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Chromium is a commonly used (or at least recommended) supplement in PCOS. What is it, why is it recommended, and should you be taking it?

Chromium is a metal, just like iron and copper. It's not really needed in large amounts to do its job, which in the body, is to help metabolize sugar and fats.

Some researchers have suggested that chromium supplementation in PCOS can help insulin function. There are two articles in the National Library of Medicine database looking specifically at the use of chromium supplementation in PCOS. One study, using a dose of 200 mcg per day, resulted in improved glucose tolerance but not fertility. The second study bumped the dose up to 1000 micrograms per day, resulting in a 38% better ability to remove glucose from the blood.

BEFORE YOU RUSH OUT AND BUY A YEAR'S SUPPLY…

There are more than a few articles in the very same database connecting chromium picolinate to DNA damage. The earliest one, for someone writing so much about infertility, really caught my eye, as it was entitled, "Chromium(III) picolinate produces chromosome damage in Chinese hamster ovary cells." Another study reported that offspring of pregnant mice who were given chromium picolinate had an increased incidence of skeletal defects.

In the United States, dietary chromium recommendations have actually been LOWERED.

Because this is such a popular supplement recommendation and I'm sure at least some readers will question this, I've put all the references I found at the bottom of this post.

What I did notice was that over time, articles started to appear that countered this finding. I'm not sure if that means that earlier studies were wrong, if study design was manipulated to generate a different outcome, or if nutrition scientists are still trying to figure out how chromium works in the body.

What I know is, there were enough reports of potential toxicity to cause concern, and I do my best not to make recommendations that future research might force me to backpedal on. The entire model of PCOS intervention promoted by inCYST is about preventing oxidative stress and its associated damage. Chromium picolinate was referred to as an oxidative stress agent in more than one of the cited references, so to encourage readers to supplement with it seemed counterproductive.

WHAT TO DO?

First of all, understand what it is that chromium does. The clue lies in the fourth sentence of this post, in which I mentioned that chromium is needed to metabolize sugar and fats. If you're eating less sugar and fat, you need less chromium! So…perhaps one very important thing you can do is create less of a need for chromium by working to reduce your sugar and fat intake. We've talked a lot about strategies for reducing sugar cravings and binge eating, which could be two of your most important chromium-balance strategies.

Know your dietary sources. What you CAN do about the deficiency that previous dietary choices may have created, is to be savvy about what foods naturally contain trace amounts of chromium. These include brewer's yeast, whole grains, liver, bran cereals, potatoes, romaine lettuce, onions, and tomatoes.

Skip the refined foods Part of the reason we may have so much trouble getting chromium in the diet is our love of processed foods. It's especially problematic when we eat a food (such as bread) that is eventually going to require chromium to be metabolized, that has had the chromium processed right out of it.

It's kind of like if your car is running inefficiently. It's blowing through gasoline at a rapid rate. You can keep the car running by putting more and more gasoline in it, or you can get a tuneup to increase your fuel efficiency. Both will work, but one is more likely to cause long term problems.

Lucidi RS, Thyer AC, Easton CA, Holden AE, Schenken RS, Brzyski RG. Effect of chromium supplementation on insulin resistance and ovarian and menstrual cyclicity in women with polycystic ovary syndrome. Fertil Steril. 2005 Dec;84(6):1755-7.

Stearns DM, Wise JP Sr, Patierno SR, Wetterhahn KE. Chromium(III) picolinate produces chromosome damage in Chinese hamster ovary cells. FASEB J. 1995 Dec;9(15):1643-8.

Stearns DM, Belbruno JJ, Wetterhahn KE. A prediction of chromium(III) accumulation in humans from chromium dietary supplements. FASEB J. 1995 Dec;9(15):1650-7. Review.

Bagchi D, Bagchi M, Balmoori J, Ye X, Stohs SJ. Comparative induction of oxidative stress in cultured J774A.1 macrophage cells by chromium picolinate and chromium nicotinate. Eur J Epidemiol. 1998 Sep;14(6):621-6.

Kato I, Vogelman JH, Dilman V, Karkoszka J, Frenkel K, Durr NP, Orentreich N, Toniolo P. Effect of supplementation with chromium picolinate on antibody titers to 5-hydroxymethyl uracil. Chem Res Toxicol. 1999 Jun;12(6):483-7.

Speetjens JK, Collins RA, Vincent JB, Woski SA. The nutritional supplement chromium(III) tris(picolinate) cleaves DNA. Mol Cell Biochem. 2001 Jun;222(1-2):149-58.

Bagchi D, Bagchi M, Stohs SJ. Chromium (VI)-induced oxidative stress, apoptotic cell death and modulation of p53 tumor suppressor gene. Mutat Res. 2002 Jan 15;513(1-2):135-42.

Vincent JB. The potential value and toxicity of chromium picolinate as a nutritional supplement, weight loss agent and muscle development agent. Sports Med. 2003;33(3):213-30.

Bailey MM, Boohaker JG, Sawyer RD, Behling JE, Rasco JF, Jernigan JJ, Hood RD, Vincent JB. Exposure of pregnant mice to chromium picolinate results in skeletal defects in their offspring. Birth Defects Res B Dev Reprod Toxicol. 2006 Jun;77(3):244-9.

Stallings DM, Hepburn DD, Hannah M, Vincent JB, O'Donnell J. Nutritional supplement chromium picolinate generates chromosomal aberrations and impedes progeny development in Drosophila melanogaster. Mutat Res. 2006 Nov 7;610(1-2):101-13.
Kim M, Lim JH, Ahn CS, Park K, Kim GT, Kim WT, Pai HS. Mitochondria-associated hexokinases play a role in the control of programmed cell death in Nicotiana benthamiana. Plant Cell. 2006 Sep;18(9):2341-55.

