into balance.

If you feel as though I'm describing you, you may be interested in another blog I write, about nutritional aspects of psychotropic medications. It goes into more detail about this specific topic, and I do post a lot of information about nutrition for brain and nervous system health.

Awhile ago I made an informal (that is, never scientifically tested) questionnaire. It's not intended to diagnose, but rather to get you thinking about what kinds of thinking patterns may be underlying how often and how intensely you experience stress. You may be blaming your racing head on your stress, but it may be that your racing head attracts you to situations and relationships that are stressful.

There is no right or wrong way to answer these questions. But do consider, the more"yes" responses you give yourself, and the less your answers change in response to reasonable changes in diet, activity, sleep, and stress management, the more important it is to consider that you may have a mood disorder.

Are You A High energy Thinker? (Copyright 2000, www.afterthediet.com)

1. I am easily flustered.

2. I am easily drawn into a conflict.

3. I am very organized, and when my routine is disrupted, it can ruin my day.

4. I have a hard time with change, I would rather control thngs than let them take their natural course.

5. I can become so attached to a person, idea, or situation that I lose sight of the"big picture" perspective.

6. Staying focused on a task is a challenge; I am easily distracted/bored.

7. I can become obsessed with an activity. I ccan lose track of time because I get so absorbed.

8. People tell me I overanalyze things.

9. Peole tell me I am an adrenaline junkie.

10. I am a perfectionist.

11. I am very sensitive to criticism.

12. I worry a lot.

13. I procrastinate/can't finish projects I start.

14. I feel like I sabotage myself.

15. I have a way of saying or doing impulsive things that undermine relationships or which hurt my credibility.

16. I toss and turn a lot before falling asleep.

17. I can do a lot of things at once; in fact, it's easier thann doing one thing at a time.

18. I feel driven by some sort of internal machine.

It was fun to see that our virtual grocery shopping tour was so popular! Here are some things to look for, either in your local grocery store, or through the provided links.

Bob's Red Mill Soup Mix, Veggie, 28-Ounce Units (Pack of 4) Bob's Red Mill is one of my favorite companies. Practically everything they sell is worth your consideration. Here's a soup mix you can throw into your slow cooker, with some favorite veggies.

Sensible Foods Organic Crunch Dried Snacks, Apple Harvest, 0.75-Ounce, 12-Count Pouches A great substitute for a bag of chips!

Tinkyada Brown Rice Penne Pasta with Rice Bran, 16-Ounce Packages (Pack of 12) Some high-fiber, gluten free pasta.

Kavli Crispbread, Garlic, 5.29-Ounce Boxes (Pack of 12) Crackers are a hard one. Here's one of my favorites.

Roland Feng Shui Edamamee Edamame is a type of tofu with lower potential to throw your hormones out of balance. It's great to throw on a salad or toss into a pilaf.

Bob's Red Mill Fig Nuggets, 18-Ounce Packages (Pack of 4) If you like Fig Newtons, why not figs? They are a great dried fruit to keep on hand!

Sahale Snacks Variety Pack of 3 Flavors, 0.75-Ounce Pouch (Pack of 30) Nuts, nuts, nuts…great source of healthy fats.

Westbrae Natural Vegetarian Organic Kidney Beans, 15 Ounce Cans (Pack of 12) A can of beans is a great basis for a quick dinner.in a salad, a quick soup or chili, or a burrito.

Honest Foods Granola Planks, Blueberry Vanilla Crackle, 3-Ounce Bars (Pack of 6) Just another"bar", but one with a nice combination of ingredients.

All things quinoa One of my favorite grains, it's high protein, low glycemic, and great for helping to balance hormones.

Happy Eating!

I've told many a client they're sick and they've been playing catch up since before they were even born. Others feel the same way, too…this was recently published in USA Today:

By Liz Szabo, USA TODAY
Keishawn Williams is already talking to her baby, although her child isn't due until November.

"What are you doing?" asks Williams, 22."Are you awake? Are you asleep? Why are you sitting on my bladder?"

Although Williams may not realize it, her body and baby are also conducting a separate, even more important conversation that may influence her child's health for the rest of its life. Although neither mother nor child is aware of this crucial dialogue, Williams' body already is telling her baby about what to expect from the world outside, says Mark Hanson, a professor at the University of Southampton in England.

And thanks to those biological signals, the choices that Williams makes today — by getting good prenatal care, eating nutrient-packed vegetables and avoiding alcohol, tobacco and caffeine — may help her baby long after birth, Hanson says. Research into the"developmental origins of adult disease" suggests that Williams' healthy living may help her child avoid problems such as cancer, heart disease, depression and diabetes not just in childhood, but 50 years from now.

Though adults still need to eat right and exercise, a growing number of studies now suggest the best time to fight the diseases of aging may be before babies are even born, says Peter Gluckman of the University of Auckland in New Zealand.

