The Hemp Connection [Search results for stress] 

I recently received a newsletter from one of our network members that I wanted to share with you. Karen Siegel, in addition to being a registered dietitian, is a licensed acupuncturist and herbalist. Her practice is located in Houston, Texas. She writes a wonderful newsletter entitled,"Qi Mail", which some of you might really enjoy. I am pasting the contents of her most recent newsletter for you to sample. Karen's contact information is listed below, if you'd like to schedule an appointment, or sign up to personally receive these wonderful newsletters. The actual layout is much more beautiful than what I can reproduce here, I can only paste the content in Blogger's format. As many of you are likely rushing around this weekend to get the last few holiday gifts, foods, and details taken care of, I thought this topic was especially pertinent. Enjoy!

REST, RESTORE, REVITALIZE

In nature, winter is the season where all living things slow down, conserve their energy and prepare for the outburst of new life and energy in the spring. Our bodies are instinctively expressing the fundamental principles of winter – rest, restoration and revitalization.

The Nei Ching, one of the earliest surviving medical books on acupuncture, advises:
“During the winter months one should refrain from overusing energy. Retire early and get up with the sunrise, which is later in winter. Desires and mental activity should be kept quiet and subdued, as if keeping a happy secret.”

Eating warm hearty soups, dressing warmly, and refraining from cold and raw foods is also recommended.

Element: Water
Nature: Yin
Organs: Kidney, Urinary Bladder, Adrenal Glands, Ears and Hair
Emotion: Fear and Depression
Flavor: Salty

Seasonal acupuncture treatments in winter serve to nurture and nourish kidney Qi (the organ associated with winter) which can greatly enhance the body's ability to thrive in times of stress and aid in healing, preventing illness, and increase vitality.

Call now for more information or to schedule your seasonal tune-up

De-stress this Winter with Acupuncture

While optimal health and well-being in the winter season calls for rest, energy conservation and the revitalization of body and spirit, your holiday activities may have a different agenda. This year can be filled with a mad scramble of visitors, family get-togethers and frantic shopping trips. Compound the usual seasonal pressures with the constant barrage of bad economic news and you may find this to be one of the most stressful times of the year.

Stress, frustration and unresolved anger can cause a disruption in the flow of qi or energy through the body. These energetic imbalances can throw off the immune system or cause symptoms of pain, sleep disturbances, mood changes, abnormal digestion, headaches, and menstrual irregularities, and, over time, more serious illnesses can develop. Acupuncture treatments can correct these imbalances and directly effect the way you manage stress.

Studies on Acupuncture and Stress

Numerous studies have demonstrated the substantial benefits of acupuncture in the treatment of stress.

A 2008 study published in Anesthesia & Analgesia found that acupuncture point alleviated preoperative anxiety in children while a 2003 study conducted at Yale University showed that ear acupuncture significantly lowered the stress level of the mothers of children that were scheduled for surgery.

A German study published in Circulation found that acupuncture significantly lowers both systolic and diastolic blood pressure. The extent of the blood pressure reductions by acupuncture treatments was comparable to those seen with antihypertensive medication or aggressive lifestyle changes, including radical salt restrictions.

Another study from the University of New Mexico measured the affects of acupuncture on 73 men and women with post-traumatic stress disorder (PTSD). The researchers found the acupuncture treatments to be as helpful as the standard treatment of cognitive behavioral therapy.

Needless to say, if the stress in your life is throwing you off balance, consider acupuncture therapy to regain peace of mind, regulate your immune system and stay healthy.

Miso Soup with Scallions

Did you know that Miso Soup with Scallions is actually an ancient herbal remedy for colds?

In 300 AD famous herbalist, Ge Hong, writes about Miso Soup with Scallions in a book called, Bei ji zhou hou fang or Emergency Formulas to Keep Up One’s Sleeve.

The soup is indicated for the onset of a cold when a person is just beginning to feel a headache, stuffy nose and a slight fever. So, the next time you feel a cold coming on, be sure to have your miso!

Miso Soup (Serves 4)

Ingredients:

* 6 cups water
* 3-4 Tablespoons Aka Miso or red soy bean paste (usually sold in the refrigerated section)
* 3-5 green onions stalks, chopped

Directions:

* Dissolve the miso in a little bit of boiling water (about 2 tsp.)
* Bring water to a boil in a saucepan and add the miso & scallions.
* Simmer for 5-10 minutes.
* Remove from heat top with green onions and serve.