Andersson MA, Petersson Grawé KV, Karlsson OM, Abramsson-Zetterberg LA, Hellman BE.
Evaluation of the potential genotoxicity of chromium picolinate in mammalian cells in vivo and in vitro. Food Chem Toxicol. 2007 Jul;45(7):1097-106.

Hininger I, Benaraba R, Osman M, Faure H, Marie Roussel A, Anderson RA. Safety of trivalent chromium complexes: no evidence for DNA damage in human HaCaT keratinocytes. Free Radic Biol Med. 2007 Jun 15;42(12):1759-65.

Bailey MM, Sturdivant J, Jernigan PL, Townsend MB, Bushman J, Ankareddi I, Rasco JF, Hood RD, Vincent JB. Comparison of the potential for developmental toxicity of prenatal exposure to two dietary chromium supplements, chromium picolinate and [Cr3O(O2CCH2CH3)(6(H2O)3]+, in mice. Birth Defects Res B Dev Reprod Toxicol. 2008 Feb;83(1):27-31.
Komorowski JR, Greenberg D, Juturu V. Chromium picolinate does not produce chromosome damage. Toxicol In Vitro. 2008 Apr;22(3):819-26.

Komorowski JR, Greenberg D, Juturu V. Chromium picolinate does not produce chromosome damage. Toxicol In Vitro. 2008 Apr;22(3):819-26.

Tan GY, Zheng SS, Zhang MH, Feng JH, Xie P, Bi JM. Study of oxidative damage in growing-finishing pigs with continuous excess dietary chromium picolinate intake. Biol Trace Elem Res. 2008 Winter;126(1-3):129-40.

Tan GY, Bi JM, Zhang MH, Feng JH, Xie P, Zheng SS. Effects of chromium picolinate on oxidative damage in primary piglet hepatocytes. Biol Trace Elem Res. 2008 Dec;126 Suppl 1:S69-79.

As a skin care therapist I would often be the first one to recognize a serious hormonal imbalance based on the acne that a client might be struggling with. As nutritionist it’s clear that it’s an “inside-out” problem.

Women with PCOS often have elevated levels of free-testosterone, which is one of the markers of PCOS. When the body breaks down the testosterone, one of the by-products that can occur is DHT (Dihydrotestosterone). There are areas on our bodies that are particularly sensitive to the signals from DHT which are the face, neck, chest and back. The message is “make more oil!”.

We do need some oil on the skin in order to keep it protected and supple, but when it goes on overdrive, it literally backs up in the pore. The oil (sebum) we produce is very sticky so it doesn’t allow the dead skin cells to exfoliate easily so it becomes like have a tight lid on a pressure cooker.

The naturally occurring bacteria on the skin, along with dead skin cells and the oil end up creating a pretty nasty “stew” resulting in reddened, painful and pustular acne. If this material cannot get out of the skin, it can break the pore wall underneath the skin causing more acne (you might notice a little “family” of breakouts that always groups together). Most people, (men get it too for the same reason), focus only on trying to treat the skin externally — but the goal is to get the body back in balance.

Some basic strategies are as follows:

1. Try to eat organic and hormone free as much as possible, especially when it comes to dairy products. The hormones that the cows receive to keep them lactating as long as possible go right into the milk and it’s by-products (cheese, ice-cream etc.) which go right into you — creating a further hormonal imbalance.

2. Stress is a huge trigger for increasing DHT — it is critical to create your own menu of"stress-busters" that can be used throughout the day and work for you! A simple one is to just stop for one to two minutes and do deep breathing. This short-circuits the stress hormone release response.

3. Acne in all forms is primarily an inflammatory disease. Fish oils, which are also beneficial for neurotransmitter balance, do double duty since they help tremendously with inflammation.

4. Eat inflammation quenching foods, rich in antioxidants — fruits and vegetables. Remember when fried foods were believed to cause acne? They may not do it directly, but indirectly they are highly inflammatory.

5. Getting hormones especially your estrogen to testosterone ratio back in balance is the key to getting to the source of the problem. Work closely with your In-Cyst trained expert toward this goal.

Next blog I’ll share information on strategies for dealing with the skin from the outside in.

Carmina McGee, MS, RD, LE
Registered Dietitian/ Licensed Esthetician
805.816-1629 / Ventura, California
www.CarminaMcGee.com
Carmina@CarminaMcGee.com

If you follow our radio show, you know we recently interviewed Stacy Citron, participant in Bravo's television show, Thintervention.

In the process of working with Stacy, I had the opportunity to become acquainted with Craig Ramsay, one of the trainers she worked with on the show. We sat down recently in Los Angeles and chatted about Stacy's PCOS, and PCOS in general. I left our brief meeting realizing PCOS had a genuine and enthusiastic ally in Craig, and we've become friends in past months.

I'll be interviewing Craig on Monday, November 15, at noon Eastern time. Please join us live or download the recorded version later at www.blogtalkradio.com/incystforhormones

In the meantime, I asked Craig to answer a few questions to help our audience get acquainted with him.

I'm so looking forward to Monday!

1. What did you know about PCOS before you began your work with Stacy?

My only knowledge of PCOS prior to working with Stacy on Thintervention was from my Broadway co-worker/friend Haviland Stillwell. Her journey with it was private. (My note: Haviland has since spoken publicly about her PCOS; her interview is in our show's archives.) All I knew of the disease was that it affects a woman's hormone levels and fertility.

2. As a trainer, what was the most challenging aspect of working with someone with PCOS?

As a trainer working on a time crunch of a fitness show, and the added responsibilities of 7 other clients, I found working with someone with PCOS was very time consuming. Not because that person is difficult, but because I had to take a great deal of time to learn about the condition for myself. Stacy knew little of the disease, so tackling it together was the hardest part, as well as getting our questions answered.
3. You have expressed a strong interest in reaching out to women with PCOS. What is it about the syndrome that has inspired you?

