The Hemp Connection [Search results for nervous system] 

From inCYSTER Karen Siegel…contact information for her Houston clinic is listed below.

"Yes. Another reason to keep encouraging the fish oil supplementation."

Public release date: 16-Dec-2009

Contact: Public Affairs Office
public.affairs@apa.org
202-336-5700 202-336-5700
American Psychological Association

New study links DHA type of omega-3 to better nervous-system function
Deficiencies may factor into mental illnesses
WASHINGTON — The omega-3 essential fatty acids commonly found in fatty fish and algae help animals avoid sensory overload, according to research published by the American Psychological Association. The finding connects low omega-3s to the information-processing problems found in people with schizophrenia; bipolar, obsessive-compulsive, and attention-deficit hyperactivity disorders; Huntington's disease; and other afflictions of the nervous system.

The study, reported in the journal Behavioral Neuroscience, provides more evidence that fish is brain food. The key finding was that two omega-3 fatty acids – docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) – appear to be most useful in the nervous system, maybe by maintaining nerve-cell membranes.

"It is an uphill battle now to reverse the message that 'fats are bad,' and to increase omega-3 fats in our diet," said Norman Salem Jr., PhD, who led this study at the Laboratory of Membrane Biochemistry and Biophysics at the National Institute on Alcohol Abuse and Alcoholism.

The body cannot make these essential nutrients from scratch. It gets them by metabolizing their precursor, α-linolenic acid (LNA), or from foods or dietary supplements with DHA and EPA in a readily usable form."Humans can convert less than one percent of the precursor into DHA, making DHA an essential nutrient in the human diet," added Irina Fedorova, PhD, one of the paper's co-authors. EPA is already known for its anti-inflammatory and cardiovascular effects, but DHA makes up more than 90 percent of the omega-3s in the brain (which has no EPA), retina and nervous system in general.

In the study, the researchers fed four different diets with no or varying types and amounts of omega-3s to four groups of pregnant mice and then their offspring. They measured how the offspring, once grown, responded to a classic test of nervous-system function in which healthy animals are exposed to a sudden loud noise. Normally, animals flinch. However, when they hear a softer tone in advance, they flinch much less. It appears that normal nervous systems use that gentle warning to prepare instinctively for future stimuli, an adaptive process called sensorimotor gating.

Only the mice raised on DHA and EPA, but not their precursor of LNA, showed normal, adaptive sensorimotor gating by responding in a significantly calmer way to the loud noises that followed soft tones. The mice in all other groups, when warned, were startled nearly as much by the loud sound. When DHA was deficient, the nervous system most obviously did not downshift. That resulted in an abnormal state that could leave animals perpetually startled and easily overwhelmed by sensory stimuli.

The authors concluded that not enough DHA in the diet may reduce the ability to handle sensory input."It only takes a small decrement in brain DHA to produce losses in brain function," said Salem.

In humans, weak sensorimotor gating is a hallmark of many nervous-system disorders such as schizophrenia or ADHD. Given mounting evidence of the role omega-3s play in the nervous system, there is intense interest in their therapeutic potential, perhaps as a supplement to medicines. For example, people with schizophrenia have lower levels of essential fatty acids, possibly from a genetic variation that results in poor metabolism of these nutrients.

More broadly, the typical American diet is much lower in all types of omega-3 than in omega-6 essential fatty acids, according to Salem. High intake of omega-6, or linoleic acid, reduces the body's ability to incorporate omega-3s. As a result,"we have the double whammy of low omega-3 intake and high omega-6 intake," he said.

###
Article:"Deficit in Prepulse Inhibition in Mice Caused by Dietary n-3 Fatty Acid Deficiency"; Irina Fedorova, PhD, Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health; Anita R. Alvheim, PhD candidate, Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, and National Institute of Nutrition and Seafood Research, Bergen, Norway; and Nahed Hussein, PhD and Norman Salem Jr., PhD, Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health; Behavioral Neuroscience, Vol. 123, No. 6.

(Full text of the article is available from the APA Public Affairs Office)

Norman Salem Jr. can be reached at nsalem@martek.com or at (443) 542-2370 (443) 542-2370. He was with the National Institutes of Health until 2008, when he became the chief scientific officer and vice president of Martek Biosciences Corp. in Columbia, Md., an ingredient supplier of DHA. He states that he and his co-authors conducted this research while with the NIH.

The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States and is the world's largest association of psychologists. APA's membership includes more than 150,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting health, education and human welfare.
--
Karen Siegel, MPH, MS, RD, LD, LAc
Acupuncture & Nutrition Clinic
9660 Hillcroft, Suite 202
Houston, TX 77096
713/721-7755 713/721-7755
www.AcupunctureandNutritionClinic.com
or
www.Karensclinic.com

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.

Last night I had a consultation with a client who is in her mid 50's. She doesn't officially have PCOS, but she has many of the symptoms, and I believe if she were younger, trying to have children, she might have the diagnosis. What is really interesting about this case is that this woman was born 2 months prematurely and spent several weeks in a neonatal intensive care unit before being able to go home. This was long before this was commonplace.

A very high percentage of my clients were born prematurely. This is a huge risk factor because it is during the last trimester of pregnancy that the brain and nervous system does the majority of its development. When the baby's nervous system is forced to grow and develop in an unfamiliar and unnatural…and stressful…environment, it just can't thrive like a nervous system that is at home in the womb.

Secondly, inside momma, there is at least a little bit of exposure to nutrients that are needed for this development. Outside the womb, we can do our best, but we can never completely replicate nature. In the case of my client, her intensive care stay happened long before we even knew much of this, and before omega-3 fatty acids were added to the feedings of babies in intensive care units. So my client, essentially, has been playing catch up at least since the day she was born.

A recent study confirmed what I just described, and what I've been teaching for several years. In a study comparing 28 babies categorized as"small for gestational age", 28 babies whose weight was statistically normal, and 56 normal-weight babies. An additional comparison was made between 60 premature babies, 20 of which were"small for gestational age" and 40 whose weight was normal.

Preterm babies seemed to have higher levels of building blocks of essential fatty acids, but the important omegas that they needed were not there, indicating that something about preterm birth may impair the conversion process. Term, normal weight babies had higher levels of DHA (one of those essential omegas), and higher ratios of endpoint to building block compounds. This suggested that the term babies were better able to convert building blocks into active omega-3's.

Term but small babies had higher levels of eicosapentaenoic acid, which is an intermediate in the conversion, meaning perhaps that lower weight babies also have important metabolic differences.