Williams' baby is still too young to kick, let alone ponder its future. But its body is already adapting and preparing for its specific environment, Gluckman says, by reading cues sent through Williams' blood and amniotic fluid.

"Every baby in fetal life is adjusting its pattern of development according to the world it predicts it will live in," he says.

Reading cues while in utero

During the crucial"window of opportunity" before birth and during infancy, environmental cues help"program" a person's DNA, says Alexander Jones of Great Ormond Street Hospital in London and the University College of London Institute for Child Health. This happens through a delicate interplay of genes and the environment called epigenetics, which can determine how a baby reacts for the rest of its life, Jones says.

Through epigenetics, chemical groups attach to DNA. Although they don't change the order of the genes, the chemical groups can switch those genes on or off, Jones says.

Many things, such as chemical contaminants, can cause epigenetic changes. So babies exposed in the womb to synthetic hormones may begin responding abnormally to the natural hormones later made by their own bodies, says Hugh Taylor of Yale University School of Medicine.

That's why, doctors believe, many babies exposed before birth to a drug called DES, or diethylstilbestrol, later developed rare cancers or fertility problems, Taylor says.

Doctors stopped prescribing DES, which had been used for decades to prevent miscarriages, in 1971. But Taylor and other scientists are concerned that"hormone-disrupting" chemicals, such as those used in pesticides and even common plastics, could cause similar problems.

Babies and children also can develop abnormal reactions to stress, says Jack Shonkoff of Harvard University, co-author of a June paper on early influences in health in The Journal of the American Medical Association.

In the short term, reacting to typical, everyday difficulties can help people develop a healthy response to stress.

But persistent,"toxic" stress — such as neglect or extreme poverty — may program a child's nervous system to be on perpetual high alert. Over time, this can damage the immune response and lead to chronic ailments, such as heart disease and depression, the study says.

Diet as a predictor

A pregnant woman's diet tells a fetus a lot about its future environment, including how much food will be available after birth, Jones says.

A baby conceived during a famine, for example, might learn to be"thrifty," hoarding every calorie and packing on fat rather than muscle, even at the expense of developing vital organs, such as the kidneys, liver and brain. Because of a lack of calories, the baby also may be born small.

In a famine, those early adjustments and predictions about the future could mean the difference between survival and starvation, Jones says.

But babies may run into trouble if the world doesn't match their predictions, Jones says.

A baby who has learned to hoard calories, for example, may grow up to be fat or diabetic once he or she finally gets enough to eat, Jones says. Doctors believe this occurs not just with babies whose mothers are starving, but with those who are malnourished because of a mother's medical problems, poor nutrition or exposure to tobacco smoke, which damages the placenta.

It's well known, Taylor says, that women who smoke are more likely to have low-birth-weight babies, who are in some ways"starved" for nutrients in the womb. Babies born too small are at risk for many immediate problems, such as underdeveloped lungs and bleeding in the brain.

If they survive, these youngsters also face long-term risks.

Studies show that small babies who gain weight rapidly in infancy or childhood — a sign that bodies are already making the most of every calorie — also have higher rates of adult heart disease and diabetes, Jones says.

Specialized X-rays have shown babies of young mothers with poor diets in India, for example, are born with extra belly fat, even though they seem to be a normal weight. Once these babies start getting an adequate diet, they are likely to put on weight, Gluckman says.

"Even by the time of birth, they're on a different pattern of development," Gluckman says.

Teaching future mothers

Adversity in early life can increase a child's risk of disease, but it doesn't seal his or her fate, Shonkoff says.

Although emotional abuse in childhood increases the risk of adult depression, for example, supportive relationships with adults can help children cope and recover, Shonkoff says.

Communities also can help, Gluckman says. By helping women such as Williams get good prenatal care and nutrition, for example, communities can reduce the number of fetuses who are malnourished and born small, Gluckman says. Babies who are born at normal weight are more likely to maintain that healthy weight.

Because half of pregnancies are unplanned, women need to learn about nutrition — and maintain healthy diets — long before they conceive, Gluckman says.

"We have got to give far greater focus to mothers, the women who are likely to become mothers and to the care of newborn children than we have in the past," Gluckman says.

Williams, who also has a 1-year-old son and 5-year-old daughter, says she's trying hard to give her children a bright future. She breast-fed both and now works as a breast-feeding peer counselor at the Family Health and Birth Center in Washington, D.C., where many patients are low-income or minority mothers.

The birth center also aims to help babies by getting their moms good prenatal care.

About 6% of black mothers who delivered at the birth center had low-birth-weight babies, compared with the citywide average of 14.2% for black mothers, says the center's Ruth Watson Lubic.

"Twentieth-century medicine dealt with child health and adult health separately," Shonkoff says."What 21st-century medicine is telling us is that if we want to change adult health, we have to look in babies, even before they're born."