My mother has Fibromyalgia. I have a sensitivity to her, and other women, who struggle with such health obstacles that get in their way of feeling and looking their best. Like Fibromyalgia, PCOS sufferers have a difficult time getting answers and respect from Doctors. It frustrates me that the medical field hasn't spent more time discovering answers to their vital questions.

I have experience working with many women that have gained control of their PCOS, and with great success!

I'm thrilled to share my experiences to help others.
4. Have you developed any different strategies for working with future PCOS clients?

I advise my PCOS women to start with their diet. Get control over their sugar levels, introduce a high protein diet, and make sure they are eating the proper foods and eating at the proper times. This will improve their energy levels, sleep and therefore their ability to properly workout to intensity.

This is the place I start with all my PSOC women.
5. Do you have any words of encouragement for frustrated women watching your series who can relate to Stacy's journey?

Frustrated women watching at home please know that you are not alone. What used to work for you"back in the day" will not work anymore. The answers are out there, don't compare yourself with others, make it your own journey.

OK! We've cruised past the candy corn…mastered the Thanksgiving pie…what is it about these nasty carbohydrate cravings that make it so darn hard to keep a respectful distance from all of these holiday sweets?!?!?

You may not be imagining things. And you may not be a nutrition wimp. Your body chemistry actually changes with the seasons.

Did you know, for example, cholesterol is actually higher on average midwinter than it is midsummer? Yup, so if you have your annual physical midwinter, get a high reading, and go on medications, the drop in your followup may not be entirely due to medication. It's just how nature does things.

One of the toughest seasonal changes is mood. Back in the days when we were more exposed to the elements, it probably made sense to want to be more sluggish and a little heavier. No need to waste body heat on exercise when we need it for warmth. And a little extra fat for insulation was more than welcome.

Nowadays, we prefer to have our weight be as stable as possible, and this time of year it can be hard to achieve that. About 20% of the population (and 4 times more women than men) experience such a radical shift in mood, hormones, and biochemistry, that they qualify for an official diagnosis of seasonal affective disorder (SAD). Symptoms include: tiredness, depression, crying spells, irritability, trouble concentrating, physical aches, decreased sex drive, trouble sleeping, less desire to be physically active, increased appetite (especially for carbohydrates), and weight gain.

I'm guessing that a pretty high percentage of the audience reading this is thinking,"But this is how I feel all the time!". If you have PCOS, that may be true, but it may become more intense…progressing to out of control…in the dark of winter. Here are some strategies to try to help you get through the winter solstice. Remember, from December 22 on…it's all uphill!

1. Check your vitamin D levels. Low vitamin D may be part of the problem. If it is, be sure to supplement.

2. Do your best to get outside. It's hard with short days and cold temperatures, but even a few minutes a day can make a difference. Even on a cloudy day! Ultraviolet rays are present even with cloud cover. Take advantage of them.

3. Consider phototherapy. I have recommended light devices for clients living in places like Seattle and Alaska, and they can work wonders. All they do is bring sunshine indoors. Working, studying, or reading the mail in the presence of one on a regular basis can help to promote a biochemistry similar to what you naturally experience in the summer.

4. If your SAD progresses to where the symptoms are incapacitating or dangerous, antidepressant therapy has also been found to be helpful. Ask your physician for a discussion about your options.

5. Of course, you know I'm going to say this…prioritize diet. Take advantage of comfort foody crockpot meals like chili, and lentil soup, to help keep your blood glucose stable. Don't forget the protein. It's easy to forget about protein in the mountain of Christmas candy and cookies we're about to tread through, but a little packet of Justin's Nut Butter or string cheese stashed in your purse or briefcase can work wonders for staving off those carbohydrate demons.

6. Don't panic. If you've noticed over the years that your weight naturally fluctuates 5, even 10 pounds between winter and summer, and it naturally self-corrects without radical dieting, you are simply in tune with Mother Nature. Appreciate the fact that you can get by with fewer bulky sweaters and scarves to stay warm, and don't get caught up in unhealthy eating and exercise habits to try and"fix" what is likely a completely natural phenomenon.

Golden, R.N., B.N. Gaynes, R.D. Ekstrom, et al."The Efficacy of Light Therapy in the Treatment of Mood Disorders: A Review and Meta-analysis of the Evidence." Am J Psychiatry 162 (2005): 656-662.

‘Tis the time of year when blogs, magazines, and radio broadcasts are full of tips for combating overeating, over-drinking, and the kind of carousing that leaves you tired, bloated, overly full, and generally disgusted with yourself. They’re often repetitive, and not all that useful. I’m full of tips, techniques, and strategies myself, actually! One that I DO think is useful and easy to remember is HALT, which stands for Hungry, Angry, Lonely, and Tired.

If you’re one of those things – hungry, angry, lonely, or tired – the risk of over-indulging rises. If you’re two, three of those things, the risk of losing control is much greater. And if you’re all four of those things, watch out world, because almost nothing’s going to stand in the way of the oncoming binge, bad behavior, or acting out.

But what’s the first aspect of change? Awareness. HALT is a way to bring yourself back to a place of awareness, so you can reign in your behavior before it becomes self-destructive. Let’s talk about the specifics:

Hungry: When you’re hungry – really hungry – your blood sugar starts to drop, and you feel tired, confused, and irritable. And did we mention, hungry? Really, really hungry. Like, so hungry you could the entire contents of a small refrigerator. Or the buffet table. Or as much as you can load up on at the drive-through. Yeah, that kind of hungry. Women with PCOS are more subject to the vagaries of blood sugar dysregulation (it’s the insulin resistance thing, AGAIN) than other people. We’re more vulnerable. Accept it, and plan for it.