So, it seems, there are two important goals: (1) keep that baby in utero as long as possible, and (2) don't get so caught up in your pregnancy weight gain that you restrict your baby's development. Goal #1, interestingly, has been shown to be more achievable in mothers who consume adequate omega-3s! Goal #2 is a little more challenging, especially if you are being managed for gestational diabetes and your weight is being more closely monitored. That's when quality or what you do eat becomes important. It's going to be hard to get enough omega-3's, optimize your baby's weight gain, and keep your insulin function under control, if your focus is not on nutritionally dense foods that give you a bang for your buck.

That's why inCYST works so hard to train its professionals. They love to do this work, and they would love to help you figure it out!

Agostoni C, Marangoni F, Stival G, Gatelli I, Pinto F, Risé P, Giovannini M, Galli C, Riva E. Whole Blood Fatty Acid Composition Differs in Term Vs Mildly Preterm Infants: Small Vs Matched Appropriate For Gestational Age. Pediatr Res. 2008 Apr 3.

My post a few days ago about the effects of PCOS on the brain seems to have created some discomfort. We lost a few Facebook fans, and those who did respond, said that learning that PCOS was taking its toll on brain tissue and function was somewhat depressing to take. Theories of behavioral change state that until you know a problem exists, you will not act to change. So while the news can be uncomfortable to live with, the good news is, now you know why you need to make changes. You can't talk yourself out of those changes by convincing yourself that you're at peace with your body type, or that maybe you can live without having a baby. You're fighting for your cognitive life, and only you can make the changes that can make a difference. Here is a list of things you can do to help preserve brain and nervous system function. 1. Get sleep. You may think it's a badge of honor to cut yourself short in the sleep department. But it takes its toll. It is when you sleep, that your brain cleans out all the crud from the day before…spit shining neurons, so to speak. If you go too long without sleep, it's like you're letting rust accumulate all throughout your brain. Make it a habit to get to bed at an hour that allows you to get at least 7 hours of sleep a night. 2. Reduce stress. Every little thought, behavior, chemical reaction, that gets you through a day, requires a series of neurons to coordinate that activity. Every time a neuron is asked to work, it uses glucose to do so. Every time a neuron burns a molecule of glucose, it uses oxygen to do so. More neurons = more glucose = more oxidation. Make it a priority to give up the small stuff…and if you can't completely give it up…learn how not to sweat it so much. 3. Manage mental health issues. Most mental health diagnoses affecting PCOS (anxiety, bipolar disorder, PTSD, OCD, ADHD), involve processes that overwork the brain and nervous system. People with these disorders are fairly high energy, and that means they are using more neurons, more often, with far more intensity, than people who don't have to live with these conditions. Get counseling. If you need medication, take it. Health means MENTAL as well as PHYSICAL conditioning. Take it seriously. Do what you need to do. Slow down those neurons in any (legal) way available to you. 4. Exercise. Research is showing that regular physical activity slows down the development of brain diseases like Alzheimer's and helps to maintain brain tissue. How many times have you struggled with a problem at your desk, put it down, walked over to the post office, and had an inspiration while moving your body? Muscles and neurons are best friends. Be sure to give them plenty of play dates.

5. Eat less carbohydrate. Because your brain uses glucose, and because it's going to want more glucose when it is stressed, you're going to want to eat more carbs when under pressure. Remember what I said in number 2. The more carbs you eat, the more oxidative stress you impose on your brain. The more easily your brain rusts out and breaks down. I want you to think of this picture every time from this point forward you see a donut, order of french fries, or bottle of soda. Look less appetizing? Good. That was my point. 6. Eat antioxidants Antioxidants, those chemicals with the funny names nutrition experts love to impress people with in their blogs…hate oxidation. Eat them. Don't worry if you can pronounce their names, just know if the food in your hand (1) doesn't have an ingredient label, (2) has color, (3) and rots if left too long in your fridge, it's good for you. Put it on your plate and into your body. 7. Use fish oil. Fifteen percent of the dry weight of a healthy human brain is DHA, one of the primary omega-3's found in fish oil. It has to be fish, it can't be nuts, or flax, or greens. Eat the fish or take the capsules. I don't care if they come up a little bit. You have a choice…burps or brains. Just do it. 8. Reduce omega-6's. All those oils beginning with the letters"s" and"c"…break down brain tissue. Read labels. Get them out of your diet. Two exceptions. Organic canola is fine and coconut oil is fine, provided you're not eating it by the tablespoonful. 9. Yoga. Yoga tones the nervous system. It chills you out. It improves circulation in your spinal column. It improves your flexibility. It helps to manage mental health issues. It pretty much takes items 1 through 8 and makes them work even more effectively for you. It's worth the time. 10. Cut the high-fructose corn syrup. Recent research suggests that HFCS affects memory. Get it out of your diet!

In addition to PCOS, I specialize in the nutritional aspects of medications affecting the brain and nervous system. That includes psych meds, Parkinson's meds…pretty much any medication that has the potential to affect how the brain and nervous system function.

A few years ago, while compiling a series of fact sheets about the nutritional implications of these medications, I started reading about the anti-obesity medication called Meridia (generic name sibutramine). This drug appeared on the market after the famous phen-fen combination was deemed dangerous. It was supposed to be a kindler, gentler alternative. And it supposedly can reduce the severity of symptoms associated with PCOS.

I was floored by what was showing up, unedited, in the peer-reviewed literature about this medication. But not at all surprised with the announcement yesterday that this drug is potentially dangerous for people with heart conditions.

Repeatedly and consistently, researchers were reporting reactions. Some of the most common problems this medication seemed to incite, were anxiety, hypertension, and elevated heart rate.

If Meridia was a drug intended to treat cancer, or glaucoma, or hangnail, and it caused this battery of symptoms, I don't think the FDA would have tolerated consistent reports that it had the ability to send the cardiovascular system into a tailspin.

Yet, in the obese research subject, in the face of these observations, researchers continued to report some of the following conclusions:

**In a 21 patient study, 40% experienced sleep disturbances and 30% complained of irritability, unusual impatience, or"excitation".
RESEARCH CONCLUSION: Sibutramine, 5 and 20 mg, added to a multimodal program assisted participants in losing weight.
Weintraub M, Rubio A, Golik A, Byrne L, Scheinbaum ML. Sibutramine in weight control: a dose-ranging, efficacy study. Clin Pharmacol Ther. 1991 Sep;50(3):330-7.