The more I work in the area of fertility, the more I realize just how stressful it is to be told you are infertile and that conceiving a child will be difficult at best. It seems to me, that the unusual woman placed in this situation is the one who lives through it without experiencing any sort of depression.

Which is why this research caught my eye.

90 women diagnosed with infertility were randomly divided into 3 treatment gorups. One-third of them were given 10 sessions of behavioral therapy, including: relaxation training, and learning to eliminate negative automatic thoughts and dysfunctional attitudes. One third of the group was given 20 mg fluoxetine (Prozac) daily for 90 days. The last group did not receive any intervention.

And look at THIS! 79.3% of the women in the behavioral training group improved, compared to only 50% of those on medication. (Ten percent in the control group improved on their own.)

There are probably many reasons for these results. Here are a few that I thought of:
1. Behavioral therapy helped to extinguish the thoughts and behaviors that potentially contributed to the depression in the first place. Medication didn't.
2. When you talk to someone about how you feel, it often helps reduce the perceived magnitude of the problem. When you hold it all in, it only fuels the depression.
3. Behavioral therapy focuses you on the many things you CAN do to take care of yourself. It's an entirely different perspective than you may be getting from doctors who are telling you that you CAN'T get pregnant, you CAN'T etc., etc., etc.

Over the years in this specialty, I've seen many women externalize their depression. That is, they blame it on causes outside of themselves--"it's because I can't lose weight, it's because I can't have a baby, it's because I look like I do"…and so on. I won't argue, when depression takes its toll on your life, its consequences can fuel a vicious cycle. But to sell yourself on the belief that"if I just lose weight, if I could just have a baby, if I could just get some cosmetic surgery…" is an invitation to disaster. The line of women I've worked with who got what they thought they wanted, and still felt the same way that they did before, and who experienced major eating disorders, postpartum depression, and even suicidal thoughts on the back end, would stretch from my office to the county line.

Depression is a metabolic state, just like diabetes, just like high cholesterol, just like a skin rash. You'd never blame your rash on your relationship with your husband or convince yourself that if you could just get rid of your"muffin top" you wouldn't have diabetes…it's equally important to not make illogical leaps when it comes to depression.

What can be crucial with infertility, is treating depression at its source. Behavioral training helps to change your perception and response to events, which in turn reduces the levels of stress hormones circulating in your body. When that happens, you sleep better, you crave less carbohydrates, and the hormones you need to work in order to conceive, feel more like it's safe to come out and play.

A word about support groups. I've seen them do wonderful things, but I've also seen them focus the participants even more on the problem they have instead of on solutions for change. I was invited to attend a support group recently and it was impossible to get the participants to talk about anything other than their personal situations, and how horrible things were for them. I don't want to invalidate these feelings, but the purpose of a support group is to come away empowered, hopeful, and with an idea or two about how to make things better. So choose your support groups wisely.

If you're feeling depressed, go talk to someone about what you can do about it. Not what someone can prescribe for you, not what needs to happen in your life in order to make it go away, but what YOU can do to get back into balance.

Faramarzi M, Alipor A, Esmaelzadeh S, Kheirkhah F, Poladi K, Pash H. Treatment of depression and anxiety in infertile women: cognitive behavioral therapy versus fluoxetine. J Affect Disord. 2008 May;108(1-2):159-64.

Here's a great summary of the effects of a high-fat diet on your hormones. A diet containing greater than 35% of calories from fat, in overweight conditions, in this study, was found to:
--disrupt 24 hour rhythms of secretion of thyroid stimulating hormone, luteinizing hormone, testosterone, and to a small extent, progesterone.
--lower total levels of thyroid stimulating hormone and testosterone.
--increase cortisol levels and disrupt the normal 24 hour cycle of cortisol release.
--induce higher blood glucose in relationship to high cortisol levels.
--reduced the magnitude of melatonin release.

So if you've got thyroid problems, can't conceive, can't sleep, and/or feel anxious or overly stressed…or have unexplainable angry outbursts…

…maybe one of the very first and most important things you can do to start to feel better…

…is reduce the amount of fat in your diet. And when you DO choose to eat fat, be sure it's the kind you see consistently recommended in our blog--seafood, nuts, canola, avocado, flax, olives.

It's really pretty simple!

Cano P, Jiménez-Ortega V, Larrad A, Toso CF, Cardinali DP, Esquifino AI. Effect of a high-fat diet on 24-h pattern of circulating levels of prolactin, luteinizing hormone, testosterone, corticosterone, thyroid-stimulating hormone and glucose, and pineal melatonin content, in rats. Endocrine. 2008 Apr;33(2):118-25. Epub 2008 May 1.

One of the most frequent questions I have gotten over the years, is whether or not a person should eat 3 square meals a day, or whether they should break that into 5 or 6 small meals.