Strategy: Have a little healthy snack with you at all times. Know that shopping is hard work and frequently results in blood sugar drops because you’re walking more than you think. Plan ahead. Decide: “If I get hungry, I’m going to Subway for a turkey sandwich loaded up with vegetables and skip the mayo.” This will prevent you from going to McDonald’s and getting a Big Mac, large fries, and a shake.

Angry: The traffic, the crowds, the prices, the shopping for people you don’t even care about, the time pressure, and the social obligations, your spouse who still expects home-cooked meals when you’re in the middle of SHOPPING!, can all lead to a build-up of anger.

Strategy: Do not shop when you’re angry. Do not expose yourself to challenging foods or social situations when you’re angry. Take five to twenty minutes to meditate, walk around the block, drink a glass of cool water, and practice forgiveness and compassion. Now engage in your usual activities.

Lonely: So often, it’s assumed that we’re off with our friends, families, and other loved ones at the holidays, but some of us are sitting home alone, without an invitation, a thought, or a concern.

Strategy: If you’re alone, embrace it. Don’t take a shower until 3:00 p.m. Spend all day on FaceBook. Eat breakfast for dinner. Revel in your ability to live precisely how you want to live today, without judgment or interference. It can be utterly rejuvenating. If you don’t like being alone, and really do feel lonely, make a point of issuing invitations to other people, or showing up at every group event you know about, and don’t tell me it’s unfair that you have to do all the asking. Life is like that sometimes, and if you want to undo this loneliness, you will have to take action. Tell people you don’t have any plans for Christmas, and you don’t have any invitations either. Quite often, one will be forthcoming. People are feeling generous this time of year. In any case, again, avoid whatever triggers you to behave uncharacteristically. This is not a good time to shop the web, bake a cake, or order enough take-out for six people. Remind yourself that this is a temporary, and repairable, condition.

Tired: Tiredness connects to hunger quite often. Drops or dips in blood sugar can leave you feeling exhausted, confused, and overwhelmed. When you’re tired, your decision-making capacity is impaired. See where I’m going with this theme?

Strategy: If you’ve been running around like a maniac, trying to get it all done (The shopping! The cooking! The baking! The cards! The decorating! The parties! OH MY!), slash and burn. You are NOT Superwoman. I repeat, you are NOT Superwoman. No one will notice. Seriously. I used to send upwards of 100 handwritten (and often handmade) greeting cards. A few years ago, I only sent a few. Now I don’t send any, except to my mother, and that’s a maybe. Not one single person has called me out for it. Wow, what a relief!

If you feel strongly, pick a few critical priorities (i.e., my husband will definitely die, or at least pout for days, if he doesn’t get a homemade peppermint cake by Christmas, my children will be ostracized if they don’t get Chanukah gifts like everyone else, and my staff assistant is going to “lose” my messages for the rest of the year if I don’t buy her a great present) and lose the rest. Children are important; adults will have to understand. Your budget, your sanity, and your ability to get the rest you need are the most important things. The rest is not. HALT. And be well.

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

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

If you're diligent about PCOS news, you probably haven't missed the press release reporting the finding that women with PCOS have 60% higher blood levels of bisphenol-a than other women.

The question is, what can you do with that information? My hunch is that many of you immediately wanted to know where you could get your blood levels tested and what to do if they turned out to be high. I worked much of yesterday trying to put together some answers for you, because it's highly likely that soon there will be people out there marketing solutions to all of you, some of which might be helpful…and others which are more likely to help fatten the other person's wallet than to improve your own personal situation.

The first thing I looked for was whether or not there was any way you could actually have your own blood BPA levels tested. I wrote to the Environmental Working Group, who has done some BPA testing, and who I trust.

Here is their response:

Thank you for your interest in EWG's work. Unfortunately, testing for toxins in the body is an expensive and time consuming endeavor. Some commercial labs will test for certain chemicals (and your physician may be some help here), but the kind of tests we ran for our BodyBurden reports would be almost impossible to procure for the average individual, not to mention cost prohibitive.

We are not associated with any lab in particular, but you might find the study’s methodologies--and what tests were run, and where--helpful:
http://archive.ewg.org/reports/bodyburden1/
http://archive.ewg.org/reports/bodyburden2/

In addition, we do not recommend that individuals seek body burden testing for the chemicals in the Human Toxome Project. These tests rarely provide any concrete information regarding the origin of your condition or the sources of your exposure.

1. Health effects of many of the industrial chemicals at levels found in people are mostly unknown. Most studies measure the toxic effects of these chemicals at high doses in animals. Few studies reveal potential health concerns from the complex, low-dose mixtures found in people.

2. We cannot at this time associate current health problems or predict future health problems from the chemicals that might be in your body. Scientists are only beginning to study the health effects of repeated exposures to trace levels of these chemicals. While studies suggest that some specific chemicals may play a role in certain health problems, risks to an individual are largely unknown. Genetics, timing of exposure, and levels of exposure all may be important.

3. Even if you were to be tested for dozens of chemicals, you would not know the added effect of the hundreds of other industrial chemicals that contaminate the human body at any given moment. The additive effects of the chemical mixtures found in people make understanding the potential health implications of your personal exposures even more complicated.

As an alternative we recommend that you review our site for suggestions of ways to limit your exposure to toxic chemicals, and join us in our fight for more protective policies that limit our exposures to harmful chemicals. Policy measures are the most permanent, cost effective, precautionary and equitable way to protect our health. Thanks again for your interest in our work.

Bottom line: running out and getting yourself tested for your own BPA levels is not a recommended response. Staying apprised and learning how to limit BPA exposure are great preventive strategies.

Hello everyone,

Just wanted to let you know, space is available in the upcoming PCOS Saturday Seminar, which is scheduled for Saturday, April 11, 2009, at the office of Marissa Kent, RD, in Rancho Santa Margarita, California.