**In a review study, the author reported,"In controlled studies, 84% of sibutramine-treated patients reported adverse events, compared with 71% of patients receiving placebo. The most frequently reported adverse events are related to pharmacological actions of sibutramine, and include dry mouth, decreased appetite, constipation and insomnia. Despite the high incidence of"side effects" in the control population, the author of this article attributed the problems in the tested population to"pharmacological actions of sibutramine".
Lean ME. Sibutramine--a review of clinical efficacy. Int J Obes Relat Metab Disord. 1997 Mar;21 Suppl 1:S30-6; discussion 37-9.

**In a study of 226 people comparing sibutramine to dexfenfluramine, researchers reported,"174 patients (77%) experienced adverse events; 17 patients withdrew due to adverse events. Pulse rate increased significantly in sibutramine-treated patients." Then they concluded,"Sibutramine (10 mg once daily) is at least as effective as dexfenfluramine (15 mg twice daily) in achieving weight loss in patients with obesity."
Hanotin C, Thomas F, Jones SP, Leutenegger E, Drouin P. A comparison of sibutramine and dexfenfluramine in the treatment of obesity. Obes Res. 1998 Jul;6(4):285-91.

**In a study of 235 people, the following was reported,"a significant increase in heart rate (about 4 beats/min) was noted for patients who received 10 mg or 15 mg sibutramine, compared with the placebo." Then it was concluded,"Doses of 10 mg and 15 mg once daily were shown to be similarly effective, well tolerated and significantly more effective than the placebo."
Hanotin C, Thomas F, Jones SP, Leutenegger E, Drouin P. Efficacy and tolerability of sibutramine in obese patients: a dose-ranging study. Int J Obes Relat Metab Disord. 1998 Jan;22(1):32-8.

**In a study of 11 men, it was observed that"the sibutramine-induced increase in energy expenditure was accompanied by an increase in plasma epinephrine, heart rate, blood pressure, and plasma glucose. The conclusion:"Sibutramine caused a significant increase in both energy expenditure and satiety, which may both contribute to its weight-reducing properties.
Hansen DL, Toubro S, Stock MJ, Macdonald IA, Astrup A. Thermogenic effects of sibutramine in humans. Am J Clin Nutr. 1998 Dec;68(6):1180-6.

As of 2006, I had found 14 studies reporting an elevated heart rate with use. You can easily find them yourself in http://www.ncbi.nlm.nih.gov/pubmed/; I encourage you to see for yourself. I've supported myself here with enough references and my Saturday has other obligations prohibiting me from using it to repeat work I've already done. I hope I've encouraged you to see for yourself what I've been talking about with colleagues for several years.

I like to call this the Biggest Loser Mentality. It doesn't matter if we make these people vomit, pull a muscle, or give them a bloody heart attack. This market of obese people is just too lucrative to ignore.

If you have PCOS and you are obese, you deserve better. You're not where you are because you have a deficiency of ANY kind of medication in your body. Don't let anyone convince you otherwise.

I was asked to clarify some comments I recently made about chia, as they were questioned for their accuracy. I'm all for revisiting and making sure my information is accurate, so here is my response.

First of all, while the information on this blog should be helpful to anyone regardless of whether or not they have PCOS, it IS targeted toward women who have this hormone imbalance. So some of the information I provide is more geared toward their specific nutritional needs and not the apparently healthy population. This should always be kept in mind when reading what I write.

One of the questions about my post was that I stated that taurine is an essential amino acid. There is actually some debate about this. Some experts say no, we can synthesize it. Others call it a conditional amino acid, meaning in some situations it may be essential.

Women with PCOS seem to have something going on in their brain and nervous systems that interferes with everything from mood and appetite regulation to speech and language function. (Simply read the responses to my question last week about the symptoms I listed and you will see what I mean.) Much of the dietary protocol we have developed is actually derived from epilepsy research at Johns Hopkins University, with the premise that calming nervous system excitability makes it easier for the brain and nervous system to function as they should when not under duress. Taurine is an amino acid showing promise as an anti-seizure compound, which makes me wonder whether or not a hyperexcitable brain blows through available taurine much more quickly than a brain that does not have to live under these conditions.

That being said, I am more comfortable with the premise that for the population for whom this blog is written, as well as anyone living with any kind of condition that places stress on the brain (migraines, epilepsy, OCD, anxiety disorder, bipolar disorder, PTSD, schizophrenia, etc.), taurine may actually be an essential amino acid. Research to support my claim still needs to be done, but I am more comfortable being conservative on this one, especially given the responses to last week's questionnaire and the severity of some of the diagnoses I just listed. Better to be safe than sorry.

Secondly, even if the amino acid profile of chia is complete, the total protein content of chia is relatively low. So if we're advocating for a 30% protein diet in a woman who is being advised to consume 1500 calories a day, she is going to need to consume about 113 grams of protein. That translates into your needing, at this protein level, to consume 700 grams of chia per day, just to get your protein needs. That is also 3,430 calories' worth of chia, more than twice your daily calorie needs. And while its amino acid profile is nearly complete, its nutritional profile is not. It contains no vitamin A, vitamin C, vitamin D, vitamin K, thiamine, riboflavin, niacin, vitamin B6, folate, or iron, to name a few.

From an omega-3 standpoint, I did invert the numbers. There is no consistent order by which omega-6 and omega-3 ratios are reported, and though I usually check to be sure I did not flip them, I did not this time. I do apologize for that.

According to http://www.nutritiondata.com/, chia seed contains an omega-6 to omega-3 ratio of 3.03, which is actually quite good.

The caveat is that the omega-3 this food contains is alpha-linolenic acid (ALA), not EPA or DHA. Most omega-3 experts will contend that in the most perfect of conditions conversion of ALA to DHA is at best 5%. Again, the women this blog serves seem to need a much higher level of DHA than average for a variety of reasons. We find that they seem to do best on 1000 mg DHA daily, the level recommended by Dr. Artemis Simopolous for treating depression. Calculated out, if you are depending on chia seed to get all of your omega-3 fatty acids, from ALA through EPA and DHA, you're going to need to consume about 115 grams of chia seeds per day. Just be forewarned.

Bottom line, I actually think chia is a healthy food--as part of a varied diet. I especially think that for vegans reading this blog it can be a great addition to your diet. However, I do not believe in superfoods. There seems to be a trend toward wanting to find one perfect food that has it all. I have yet to find it. It's understandable when we're surrounded by a lot of confusing information and we live in a culture where over 10,000 new products hit the grocery shelves each year (I saw half of them in Anaheim last month and it was overwhelming!) that we'd want to have just a few foods and a small nutritional comfort zone. Unfortunately that is not really how human nutrition works.