Variations: you can add various other ingredients to make a more substantial soup, such as tofu, seaweed, fresh mushrooms, cooked shrimp, snow pea sprouts, cooked rice noodles, or paper-thin slices of fresh ginger.

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Stress Busting Foods

The foods that you eat play a crucial role in your overall well-being as well as your ability to handle stress.

Over 1400 chemical changes occur as stress hormones, such as cortisone, sap important nutrients such as B vitamins, vitamin C and magnesium from the body.

Here are three foods that can replenish your supply of these nutrients and enhance your ability to manage stress:

Cauliflower – Cauliflower and other cruciferous vegetables, such as broccoli, cabbage, and kale are chock full of stress-relieving B vitamins. Cauliflower is also one of the very best sources of vitamin B5 or pantothenic acid.

Pantothenic acid helps turn carbohydrates and fats into usable energy and improves your ability to respond to stress by supporting your adrenal glands. Fatigue, listlessness, numbness and tingling or burning pain in the feet are all indications that you may need more vitamin B5 in your diet.

Salmon – Salmon is a healthy and delicious way to get your dose of B vitamins and omega-3 fatty acids. Vitamin B12 supports production of red blood cells, allows nerve cells to develop properly and is essential to the synthesis of the “happy” brain chemical serotonin.

Among the many benefits of omega-3 fatty acids, a 2003 study published in Diabetes & Metabolism found that a diet rich in omega-3 fatty acids significantly reduced the stress response and kept the stress hormones cortisol and epinephrine in check.

Blackberries – Blackberries are jam packed with Vitamin C, calcium and magnesium. Vitamin C has shown to be a powerful stress reducer that can lower blood pressure and return cortisol levels to normal faster when taken during periods of stress.

Magnesium and calcium act together to help regulate the body's nerves and muscle tone. When there is too little magnesium in your diet, nerve cells can become over activated and can trigger muscle tension, muscle soreness, muscle spasms, muscle cramps, and muscle fatigue.

Blackberries have more than double the amounts of vitamin C, calcium and magnesium than their popular cousin, the blueberry.

Karen Siegel MPH, MS, RD, LD, L.Ac.
9660 Hillcroft, Suite 202
Houston, TX 77096
713-721-7755
karensclinic@gmail.com

Oxidative stress, in the body, is much like rust on a car. It chips away at the integrity of body tissues, rendering them unavailable to function as they should. I don't have to tell you that…if you have PCOS and you have brain fog, it's a pretty huge red flag that you've got a degradative process going on. A recent study out of China has shown that oxidative stress is present in all women with PCOS, regardless of weight. Being lean does not protect you. This is extremely important to understand because the vast majority of advice I see given to women with PCOS, is simply to lose weight. Even though, if you are overweight, and you do lose weight, you may only be taking care of part of the picture. This Chinese study is important because it took the time to take out the weight issue, which can distract a lot of researchers from what may be the core issue. Forty-three obese women with PCOS and forty-two lean women with PCOS were evaluated for levels of several markers of inflammation and oxidation, including superoxide dismutase, 8-iso-prostaglandin F2alpha, and visfatin. For each of these compounds, regardless of weight, women with PCOS had higher levels of oxidative stress indicators than infertile women without PCOS. In the lean women, these metabolic disruptions were not as obvious, but they were still there. It looks like this is an additional layer of pathology that women with PCOS have, over and above infertility. And if all your physician or dietitian has done is suggest"lose weight"--it potentially could be part of the problem. I don't have to tell you that this can be an ominous task with PCOS, and women can often overexercise and over-restrict their diet in an effort to do so. Both of those choices can fuel the fire of oxidative stress and push your body in the wrong direction. See that Patriot missile in the photo? Oxidative stress works like that. It's like a million metabolic missiles floating all over your body, searching and destroying DNA, tissue, hormone function, pretty much everything. Losing weight the wrong way won't get you where you want to go. On the contrary, it only unleashes a whole new battalion of them. My message to you is this. Instead of beating yourself up in the gym with too much exercise and then punishing yourself when you get home with too little food, focus on ways to reduce that metabolic stress. You know we have four areas we like to see you focus on: (1) eating in a balanced fashion with plenty of fresh fruits and vegetables, (2) moving your body in a moderately active way, (3) getting enough sleep, and (4) managing your stress. It's not news on this blog. We just have some new friends in China who gave us some great research to reinforce that message. Liu J, Zhang D. [The role of oxidative stress in the pathogenesis of polycystic ovary syndrome]. Sichuan Da Xue Xue Bao Yi Xue Ban. 2012 Mar;43(2):187-90.