This program starts at 9 am and ends at 3 pm, and will cover the basics of nutrition, activity, sleep, and stress management strategies that are the basis of our PCOS program. Marissa and I (Monika Woolsey) will be co-facilitating.

Cost is $50. If you are a health professional, you may apply this registration fee toward a registration in my upcoming comprehensive PCOS training, in West Los Angeles, in July of 2009.

Click here to register for the Orange County event.

Click here to learn more about the professional training.

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

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

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

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

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

Can you tell how much I thought this job sucked?

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

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

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

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

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

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

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

I just found this abstract in Pub Med. The full article is referenced at the bottom. I would love to hear any and all comments from readers about this issue!

Resource allocation towards fertility treatment has been extensively debated in countries where fertility treatment is publicly-funded. Medical, social and ethical aspects have been evaluated prior to allocation of resources. Analysis of cost-effectiveness, risks and benefits and poor success rates have led to calls of restricting fertility treatment to obese women. In this debate article, we critically appraise the evidence underlying this issue and highlight the problems with such a policy. Poor success rate of treatment is unsubstantiated as there is insufficient evidence to link high body mass index (BMI) to reduction in live birth. Obstetric complications have a linear relationship with BMI but are significantly influenced by maternal age. The same is true for miscarriage rates which are influenced by the confounding factors of polycystic ovary syndrome and age. Studies have shown that the direct costs per live birth are no greater for overweight and obese women. With changing demographics over half the reproductive-age population is overweight or obese. Restricting fertility treatment on the grounds of BMI would cause stigmatization and lead to inequity, feelings of injustice and social tension as affluent women manage to bypass these draconian restrictions. Time lost and poor success of conventional weight loss strategies would jeopardize the chances of conception for many women.
Pandey S, Maheshwari A, Bhattacharya S. Should access to fertility treatment be determined by female body mass index? Hum Reprod. 2010 Feb 3. [Epub ahead of print]

It’s National Anti-Boredom Month, and I’m thinking about how much of our bad eating habits are triggered by boredom. How often have you sat at home in front of the television, flipping channels, and snacking mindlessly? How about being at work, where you’re trapped in a cubicle you hate, and the only really good reasons to get up are to go to the bathroom, or to go get a snack or a meal? How often do you “need” a snack under these circumstances?

Quite often, we do a semi-decent job of planning ahead for breakfast, maybe even lunch or dinner, but snacks are hazardous territory. And unfortunately, it’s not usually the planned meals that do us in; it’s the random, boredom-based snacking. When you’re bored, it’s a little more complicated than suggested by merely moaning, “I’m bored.” When you’re bored, you’re probably also dealing with at least one of the following:

• Anger about being stuck in a situation you don’t like, or doing a task you don’t want to do, or being with people you don’t necessarily want to be with;

• Feeling trapped/having limited choices;

• Limited mental engagement (you’re under-performing, not challenged enough, or doing something for the millionth time, without thought);

• Fear of being stuck in this sensation of boredom forever;

• Frustration about all of the above.

When all of those things are going on, it’s likely that your brain starts to shut down from the overwhelm. You need soothing. You get a snack. You reach for something carby/fatty/sugary – anything that’s not on your self-determined, approved healthy eating plan. Seriously – have you ever noticed that you’ve just gotta’ have some cold sliced chicken breast, or a cup of low-fat milk? No, it’s much more likely you’re going after chips, salted nuts, chocolate, pastry, cookies, ice cream, or something along those lines. You want a treat, some compensation for your misery. Food is the easiest way to treat yourself. It tastes good. It takes your mind off the other stuff. It gives you something else to focus on.

Next time you’re feeling bored, I suggest the following instead:

• Get off the couch and get outside for a little walk;

• Make a gratitude list, and see how long you stay focused on your boredom;

• Call a friend who’s prone to boredom-based eating (don’t tell me you don’t know anyone!) and ask her to talk you out of it;

• Sneak into the restroom with your cell phone and play a game on it;

• Grab a notepad and start writing with “I am bored because… ” See what happens. Repeat this phrase until the page is full.

Other helpful strategies include:

• Prepare some healthy, balanced snacks in advance, maybe even while you’re feeling bored, and make sure they’re readily accessible in all the places where you’re prone to derailing from your plans.

• Make sure you don’t go too long between meals; you might really be hungry!

• If you just can’t seem to contain your behavior, consult with a mental health practitioner who can help you get to the roots of the behavior.

• Eat enough at your meals; this may mean abandoning the idea of grazing or having five or six small meals a day. What works better for you might actually be three squares a day. You don’t know until you try.

• Make sure your meals consist of a balanced, attractive, and tasty group of foods. That may seem obvious, but I can’t tell you how many times I’ve seen my patients get frustrated and overdo it on unhealthy snacks, because they’re dying for some carbs, some salt, or a little sweetness.

• If you need help with the food part, hire a dietician who knows something about PCOS.

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

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

“Gretchen, oh Gretchen! It’s Halloween, come on, I’m so tiny, just eat me. You deserve a treat. I’m only here once a year.” Sound familiar when you substitute your own name?

A few M&Ms, an itty-bitty Butterfinger, those adorable little packets of candy corn, or whatever form of cheap sugar it is that you favor are probably calling your name – LOUDLY – right about now. If you haven’t already succumbed repeatedly to the bowls scattered throughout many offices, or sneaking some out of the stash you intend to distribute tonight, or if you didn’t full-on snag an entire bag of your favorites for yourself, which is even now lurking in your desk drawer. I know the drill. You’ve got that guilty laugh, don’t you?