This is an especially important philosophy to stick to on this blog, given the fact that we're learning that a very high percentage of the women we're helping have some kind of history of"veganism gone wrong"…in other words, overzealous veganism with a focus on eliminating foods rather than on learning how to eat to be nutritionally complete with no animal products on the menu. We discourage fanaticism and encourage food curiosity and variety!

We were designed to be omnivores and to eat a variety of foods from a variety of sources. I encourage you, rather than arguing for why you should narrow your choices down to feel more comfortable around food, to learn to negotiate a wider variety of foods you are willing to include in your diet.

Gaby AR. Natural approaches to epilepsy. Altern Med Rev. 2007 Mar;12(1):9-24.

It never fails, I teach a PCOS class and walk away learning something new that challenges me to learn more about the syndrome.

This past week in Vermont, more than one woman in the class asked me why they experience so much physical pain after exercise.

I'd never heard that complaint before, but it made sense. With regards to a simple concept that can come into play for a couple of reasons.

The concept: When your body and diet's omega-6 content is high compared to its omega-3 content, one of the things that can happen is that your nervous system registers incoming stress at lower real levels of stress. And when it's there the way the nervous system registers that stress is more profound than it would be in a woman without PCOS. And…women with PCOS seem to already be programmed to have hypersensitive nervous systems.

Simply put, there's a double exercise whammy. Imagine you and your BFF, non-PCOS friend, are next to each other at the gym, both on elliptical trainers, set at the same intensity, same exercise duration, same data entered into the machine. You, with your PCOS, are likely to feel more stressed, more winded, and to experience a higher heart rate than your friend. Even if you've been training longer and are logically/theoretically in better shape than your friend.

What that means, is that you likely leave your aerobic/cardio intensity zone at a lower intensity of exercise than your friend, and enter the carb burning range, also meaning:
--you're not burning as much fat
--you're feeling more winded
--over time, you're bulking up more than you're burning fat.

When you burn a lot of carbohydrates with exercise, you create a lot of lactic acid, which can result in muscle soreness.

I proposed to the women in the class that for the rest of the week, they be sure to keep their exercise in the target heart rate zone. They did report that this level of exercise was lower than what they had been pursuing prior to our discussion, and that at this level of exercise they did not experience the soreness.

If we're on to something, there are some really important things to remember about exercise with PCOS.
1. Don't succumb to the"more is better" mentality! It may end up, because of the pain, making exercise so painful, you will develop a negative association with it. Don't let anyone who is not studying PCOS tell you that you need to work out harder. Listen to your body, and your target heart rate.
2. Drink plenty of water after you're finished. It does help to flush out any lactic acid you've accumulated, giving it less of an opportunity to hang around and cause pain.

Another likely consequence of this scenario is that because you're not burning fat, and you've used a lot of your muscle's carbohydrate stores, you are more likely to crave carbohydrates with exercise. So if exercise seems to be intensifying your cravings instead of tempering them…it could be a sign you're pushing yourself too hard. Women with PCOS often do that because they have been conditioned to believe they're not working hard enough at being healthy. Au contraire, they're often times working too hard at it…so hard the body fights back!

To calculate your THR:
1. Subtract your current age in years from 220.
2. Multipy this number by 0.65 and 0.8. The two numbers you get are the range between where your heart rate should be stabilizing during your exercise. If it's higher, dial it back…if it's lower, step it up.

Now go have some fun at the gym, in the yard, on the tennis court, wherever you enjoy moving!

It was 1975, and my father had a powder blue polyester double-knit “leisure suit,” a weight-loss plan disguised as a plan to single-handedly re-roof our house, and a keen interest in alternative nutrition and well-being. The latter took the form of upside-down eating, in which we had our smallest meal at dinner and our largest meal at breakfast. My friends thought it was very strange that we ate steaks and pork chops for breakfast, along with huge salads.

We were also eating texturized soy protein, roughly ground grains made into coarse earthy breads, spoonfuls of lecithin, mung bean sprouts, and a whole lot of strange things that you could only get out of the bulk food barrels at Elliot’s Natural Foods. We had a copy of “The Whole Earth Catalog” on the coffee table, and there was also a well-worn copy of my dad’s new bible, Adelle Davis’ “Let’s Eat Right to Get Fit.” There was some new thinking going on in this middle-aged straight-laced German guy, and I was curious about it. Extremely curious. I read the books, and ate whatever weird stuff I was supposed to be eating.

Things got even more curious when my father signed the entire family up to learn Transcendental Meditation (TM), which was developed by the Mahareshi Mahesh Yogi in the 1950s. Although it started elsewhere, by the 1970s, it had penetrated as far as “The Big Tomato,” my hometown of Sacramento, California. He went to a couple of introductory lectures, and the next thing we knew, all five of us were learning TM! It sure seemed exotic at the time, but it’s a technique I have practiced off on and on for over three decades. It’s so simple, I find it the easiest place to return to when I’m most stressed.

TM is a mantra-based meditation technique that has been scientifically validated for stress reduction, blood pressure reduction and, most recently management of the symptoms of Post Traumatic Stress in veterans. The National Institute of Health has spent in excess of $20 million validating the benefits of TM. It increases mental clarity, creativity, and overall health, and decreases stress by decreasing the activation of the sympathetic nervous system. When the sympathetic nervous system’s activity decreases, so do adrenaline, noradrenaline, and cortisol levels. Therefore, it is quite effective for stabilizing mood and even controlling appetite, because your appetite tends to go out of control when you’re feeling stressed.

Technically, it must be taught through an authorized trainer (see www.tm.org), but a great deal of introductory information can be gleaned online. I’ve written previously here about the benefits of meditation, and I’d love to introduce you to this technique.

Simply sit quietly and comfortably. This is essential to all forms of meditation. The mantra would be assigned by your teacher, but you can choose a syllable or sound with no inherent meaning (other forms of meditation might focus on a word with a meaning, such as “love” or “peace.”). The act of focusing on the mantra draws your mind out of its normal state of anxiety, chatter, and activity. If your mind drifts, return your attention to the mantra gently and repeatedly, for a period of 20 minutes per day. Results have been verified with as little as eight weeks of consistent daily practice. Optimally, practicing twice a day for twenty minutes each time is the goal, but benefits can be derived from as little as five minutes a day.