If I could have a dollar for every time in 26 years I've heard a client…or friend…or relative…say they don't cry, or can't remember the last time they did…I'd have so much money, even in the midst of this financial crisis, I wouldn't have to write this blog to pay my mortgage.

We as a culture have this"thing" about tears. We're not supposed to have them, because if we do, we believe, we're weak in character.

Guess what? Tears are a very important part of our physiology. When analyzed, they are very high in cortisol, one of the stress hormones. Tears are the body's way of clearing out stress hormones when they get so high they have potential to do serious physical damage. If we couldn't cry, stress might kill us a lot more quickly than it already does.

Years ago, when I first had this business, I was under contract to write a textbook. Numberous delays on the publisher's ended created backups and backlogs that, through a domino effect, crushed my business plan just as I was starting to see a return on my investment. To this day, I tell people I felt like I was in an old"Roadrunner" cartoon, standing on top of a cliff, watching my business fall to the ground like the cartoon anvil, with a momentum so powerful there was nothing that was going to stop it. All I could do was sit there and watch it happen, wait until the cloud of dust from the impact settled, and then start to rebuild my dream.

Talk about stress. A lot of what happened reflected on me, because it was my name that ultimately showed up on the cover. Like anyone, I value the brand I've created for my name, and it was pretty devastating to watch events completely out of my control chip away at that brand's reputation.

It was ironic that at the very time all of this was happening, I was researching a concept called"restraint stress", which is the kind of stress any animal experiences when it perceives that it is locked into a situation with no way out. In the laboratory, restraint stress is researched by immobilizing rats and subjecting them to electrical foot shocks. After repeatedly experiencing these shocks, these rats develop a behavior called"learned helplessness", which is essentially giving up even trying to escape their dilemma, and instead just sitting there and passively allowing themselves to be subjected to discomfort.

In a way, it helped to be researching this, because at least in my head, I knew that the very worst thing I could do was follow in the footsteps of those rats. I had to make sure, that every single day, even if it was something small, I had to do something that moved me forward.

I can tell you now that I am many years past the initial crisis, that there were days when getting out of bed was the something small that I managed to do.

Most days I could motivate to make coffee, and then the rest of my energy was devoted to being as engaging as I could with anyone I needed to interact with.

Sometimes the smallest thing would just push me over the edge. And a lot of times, when I wasn't feeling sad at all, usually in a very inopportune moment like when I was in the checkout line at the grocery store, tears would appear out of nowhere.

Honestly, it felt great to cry. What was really hard was dealing with the reactions of people who were around me when the tears came. They usually wanted to hover, comfort, make them go away. And that put me in a position of having to take the energy I needed to take care of myself, and put it into taking care of the people who thought they were taking care of me, but who were really making their discomfort with my stress, my responsibility.

I realized that it is probably this discomfort we have with tears that makes many of us shove them back into our heads when we feel like letting them flow.

Why am I telling all of you this? Well, it's interesting. I started to tell you because tears have come up in more than one counseling session recently, and I've shared the tears and cortisol fun fact. I thought, since cortisol can wreak havoc on PCOS and fertility, that it might be a good idea to put that fun fact on this blog.

But as I was writing this, I realized that in recent weeks I've heard many, many stories from friends who are losing jobs, freaking out, experiencing losses both personal and financial, that are leaving them feeling like those tied down rats.

Just wanted to tell you, first of all, if you feel like crying, it's ok. It might be the best thing you can do for yourself today, to do just that. It also means you're human. And that your brain is working, doing exactly what it's supposed to do when you're stressed and it's starting to put you at risk.

For what it's worth, the times my life has been thrown into the greatest of upheavals have also been the times when the land needed to be cleared, so to speak, for newer, bigger, and better things. I just had to stop resisting it and let the momentum go where it needed to go. When I was standing on the cliff, thinking the momentum was downward because all I could see was that anvil, I should have been looking up and forward. There were amazing things coming that the anvil was making room for.

I encourage all of you, if you've been feeling like it but resisting it, to have a good cry. Then get some sleep. And marvel at the fact that no matter what happened today, the sun will come up tomorrow.

Have a great week!