It’s darn near impossible to be perfect around the issue of refined sugar. It’s in everything from the obvious baked goods and candy to the less obvious prepared salad dressings and sauces – even a Chinese stir-fry or some other meat dishes. Many of us set abstinence from sugars as a goal, and/or adhering to a low-glycemic diet. This is a great idea generally speaking. But we’re entering the time of year when treats abound (I’d say treat season pretty well spans Halloween through Valentine’s Day, which is a long time to be totally out of control), and it’s time to get a grip on yourself, and implement a strategy that works. Here are some of my favorite self-protection strategies:

• Don’t buy the stuff – DUH!? If you don’t have it in your house, you can’t eat it. Or at least you’d have to go make a special trip to buy it, which gives you enough time to re-think that idea. Refusal to participate in self-destruction is empowering.

• If you must buy it, buy something you don’t like – personally, there’s no way on earth I’m going to eat gumballs, Twizzlers, or Skittles. If that’s what I’m handing out, it’s ALL leaving the house. Saved!

• Turn down offers quickly – when you’re standing at the receptionist’s counter staring at that giant bowl of toxic sugar, and she pushes some on you like a perfect hostess, quickly excuse yourself by saying you’re diabetic, you’re allergic to chocolate, or whatever else you need to say. This is one occasion where you should feel free to lie. It’s highly likely the embarrassment and potential questioning (“Um, I’m not trying to tell you what to do, but didn’t you say you were diabetic?!) will prevent you from sticking your hand in that very public bowl.

• Buy yourself a real treat – if I’m going to do chocolate, I want it to be European, very dark, very smooth, and preferably kind of expensive. That doesn’t sound like any of the usual Halloween treats, does it? Better yet, buy yourself a non-food item as a reward for your good behavior. Make your calories and your glycemic bumps meaningful, for cryin’ out loud!

I’m all for self-indulgence, but I believe it is best practiced with thoughtfulness and, frankly, dedication. We should PLAN for indulgence, actually. It shouldn’t be random, stupid, or designed to give you a sugar rush followed by a sugar crash, wildly fluctuating insulin levels, and a bad mood (because yes, the sugar crash causes headaches, stomach aches, insomnia, and contributes to anxiety and depression).

In the world of PCOS, you need to make smart choices. I don’t think choosing cheap Halloween candy is a good choice for your mind or your body because it doesn’t make you feel better, bottom line, and I’m all about feeling better, not throwing things out of balance.

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.

Over the weekend, I had the honor and pleasure of training the newest members of the inCYST network. I'll share more about them in another post!

I realized while doing that training that there is something I always share in professional presentations, that I have yet to post on this blog. It has to do with my perspective about the fact that walnuts consistently show up on every blog post and in every interview about increasing the omega-3's in your diet…and when you do the math…it turns out there may be some other great choices, potentially even better choices, than walnuts for doing this job.

TRUE Walnuts have the highest amount of omega-3 fatty acids per gram of nut than any other nut, about 2.5 grams per ounce.

TRUE Walnuts also have a very high amount of omega-6 fatty acids per gram of nut, about 10 grams per ounce.

TRUE Walnuts have an omega-6 to omega-3 ratio of 4 to 1. If this was the only food we ever ate, this is actually a decent ratio.

HOWEVER…The problem is, when people are trying to use diet for help with inflammatory diseases like PCOS, their ultimate goal is to simultaneously reduce omega-6 intake and increase omega-3 intake. Every time you eat walnuts, you increase both omega-3 and omega-6 intake.

NUTTY STRATEGIES FOR BALANCING OMEGA-3'S AND OMEGA-6'S
1. Don't eliminate walnuts! They still, in moderation, have a lot of great health benefits.

2. Eat a variety of nuts. I like to shop at a store that has bulk food bins. Every week they have a different nut on sale. I went to IKEA and bought a bunch of see-through canisters. Every week I purchase a pound of whatever is on sale and add it to my collection. That way I can snack on almonds, cashews, macadamias, pecans…and always have them on hand for cooking or salads. That way I get the best each nut has to offer, while minimizing potential problems that might arise from getting too much of one kind of nut.

3. Know your anti-inflammatory nuts. If correcting your omega-6 to omega-3 ratio is your current most important goal, get friendly with the following nuts: macadamia, hazelnut, pecan, pine, pistachio. I ranked them in order of which ones have the highest ratio of omega-3 and monounsaturated fats compared to omega-6 and saturated fats. (Thanks to friend and colleague Johanna Roth for helping with that analysis).

Each of these types of nuts, has an anti-inflammmatory benefit related to its fat profile. Peanuts, peanut oil, and old-fashioned style (no trans fat) peanut butter are pretty neutral, won't hurt your ratio, but won't really improve it. (Peanut butter is a great and inexpensive choice, and is perfect when eaten in an overall diet that also includes fish, flax, and other omega-3 balancing choices.)

(Monounsaturated fats are mathematically neutral and healthfully beneficial. They are the type of fats also found in olive oil and avocados).

Most people who recommend walnuts as part of their Top Ten List of Foods have not taken the time to do all of the math. They simply stopped at the basic analysis.

Hazelnut-encrusted halibut, anyone?