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

References:
Dillbeck M.C. and Orme-Johnson D. W. Physiological differences between Transcendental Meditation and rest. American Psychologist 42:879–881, 1987.
Jevning R., et al. The physiology of meditation: a review. A wakeful hypometabolic integrated response. Neuroscience & Biobehavioral Reviews 16(3):415-24, 1992.
Orme-Johnson D.W. and Walton K. W. All approaches of preventing or reversing effects of stress are not the same. American Journal of Health Promotion 12:297-299, 1998.

Most of you know that your PCOS is an inflammatory disorder. But if someone asked you what that meant, would you be able to explain it? I've found that it's a pretty meaningless and misleading term to most people. So I like to use a visual. This visual has had such a profound impact on some of my clients that they've printed it out and they hang it on their computers or other prominent place to graphically remind them of the importance of making proactive choices.

Inflammation is a misleading term because most people, when they hear it, tend to think of swelling, as you might experience if you sprain your ankle. In the case of inflammatory disease, it's really more oxidation that we're talking about. (Hence the focus on antioxidants by the supplement industry).

But even then…what is oxidation? It is the metabolic effect of oxygen being broken down. Outside of your body, the easiest illustration I've come up with is rust. When metal reacts with oxygen, and an oxidative process occurs, rust is the result.

It's no different in your body. An inflammatory, or oxidative process, is essentially the rusting out and deterioration of your tissues. It happens when the balance between processes that oxidize outweigh those that do repair work.

One of the most important places where this oxidation has effect is in your brain and nervous system. Oxidative processes are known to destroy neurons! For example, depression, another inflammatory disorder and one which commonly co-exists with PCOS, is known to destroy neurons in the hippocampus, the brain's memory center. And as many of you know, loss of memory, concentration…brain fog…are common side effects of PCOS.

Take a look at this photo. If the balance in your own body is tipped toward inflammation, it's literally like your brain and nervous system are rusting out. Yes, this is your brain on inflammation.

Your job is to reverse that process.

And it can be reversed! Studies also show that the hippocampus rebuilds those lost neurons as an indication of resolving depression.

What to do?

1. Remember that the substance that the brain needs in order to rebuild neurons is DHA. It's not sugar, it's not flax, it's not a vitamin or mineral. It's DHA, the fish oil that is found in fish and marine algae. Dr. Artemis Simopolous, omega-3 expert, has written that treating depression with DHA requires a dose of about 1000 mg per day. That is about 4 times what is recommended on the bottles of most supplements, and eating fish a few times a week is far below that. If you really want to experience the benefits of omega-3's, you likely need to up your dose.

2. You need to remember to take your fish oil! I know, it sounds funny, that in order to improve your memory you need to remember to use the thing that improves your memory…but that's one of the biggest barriers I've seen to PCOS success…consistency. If you cannot put your fish oil next to your milk in the refrigerator, or remember to take it when brushing your teeth, program your computer or smart phone to remind you to do so. I cannot reinforce the importance of consistency.

3. Slow down the rusting out process. Anything that raises metabolism, speeds up the rusting out process. That means extra stress. Sleep deprivation. Diet excesses. Dietary deficiencies. Too much exercise.

4. Eat a variety of foods from a variety of food groups. There are so many antioxidants available to you, none of them is the be-all-end-all…you need to mix it up so you get the most opportunity to benefit from the entire palette.

My hope is that now that you've seen what inflammation is, you will understand why it is so important to take action and do the repair work, then rust-proof yourself against further damage.

We just received a question about carbohydrates, how much is enough, and how much is too little.

Personally, I like to aim for about 30% of calories as carbohydrates, with as many as possible being whole grains, vegetables, and whole fruits. Remember, the brain and nervous system run primarly on carbs and you can't completely eliminate them.

Doing the math, the amount of carbohydrates corresponding to common calorie levels are as follows:

Calories Grams of carbohydrate
1500 113
1600 120
1700 128
1800 135
1900 143
2000 150

BTW, just how important is your brain in the big scheme of metabolism?
--A pound of fat burns 2 calories per day.
--A pound of muscle burns 6 calories per day.
--A pound of brain/nervous system tissue burns 109 calories per day!

Could be that this explains why we always want to eat when we're stressed…it's ramping up the metabolism.

Manage the stress, manage the appetite, lessen the carbohydrate need.

It's not uncommon to read blog posts, tweets, and chat room conversations in which women with PCOS describe their depression, and attribute it to the weight gain and appearance that their PCOS has promoted. It can be easy to blame the discomfort, fatigue, restless, and anxiety that depression provokes, on tangible and unwanted physical changes

A recent study helps to verify what I've believed all along…that depression, like hirsutism, weight gain, and infertility, is another condition that PCOS has potential to create. It is not the result of other symptoms associated with PCOS.

Here's the study.

Thirty women with PCOS and thirty women without PCOS participated in this study. All subjects had similar BMI's/weights. Only women who were not on any psychotropic medication were included. Women with PCOS scored higher on an anxiety scale than women without PCOS. They also slept less, worried more, and experienced more phobias than women without PCOS. Weight was not associated with any of the symptoms, except for sleep.

In other words, regardless of your weight, you can be depressed if you have PCOS.

If you attach or blame your depression on your weight, your appearance, or your infertility:

--you can set yourself up for an eating disorder…if you actually lose weight and discover it didn't change how you feel.
--you can feel even worse if you spend time and money on cosmetic surgery, only to realize you don't feel as good as you hoped you would.
--you can put yourself through the tremendous stress of infertility treatment, and get the baby, only to discover that you still feel depressed, and now you've got a baby who isn't sleeping through the night who is dependent on you.

That's the bad news. The good news is that the inCYST program is very helpful at reducing anxiety and depression. So in addition to helping you normalize your weight, reducing the progression of testosterone-related programs, and increasing your fertility, it helps you to feel better. It literally rebuilds your nervous system so it can reduce the influence depression can have. And in rebuilding the nervous system, it helps to balance hormones so that symptoms can lessen.

We like to focus on feeling better, since we know that in women who do, the other problems tend to fall into place. That's not to say that being anxious about your PCOS doesn't worsen when you focus on your symptoms, and that when you learn better coping skills you won't feel even better. Gretchen Kubacky has done a great job of discussing that here, on her blog, and on PCOS Challenge.

It's just that you want to be sure you're tackling the core cause of the problem, and not simply putting band-aids on the symptoms. Nothing can be more frustrating than investing all your time, resources, and money into diets and medical procedures, only to feel the same or even worse once you've done so.