The answer is…it depends.

If you are asking if I think you should make room in your diet for the top 10 foods people are likely to think of when they hear the word,"snack," the answer is no.

Unfortunately, we've let the food industry define"snack" for us, and if you look at the average snack machine in the break room, airport, or hotel, it is more likely to contain Pop Tarts, candy bars, and corn chips than it is apples, string cheese, or anything containing protein.

If you are asking if you should add more eating moments to your day without making your normal meals smaller…the answer is no. This is one of the issues I see with people switching to more meals. Their definition of meal is preset, and the switch adds unnecessary calories. If you want to eat more meals, each meal needs to be smaller so that the total adds up to be the same at day's end.

One of the biggest issues with PCOS is that large amounts of calories, especially when they are carbohydrate calories, are not handled well by the hormones that digest and absorb those calories. It may be easier for your body to process the food you eat if you do eat smaller amounts of food, more frequently.

All of your"eating incidents" should include some type of protein and a healthy fat. I almost don't like to use the words"meals" and"snacks", because each one conjures up images of what is and is not ok for each. I encourage you to redefine, and to eat what works best for you. When we use those words, it is almost as if one kind of eating is when we're doing healthy,"good" stuff, and the other is when we try to sneak in the other stuff. Every time you eat is an opportunity to be good to yourself, so be sure you choose wisely.

If an energy bar is an easier breakfast for you than a traditional breakfast, then do it!

If a half sandwich before bedtime is more reasonable than something that feels like a sweet and may trigger binge eating, then do it!

It can be challenging to figure out what plan works best for you. Here are some scenarios that would tell you a smaller, more frequent eating pattern might work better for you:

--you wake up not feeling hungry. If you didn't binge the night before, this may mean your blood sugar bottomed out overnight and your stress hormones released sugar to compensate while you were sleeping. A high protein meal/snack shortly before bed might help prevent this from happening.

--you eat a healthy meal, and just as you're finishing up, you start to feel ravenous. In this case, your blood sugar levels are telling you there was a dip prior to dinner, and the food you just ate has not had a chance to fix the problem. The answer is not to eat more food in the moment (as it is tempting to do), but to add a protein/carb combination a few hours before dinner to stablize your blood sugar.

--you participate in physical activity. You're simply going to need more food, more often, since you are using more energy.

--your schedule is not 9 to 5. If you work hours that interfere with our culturally standard mealtimes, you may do better with smaller meals that do not interfere with sleep. This is a situation where prepackaged foods that you can throw in a backpack or briefcase could be the answer.

A PCOS-trained dietitian can help you to analyze your food preferences, your lifestyle, and your own personal blood glucose response to certain types of foods. Whatever approach you determine is best for you. As I said, every time you eat is an opportunity to treat yourself well. Don't miss out!

I'm firming up the schedule for the next few weeks on our Blogtalk Radio Show,"Healthy Planet, Healthy Hormones". The primary topics will always be to the right for easy reference if you forget. If you can't attend live, the recordings will always be in our archives, and you can listen at your leisure. All shows are on Monday mornings at 9 am Pacific time.

What's Cookin' at Green Mountain? is our newest regular feature. We'll check in each week with the fabulous chefs at the resort which hosts a twice-a-year PCOS event. They're always up to something delicious!

Designer, community market organier, and Central Slope owner Michael Keele has great info in store for his half of the segment. Stay tuned for details!

September 13--Living Lean With PCOS
One of the most common search terms for our blog is"lean pcos". So we're well aware that you lean women with this disorder need more information and support. We'll be talking to actress and singer Haviland Stillwell about her experience with this situation. Haviland isn't one to let a little thing like chronic disease stop her from anything…and I think you'll be inspired by her story. (If you are in the NYC area, Haviland has an album release party on September 12. Click on her link for more information.)

September 20--Overcoming Fish Phobia
No matter how much we encourage you to eat fish, we still hear hesitation in your voices. Chef Nancy Banner of The Holistic Kitchen will be chatting with us and sharing some easy ways to become more fish confident.

September 27--In the Mood to Be Well
Dr. Gretchen Kubacky is in the house! You all love her practical and humorous insights into hormones, mood, and behavior, and we'll be checking in to see what's new in the world of psychology.

Do you have an idea for a program? Shoot it our way for consideration!

We've got a great new resource for you!

Gretchen Kubacky, Psy.D, is a psychologist practicing in Los Angeles who specializes in helping people diagnosed with endocrine disorders.

She's dedicated to helping women like you, and we're so excited to have such an awesome member on our team!

PCOS may be about hormones, but hormones are what create emotions. If you don't recognize both parts of the disorder, it's going to be hard to get better.

Gretchen, we're so glad you are here and we look forward to your contributions!

www.drhousemd.com
http://www.twitter.com/askdrgretchen
http://askdrgretchen.blogspot.com