Couples are funny things, and their communication dynamics can be complicated by their different styles and approaches to problem-solving. For example, I’m pretty equally right brain/left brain in my approach to things – I’m always in touch with my emotions, but there’s a good dose of logic that goes with it most of the time. However, I often take a non-linear approach to problem-solving. I often think about the problem, research it a bit, tuck it away, pull it out and look at it again, consult with someone, ignore it, make a decision and change my mind, and then do a little more thinking, and finally come to THE ANSWER. My partner, however, is both an engineer and a mathematician – as in, he has a Ph.D., and teaches the stuff. Engineering is the art of reducing complex problems to a series of readily implemented, streamlined strategies that improve function and efficiency. Needless to say, he often approaches problem-solving quite differently! His process looks more like this series of questions: • What is the problem? • How bad can it be? • What’s the worst outcome? • Can I survive this outcome? • What is the urgency level of this problem? • What resources do I have for solving this problem? • Who will be impacted if I don’t solve this problem now? • How will I know if the solution is satisfactory? He does not proceed to the next question until he has answered the first question, and so on. At first, this process of his really irked me. I thought it was slow, painful, tedious, and unnecessary. I thought it was slowing down getting to THE ANSWER. My brain’s not going to change when it comes to this fundamental wiring, but what I’ve learned from his process is the same thing I’ve learned from practicing mindfulness, hypnotherapy, and psychotherapy. Slowing down leads to better results. Applying logic reduces stress. Rating/ranking your priorities minimizes pressure. Looking at all of your options, and perhaps selecting one that is just “acceptable” is better than searching for elusive “perfection.” When it comes to PCOS, and the many complex and related diagnoses, treatment plans, supplementation options, diet and exercise approaches, and mental health conditions that we face, it’s easy to get overwhelmed, and caught up in a psychological spin cycle. We try to solve all of our problems at once. We get angry and frustrated when yet another approach isn’t working. We’re always looking for the best, the latest, and the greatest dietician, supplement, prescription medication, miracle food, or whatever else it is that we think will rebalance our unbalanced hormones. We forget to apply logic. We dismiss the engineering approach as unnatural, overly masculine, or outside of our training. I suggest that, instead, you view yourself as capable, competent, and curious. Then make it true. Try the engineering approach, and see if you land on a different solution that fits or feels better. I’d like to hear how it goes. Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She has completed the inCYST training. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses. If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at AskDrHouseMD@gmail.com. You can also follow her on Twitter @askdrhousemd.

In the series “Mary Portas queen of shops” we watched how Portas tackled struggling independent businesses and breathed life and wealth back into them with ideas about merchandising the store, to buying and pricing strategies. Now Mary has got her beady eyes on Britain’s charity shops.

Mary believes charity shops represent a key part of the future of shopping: “a vast number of consumers worry about ethical shopping and the environment and charity shops provide a route to a greener way to shop where everybody wins”.

I loved “Mary Portas queen of shops” first time round and with my love of charity shops I cannot wait to see how this series is going to go and if Portas will succeed in her mission. I was watching last night on BBC2 at 9pm along with you guys thinking it was all going to have to turn out nice in the end because otherwise what is the point of the series? Awareness?

After watching the first five minutes it was clear poor Mary had her work cut out for her with the shop, dumped donations and Nick the apparent “Manager”. What surprised me most was the mindset of the people. Some of the volunteers did not think the shop needed a change, some were not open to change and some refused to change. If Portas cannot get the volunteers to want to change their mind sets about the store how does she endeavour to change the buying public’s minds about shopping at charity shops?

I am more than sure the BBC show will split people’s opinions on Mary Portas. Some cannot stomach her and find her patronising or condescending. Making the complaint that the shop workers were just volunteers and that they had been in that same job for 30 odd years. On the other side we have Mary Portas who has a wealth of retail knowledge and wants to help them make money by making some simple changes and treat them like a business. Mary Portas is marmite?

I cannot wait to watch the rest of the series and I really want this “plan” to work for Portas, the charity shops and the public. If we can change people’s ideas or perceptions that these stores are not just dumping grounds for our old tat and are in fact goldmines for great fashion and bric a brac than I will be happy and content. I will be tuning in for more “Mary Portas queen of charity shops” next week.

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

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

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

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

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

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

Harmonic Nutrition and Wellness, LLC
847-381-5947

Monika, I want to add to your post about a"Bill of Rights" for pcos cysters, only I have termed it"Fifteen Tips for PCOS Physicians". Everyone, please feel free to add to it.

Fifteen Tips for PCOS Physicians
Stacy Korfist, LMFT

1. Please do not minimize, downplay, disregard or discourage our researching on the internet. PCOS is a chronic condition, one that requires our understanding of what is happening to our bodies. That cannot occur in a 20 minute doctor’s appointment and to take better care of ourselves we need to have a full understanding of a very complicated endocrine system.
2. If you do have concerns however, please ask which websites we are obtaining our information from, be familiar with them and either offer better alternatives or affirm the resources we have.
3. When assessing degree of hirsutism please be sure to ask about our maintenance practices. Sometimes it can look fairly mild but it is misleading because we spend an extraordinary amount of time plucking.
4. Be conscientious, but thorough when addressing weight. For those that are not obese, but hovering around the high end of the normal BMI range or over, it’s probably not ok with us. Please do not say that we are ok and not to worry. We are worried. Worried that we will stay that way, worried that we will continue to gain, worried about plenty.
5. If you do not know the answer to something, please just say so. We know doctors aren’t taught everything in medical school. It will earn our respect. In fact, if we teach you something don’t be shy to tell us so.
6. Please do not tell us to exercise more and eat less without also referring us to a dietitian. Have the name of several good dietitians that treat pcos and develop a professional relationship with them as well.
7. In fact, work with a multidisciplinary approach. Ask if we are interested in seeing a psychotherapist if needed. Know of various referral sources such as hair removal clinics, acupuncture centers, infertility support programs.
8. Be aware of each and every medication, herb and supplement we are taking.
9. When we make our appointment, ask us to be prepared with questions and concerns upon our arrival so that we may make good use of your time.
10. Allow us to take part in the decisions being made about our health. Inform us of respected alternative therapies, even if it’s something you may not provide or even agree with.
11. Be certain we are aware of all health risks related to pcos, now and over the lifespan. There are many and this will take time. Be sure we understand strategies for prevention. If we are minors be sure our parents know how to best support our needs.
12. Stay current with treatment approaches and healthcare industry trends. Be an advocate and get involved. Step out and teach others.
13. Make a follow up appointment with us.
14. Explain the lab work. Don’t just say everything is in normal range, especially if it’s something that shows deterioration. Allow us to ask questions.
15. Most importantly, treat us as an individual and not just be a cookie-cutter practitioner. This can only be accomplished with good listening skills.