Anxiety and depression symptoms in women with polycystic ovary syndrome compared with controls matched for body mass index

REFERENCE
E. Jedel1, M. Waern2, D. Gustafson2,3, M. Landén4, E. Eriksson5, G. Holm6, L. Nilsson7, A.-K. Lind7, P.O. Janson7 and E. Stener-Victorin8,9 Anxiety and depression symptoms in women with polycystic ovary syndrome compared with controls matched for body mass index

1 Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden 2 Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 3 Rush University Medical Center, Chicago, IL, USA 4 Department of Clinical Neuroscience, Section of Psychiatry, Karolinska Institutet, Stockholm, Sweden 5 Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 6 Department of Metabolism and Cardiovascular Disease, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 7 Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 8 Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 434, 40530 Gothenburg, Sweden

It came up in a Facebook conversation yesterday that a woman with PCOS had been prescribed Depakote (valproic acid) and her PCOS became worse.

It is important to know that this medication, commonly administered for the treatment of bipolar disorder and epilepsy, has actually been reported in several research studies to worsen laboratory values and symptoms of PCOS (see references below).

There is speculation that this is partially due to the fact that carnitine levels drop in the presence of Depakote.

The good news is, carnitine is available as an over the counter supplement, and research has suggested that taking acetyl-l-carnitine supplements while on valproic acid is beneficial to help minimize these side effects. The dose that has been reported/suggested is 4 grams per day.

Even though the research isn't as strong for other psych meds that have been correlated with weight gain, it's in my tool box to recommend to anyone who has noticed their symptoms worsen after starting medications in this category (psych and nervous system medications), to use the carnitine supplements.

I have written in other places that I believe it should be standard protocol when prescribing Depakote, to also prescribe carnitine. I hope, at least in practices where women with PCOS are part of the specialty, that this can become part of the treatment plan. It's an easy tool with a lot of potential.

Popovic V, Spremovic S. The effect of sodium valproate on luteinizing hormone secretion in women with polycystic ovary disease. J Endocrinol Invest. 1995 Feb;18(2):104-8.

Stephen LJ, Kwan P, Shapiro D, Dominiczak M, Brodie MJ. Hormone profiles in young adults with epilepsy treated with sodium valproate or lamotrigine monotherapy. Epilepsia. 2001 Aug;42(8):1002-6.

Luef G, Abraham I, Trinka E, Alge A, Windisch J, Daxenbichler G, Unterberger I, Seppi K, Lechleitner M, Krämer G, Bauer G. Hyperandrogenism, postprandial hyperinsulinism and the risk of PCOS in a cross sectional study of women with epilepsy treated with valproate. Epilepsy Res. 2002 Jan;48(1-2):91-102.

McIntyre RS, Mancini DA, McCann S, Srinivasan J, Kennedy SH. Valproate, bipolar disorder and polycystic ovarian syndrome. Bipolar Disord. 2003 Feb;5(1):28-35.

Ribacoba-Montero R, Martínez-Faedo C, Díaz-Díaz C, Salas-Puig J. [Remission of polycystic ovary syndrome associated with valproic acid in an epileptic female] [Article in Spanish] Rev Neurol. 2003 Apr 1-15;36(7):639-42.

Betts T, Yarrow H, Dutton N, Greenhill L, Rolfe T. A study of anticonvulsant medication on ovarian function in a group of women with epilepsy who have only ever taken one anticonvulsant compared with a group of women without epilepsy. Seizure. 2003 Sep;12(6):323-9.

Wood JR, Nelson-Degrave VL, Jansen E, McAllister JM, Mosselman S, Strauss JF 3rd. Valproate-induced alterations in human theca cell gene expression: clues to the association between valproate use and metabolic side effects. Physiol Genomics. 2005 Feb 10;20(3):233-43. Epub 2004 Dec 14.

Flück CE, Yaworsky DC, Miller WL. Effects of anticonvulsants on human p450c17 (17alpha-hydroxylase/17,20 lyase) and 3beta-hydroxysteroid dehydrogenase type 2. Epilepsia. 2005 Mar;46(3):444-8

Rasgon NL, Altshuler LL, Fairbanks L, Elman S, Bitran J, Labarca R, Saad M, Kupka R, Nolen WA, Frye MA, Suppes T, McElroy SL, Keck PE Jr, Leverich G, Grunze H, Walden J, Post R, Mintz J. Reproductive function and risk for PCOS in women treated for bipolar disorder. Bipolar Disord. 2005 Jun;7(3):246-59.

Morris GL 3rd, Vanderkolk C. Human sexuality, sex hormones, and epilepsy. Epilepsy Behav. 2005 Dec;7 Suppl 2:S22-8. Epub 2005 Oct 20.

Joffe H, Cohen LS, Suppes T, McLaughlin WL, Lavori P, Adams JM, Hwang CH, Hall JE, Sachs GS. Valproate is associated with new-onset oligoamenorrhea with hyperandrogenism in women with bipolar disorder. Biol Psychiatry. 2006 Jun 1;59(11):1078-86. Epub 2006 Jan 31.

Joffe H, Cohen LS, Suppes T, Hwang CH, Molay F, Adams JM, Sachs GS, Hall JE. Longitudinal follow-up of reproductive and metabolic features of valproate-associated polycystic ovarian syndrome features: A preliminary report. Biol Psychiatry. 2006 Dec 15;60(12):1378-81. Epub 2006 Sep 1.

Prabhakar S, Sahota P, Kharbanda PS, Siali R, Jain V, Lal V, Khurana D. Sodium valproate, hyperandrogenism and altered ovarian function in Indian women with epilepsy: a prospective study. Epilepsia. 2007 Jul;48(7):1371-7. Epub 2007 Apr 18.

Reynolds MF, Sisk EC, Rasgon NL. Valproate and neuroendocrine changes in relation to women treated for epilepsy and bipolar disorder: a review. Curr Med Chem. 2007;14(26):2799-812.

Morrell MJ, Hayes FJ, Sluss PM, Adams JM, Bhatt M, Ozkara C, Warnock CR, Isojärvi J. Hyperandrogenism, ovulatory dysfunction, and polycystic ovary syndrome with valproate versus lamotrigine. Ann Neurol. 2008 Aug;64(2):200-11.

Bilo L, Meo R. Polycystic ovary syndrome in women using valproate: a review. Gynecol Endocrinol. 2008 Oct;24(10):562-70.

Gorkemli H, Genc BO, Dogan EA, Genc E, Ozdemir S. Long-term effects of valproic acid on reproductive endocrine functions in Turkish women with epilepsy. Gynecol Obstet Invest. 2009;67(4):223-7. Epub 2009 Feb 24.