If you are a physician and have taken the time to read this then you are one of the good ones.

Stacy Korfist, LMFT Redondo Beach, CA
310 720-6443

Yesterday I shared some great news from an Italian research group about myoinositol for improving fertility. In the process of corresponding, they sent me a series of articles from their lab. One of their most recent investigated the combination of myoinositol and melatonin in fertility treatment.

Here's how it looks like the story goes.

Ovulation is an inflammatory process Yes, the process of releasing an egg, and giving life, is pro-inflammatory. It takes a lot of energy to do this, and as that energy is metabolized, it's oxidizing tissue around it.

Melatonin is one of the most powerful antioxidants we have You know, if you think about this the way Mother Nature does, it makes sense that we'd want to roll over and sleep all cuddled up after sex. It is her way of protecting that fragile egg from all of the stresses of the day.

The research I read yesterday was about INOFOLIC PLUS, an Italian proprietary blend of inositol, folic acid, and melatonin. Forty-six women who had previously undergone in-vitro fertilization (IVF) and failed, used this supplement daily for 3 months before undergoing another IVF procedure. They also continued to take INOFOLIC throughout the entire IVF cycle. This study, by the way, did NOT focus on women with PCOS, merely women who had failed IVF.

Here are some of the results of the second IVF in which the supplement was used:
--Higher number of embryo transfers
--Higher embryo quality
--Where all of the subjects had failed with their first IVF the first time, 13 (28%) became pregnant during the study, 4 miscarried.

What is remarkable about this study is that the average age of these women was 39 years, an age where fertility is starting to become difficult even without a diagnosis of infertility.

The supplement is not perfect, but it shows promise for helping women for whom other strategies have failed. It seems to be a great combination of compounds for peeling off the layers of inflammatory/oxidative damage have inflicted on reproductive systems…talking your ovaries down out of the tree, so to speak. What it seems to do, is both create a higher quality egg and then protect it from the ravages of oxidation long enough for it to meet a sperm, conceive, and create an embryo.

Ahhhhhh…just love the power we have within ourselves to create healing solutions!

As I mentioned yesterday, unfortunately, INOFOLIC is not available in the United States. However, there is an important bottom line message here that cannot be ignored.

When you're not eating enough antioxidants, not delegating, working too hard, not sleeping well, not managing your stress, the melatonin Mother Nature given you to protect your eggs, may likely be channeled into fighting other damages those lifestyle choices have promoted.

Not trying to shake the eFinger at you here, it's just becoming apparent from listening to so many of your stories that when we don't take good care of ourselves, the effects can stick around for a very long time. And when we do things in an effort to eat well but don't do our homework first (such as eating vegan but not making sure all nutrients are still adequate in the diet or panicking and going on a crash diet in order to get pregnant, or overexercising as the only way to manage stress), they can hurt us in the long run.

If you start to think about your choices as"What can I do to not unnecessarily use my own antioxidant power so it can be there for that egg?"…perhaps making some of those choices you've been reluctant to take on, might become easier to embrace.

Unfer V, Raffone E, Rizzo P, Buffo S. Effect of a supplementation with myo-inositol plus melatonin on oocyte quality in women who failed to conceive in previous in vitro fertilization cycles for poor oocyte
quality: a prospective, longitudinal, cohort study. Gynecol Endocrinol. 2011 Apr 5. [Epub ahead of print]

VITTORIO UNFER1, EMANUELA RAFFONE2, PIERO RIZZO2, & SILVIA BUFFO3

(Note from Monika: Dr. Gretchen will be offering counseling from our Santa Monica office. She has a few spaces left in her"pay what you can" introductory offer for Friday, September 16. If you're interested, email monika at afterthediet dot com for more information)

One of the purposes of the “Mental Health Monday” feature of this blog is to acquaint you with some of the psychological aspects of PCOS, and how mental health issues are impacted by the condition. There are also coping skills, insights and ideas about ways to help yourself, and education about how to create change.

You may have some vague symptoms that seem like something a therapist would know about, but you’re not really sure when or if it’s appropriate to have a consultation or session with me or some other health psychologist or therapist. My specialty, health psychology, focuses on medical conditions and how they impact our mental well-being.

PCOS causes or contributes to a variety of mood disorders, and can either mask or mimic some other physical conditions. It can be challenging to sort out which symptoms came first, and what your treatment priorities are. Here are some of the symptoms you may be experiencing that indicate a need for psychological evaluation and treatment, and that may be connected to your PCOS:

• Difficulty sleeping, or sleeping far too much
• Physical aches and pains
• Unexpected weight gain or weight loss
• Uncontrollable food cravings, especially for carbs
• Panic attacks, or anxiety attacks
• Feeling jittery all the time
• Mood swings
• Thoughts of suicide
• Constant irritability
• Trouble relating to other people
• Isolating yourself
• Pain issues that don’t seem to be connected to injury
• Feeling overwhelmed
• Difficulty coping with your diagnosis
• Having a new diagnosis
• Infertility issues
• A recent loss
• History of trauma, domestic violence, or other acute stressors
• Developing complications, such as diabetes

Additionally, you may want to receive education about PCOS and related mental health issues, identify a medical and psychological treatment team or plan, and work on developing coping skills and strategies for managing your PCOS. These are all things that health psychologists do, and that could be part of your reasons for consulting a health psychologist.

It can be scary to contemplate calling a psychologist, but at the same time, simply taking the first steps to get help may also result in improvement. Knowing that you’re doing something good for yourself, and that there ARE experts who can help, will often jump-start the healing process. You may be inspired to improve your self-care practices. You may also start practicing the self-care skills that you have, but haven’t been using often enough.

In a future “Mental Health Monday” post, I’ll address what actually happens in a therapy session, so you can learn more about what to expect, if you haven’t already experienced therapy.

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.