It's a quiet day around here, and I am cleaning up papers. I found a chart I prepared several years ago, in which I listed the commonly recognized symptoms of PCOS, and did literature searches to see how often these symptoms appeared in other medical diagnoses. The diagnoses that occurred most often were epilepsy, bipolar disorder, and anxiety disorder.

I don't really know what this means, except that maybe we're not always looking at the right places when we try to understand the syndrome. Maybe we're not correctly connecting the dots.

I sent this to a PCOS researcher who didn't seem very excited about the information at the time. I am not a researcher, and I will never have the laboratory that can do this research. So I am posting the information hoping that someone who can…will pick up where I left off and do some creative work on behalf of the women with PCOS.

One comment I WILL make, is that I don't entirely believe PCOS is caused by insulin resistance. It is a very
prevalent symptom, but correlation does not always equal causation. I don't think we would say that insulin resistance causes epilepsy or bipolar disorder. I do wonder what function insulin resistance plays in an imbalanced system, as the body wouldn't have that mechanism if it didn't have a need for it.

I know, I know, I'm stepping away from conventional wisdom on this one. I just think we need to think outside a much bigger box for the most profound answers to the PCOS mystery.

I wonder sometimes if insulin resistance isn't a way for the body to shuttle glucose to a brain and nervous system that are overstressed, since that system is so dependent on glucose for fuel.

The letters after each symptom denote which of (E) pilepsy, (B) ipolar disorder, and (A) nxiety disorder has been reported in peer-reviewed research to be associated with that particular symptom.

Acne E, B

Infertility E, B

Irregular periods E, B, A

Decreased sex drive E, B

Obesity/rapid weight gain/difficulty losing weight E, B, A

Acanthosis nigricans E

Male pattern baldness/alopecia E, B, A

Hirsutism E

Binge eating E, B, A

Intense cravings for sweets E, B, A

Anxiety E, B

Insulin resistance E, B

Something I am committed to with this work is making sure that every mother out there who plans to get pregnant or who is pregnant understands, is that they need marine oils in their diet. I don't care if you get them from algae, I don't care if you get them from fish…I care that you get them.

We've gone so overboard in steering women away from fish that we're creating more problems than we're solving.

Our brains and nervous systems are in large part made of marine oils. When pregnant, especially in the final trimester, a significant percentage of those oils are given to our developing babies. That is the time during pregnancy when the brain and nervous system develop. In one study, between the 28th week and delivery, blood DHA levels were measured and found to decrease. It didn't matter if the baby was born prematurely, to term, or late, the trend persisted. It happened even in women who were eating what they considered to be a lot of fish.

It bothers me greatly that a population that may actually need to be supplemented with fish…is encouraged to stay away from the very nutrient they need larger quantities of. And then we wonder why problems such as autism are epidemic.

I am hoping that the pregnant and future pregnant readers of this blog use this information to their benefit, and share it with anyone who could use it. We just aren't making sense with our recommendations when it comes to this crucial nutrient.

Bonham MP, Duffy EM, Wallace JM, Robson PJ, Myers GJ, Davidson PW, Clarkson TW, Shamlaye CF, Strain JJ. Habitual fish consumption does not prevent a decrease in LCPUFA status in pregnant women (the Seychelles Child Development Nutrition Study). Prostaglandins Leukot Essent Fatty Acids. 2008 Jun;78(6):343-350. Epub 2008 Jun 26.

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.

Why is it that we have a need to wear on our sleeves how little we sleep, as if it's a badge of honor?

People who don't sleep are physically hurting themselves in ways that diet and exercise can't always repair.

The large and famous nurses' study showed that women working night shifts had a greater incidence of breast cancer than those working during the day.

Accumulating research is connecting poor sleep with weight gain, insulin resistance, and diabetes.

What is it about sleep that is so crucial?

Melatonin. It's our body's most powerful antioxidant. It literally acts like a scrubbing bubble when we sleep, scouring that inflammatory damage from a day's worth of living, thinking, and stressing, leaving the brain and nervous system clean and ready to go the next day.

When we cut ourselves short on sleep, we don't give melatonin a chance to do its job.

We age ourselves much more quickly than we do when sleep is something we prioritize.

First thing you need to do to change things, is change your attitude about sleep.

You are not a better person because you deprive yourself of it.

You can't make up for what you lost during the week, over the weekend. Once it's lost, it's lost.

You may not be able to overcome the damaging effects of too little sleep with better eating and more exercise. In fact, it may be harder to achieve this while sleep deprived, because you are more likely to accelerate aging even more with the caffeine and sugar you're using to get through the day.

Want to get your weight under control? Reduce your cancer risk? Improve your fertility?

Sleep. It's that simple.

Secondary infertility is the inability to conceive or carry a pregnancy to term after successfully and naturally conceiving one or more children.

Secondary infertility also appears to often be a condition with a significant nutritional cause…and a fairly easy solution.

A developing fetus has no way of obtaining the important omega-3 fatty acids, EPA and DHA, that it needs for adequate brain and nervous system development, except from its mother.

And what do we do to pregnant moms? We tell them to not eat the main source of these fatty acids, fish.

Even though the FDA warning limits their advised restrictions to four fish (shark, tilefish, king mackerel, and swordfish), studies have shown that women tend to limit ALL fish consumption while pregnant.

So as their firstborn develops, mom's omega-3 stores gradually dwindle. It's highly likely, given the stressful demands of new motherhood and the continued concern that fish may not be safe while nursing, that omega-3 intake continues to be inadequate.

And since fertility is dependent on adequate omega-3's as well, it makes sense that what it required to conceive and carry the first baby to term, may be exactly what's keeping baby #2 from happening.

We've been pretty successful at inCYST with this type of infertility. It's about getting over the fear of eating fish when you're pregnant.

At this point, pretty much every reputable fish oil on the market is molecularly distilled, meaning it's clean. Random tests of bottles of fish oil pulled off of pharmacy shelves rarely find mercury. Believe me, if they did, with the popularity of fish oil, it would be all over the news.

You can't just take fish oil and expect your problems to be solved. It is important to combine this with a healthy diet free of trans fats, low in inflammatory fats (safflower, sunflower, soybean, corn, cottonseed), and rich in antioxidants.

When you DO dose the fish oil, you'll need to take more than the recommended dose on the bottle; about 1000 mg DHA. You will need to calculate the number of capsules your favorite brand provides.

This issue is actually one of the things that inspired me to create the inCYST Network. When I saw what the fish fear was potentially doing to mother, child, and unborn children, I decided it was time to step up and speak out.

I hope you find this information helpful!

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."

We've all heard it--the stereotyped observation that obese people are lazy and stupid. People carrying more weight than the health charts have decided they should, are often discriminated against with regard to social popularity, salary, simple courtesy in retail stores. Weight and body image activists have tried to fight back with a"Health At Any Size" paradigm. Sometimes it seems as though it is taking hold. Most of the time it doesn't. If I didn't have a lot of compassion for people struggling with weight issues, I would not have devoted my career to nutrition, a specialty where these problems inevitably find themselves. That being said, there are characteristics of this population that can test my patience. When I find myself frustrated, I think about the"fat, lazy, and stupid" label that has stuck like glue and seems so impossible to change. Some of the situations I deal with consistently: 1. Lack of follow through on commitment to exercise. 2. Lack of follow through on keeping a diet diary. 3. Lack of follow through on scheduled appointments."Lazy" can be easy to replace those with, to the untrained eye. But I also see other things equally as frequently. 1. Extreme forgetfulness. One client was so forgetful he would forget he ate lunch and go fix himself a second, stopping only when he saw dishes in the sink to remind him he'd already eaten. 2. Pretty poor grammar and spelling. 3. Difficulty grasping concepts that are fairly easy for other audiences I teach to grasp. I have come to a place that lies halfway between Health at Any Size and Fat, Lazy, and Stupid. The behaviors are there, but I don't label them judgmentally. I view them as clinical symptoms. If you're having trouble remembering, spelling, adding, following instructions…you need to speak up. You need to let your caregivers know so they can start to associate neurocognitive issues with weight. You can't keep them to yourself because they are embarrassing. You're not stupid. Your nervous system is struggling. If you're too exhausted to exercise because you didn't sleep the night before, welcome to the club. A pretty high percentage of Americans are in the same boat. If your physician or personal trainer is so into their own physique that they can't hear that this is a problem for you…find another. A very high percentage of our clients discover that once they get the sleep corrected, they have all kinds of energy for exercise. Calling someone lazy and hoping to shame them into punishing themselves so you feel good about your reputation as a coach is not the answer. Fixing the sleep problem just might be. This was kind of a hard blog post to write. I am guessing some people got angry and quit reading before they got to this point because they are so adamant about their own viewpoint, or were so offended because they jumped to a conclusion that I was going to be condescending, they just checked out. If you didn't, and you're still with me, thank you. It is really hard to try and talk about these neurocognitive issues with a target audience who really just wants to lose weight or have a baby and doesn't want it to be any more complicated than that. Last Tuesday, the day I posted about brain oxidation, we lost a lot of Facebook fans. I may lose more with this post. That's ok. I want to find the real answer to the real problem with PCOS, not just tell you what you want to hear in the short term, leaving you set up for bigger problems awhile down the road. I can't wave a magic wand and make it all go away, but I can tell you I really want to know what is going on with you. We are putting a project together where members of our Institute will have an opportunity to share their symptoms in a collective database, so that we can look for relationships and correlations that may not be currently on research radars. If you're not part of the Institute, we do encourage you to share, honestly, with your caregivers, what is really going on. I believe we'll have a whole lot more success transitioning the"fat, lazy, stupid" stereoptype into a"hormone-imbalanced, exhausted, brain-fogged" clinical presentation, than we will in just making those horribly judgmental words go away. Besides, one way feels to me like it's just giving in and trying to believe you're healthy as you are. If that is truly how you felt, I'm guessing you wouldn't be sitting here on this blog. We look forward to working with you on unraveling this mystery and getting your life back on course.

I got my start in this specialty in a nontraditional fashion. Even though I did a lot of work in endocrinology initially, I gravitated into sports nutrition, and from there, eating disorders. I initially started my business thinking that it would be a resource center for eating disorders. But PCOS followed me. I kept getting phone calls from women looking for help with their eating disorder who mentioned they'd recently been diagnosed with PCOS. Thinking there must be some relationship, I started mentioning the symptoms of the syndrome at local mental health networking meetings. I started getting counseling referrals from eating disorder specialists--and they tended to be women who had initially been diagnosed with bulimia, put into traditional eating disorder treatment, and then a few years later,"relapsed". It was with this"relapse" that the PCOS was diagnosed.

I put that word into quotes, because you can only relapse from a disease you've been treated for…if the treatment you received is for the problem you have. The word blames the person for the diagnosis with the problem.

I have come to believe the problem may lie, in large part, with the caregivers. Eating disorder symptoms are primarily behavioral. There isn't a blood test you can administer, or an x-ray you can examine. And therefore, if you fit a certain criteria, you must have the disorder.

Just as diabetes won't respond to psychotherapy, PCOS, which in many cases is PREdiabetes, won't either.

The problem with PCOS is, the hormonal imbalances it renders can induce the very same behaviors that we use to diagnose eating disorders. Carbohydrate cravings are extreme. Hormones are so out of whack that the only thing that manages them, it seems, is extremes in diet and in activity. And God forbid, if no doctor caught on to your hormone problem and you decided to take things in your own hands…then you have control issues and you have an eating disorder.

What can make it especially challenging to diagnose PCOS, if it has progressed this far, is that the extremes in exercise and diet may, at least temporarily, suppress abnormal labs. It takes a skilled clinician to even see what's going on. I think back to my 3 1/2 years in an inpatient treatment center, and how many young women came to me complaining that as they started to refeed, they were craving carbohydrates. And because it was the treatment center's philosophy, I smiled back and told them all foods could fit.

A lot of eating disorder treatment is about the battle between the clinician, who wants his/her clients to believe that they can get back to eating everything in moderation, and the client wanting to tell the clinician that just isn't so, but playing the game as long as she needs to in order to graduate to the next level move toward discharge.

Last year I wrote to several hundred mental health practitioners who specialized in PCOS, introducing my company and the work I do with PCOS. I described the symptoms and explained to them what I just explained above. I received who knows how many polite responses, thanking me for my interest, but they worked with eating disorders, not PCOS, and there wasn't really a need for my information. I wondered how many thousands of women were sitting in therapy, being told if they just addressed their"issues"…they could beat the problem.

Don't get me wrong, I know there are plenty of issues in PCOS that psychotherapy can benefit. But there's a difference between anxiety over the prom and anxiety driven by excess cortisol levels resulting from a poorly balanced nervous system.

Sometimes I wonder if it's not the same diagnosis, being given a different name depending on the office in which it first shows up?

I sure hope at least some of those women have found my website on the Internet and have benefitted from the information I've learned and posted there since that tenure.