You’ve heard it a thousand times, from every doctor, dietician, and well-meaning person you’ve ever encountered – you’ve got to lose weight, get out there and get some exercise, and change what you’re doing with your body when you’ve got PCOS. It’s important advice, to be sure, yet tedious to hear – and sometimes when we’re in the midst of trying to change our lifestyle and behaviors, we forget why we’re doing it.

All we hear is this pointed and difficult direction to improve things, and we fail to spend time linking it intellectually and emotionally to positive outcome, which helps drive motivation. It’s particularly frustrating with PCOS, because change occurs painfully slowly, and when you don’t see change, you lose motivation. Others can go on a diet and lose five pounds immediately, whereas that’s rarely the case for someone with PCOS.

Sometimes the changes are only visible when you get your lab results every few months, and the doctor congratulates you on lowering your cholesterol 20 points (personally, I don’t find that terribly exciting, although I know that it’s good) – in which case you might get it intellectually, but still be saying “yeah, yeah, yeah, that’s great, but where’s the weight loss?!” What we want is weight loss, pregnancy, a reduction in hirsutism, or some other visible proof that what we’re doing is working.

When you really understand the importance of exercise for both your body and your brain though it’s a little easier to stick with a program of self-improvement. In a 2011 study entitled Lifestyle Changes in Women with Polycystic Ovary Syndrome, researchers examined numerous studies, papers, and research projects and validated the benefits of lifestyle change. Women with PCOS who made positive dietary, exercise, and lifestyle changes (i.e., stress reduction, increased movement, lower glycemic diets) experienced reductions in weight, testosterone levels, waist circumference, and other meaningful markers of the syndrome.

To support not only weight loss and improvement in body composition, but also, from my perspective as a psychologist, the stress reduction and mental re-wiring that goes on as a result of exercise are spectacular. I particularly like the following forms of exercise:

Walking – the cross-lateral motion of walking oxygenates and re-synchs your brain, and leads to a literal feeling of “clearing out” – plus walking is an excellent low-impact exercise that leads to improved glucose control. Does it get any better than that?!

Yoga – numerous studies continue to validate the importance of yoga for stress reduction and pain management. A study entitled Stress, Inflammation, and Yoga Practice indicated that yoga practice, regardless of skill level, resulted in marked reductions in both stress level and, even more exciting to those with PCOS, inflammation! Many fertility improvement programs involve yoga and other forms of stress reduction. And, while you’re improving your physical balance, you might just be improving your mental balance as well.

Swimming – swimming in a pool, lake, river, or ocean can be soothing and meditative. We are made primarily of water, and it is a return to water, and to the center of our selves. The silence and internal nature of the echoes and ripples brings us back into alignment with our natural rhythmic movement patterns.

Dancing – improves coordination, synthesizes mind/body, and is a form of creative expression. Much emotion is stored in the body, and can be expressed through the body. Plus, dancing is fun, at least when you “dance as if nobody’s looking!”

Weight training – feeling a strong body is empowering, and increases confidence. Sure, it’s hard work, but it has profound mental benefit when you conquer that final set, and your lifting is finished. There’s a sense of accomplishment and pride that boosts your self-esteem for hours. You’ll move better in your body too, and perhaps respect it a little more, for its ability to become so strong. (By the way, this is one really positive aspect of PCOS – that androgen imbalance will allow you to develop muscles more quickly!)

The mind and body are inseparable. If you work on improving the mental (motivation, drive, commitment), you will improve the physical. If you work on the physical, you’ll achieve the psychological rewards of calming, anxiety reduction, and depression reduction. Additionally, you’ll have fun and also be doing the right thing to keep your self-improvement program going. That leads to increased confidence, self-esteem, and overall improvement in your sense of well-being.

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:

Kiecolt-Glaser JK, Christian L, Preston H, Houts CR, Malarkey WB, Emery CF, Glaser R. Stress, inflammation, and yoga practice. Published in final edited form as: Psychosom Med. 2010 February; 72(2): 113. Published online 2010 January 11. doi: 10.1097/PSY.0b013e3181cb9377.

Moran LJ, Hutchison SK, Norman RJ, Teede HJ. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database of Systematic Reviews 2011, Issue 2. Art. No.: CD007506. DOI: 10.1002/14651858.CD007506.pub2.Australia, 3168.

You all are must be sooooooooooooooooooooooooooo tired of hearing me talk about the benefits of sleep. But I work with a sleepless population and it takes a few times to present my case before I make my point. I figure if I hammer at this from as many different angles as I can, and present as many examples of how poor sleep quality can interfere with your health, at least one of my examples will hit home and inspire you to consider your sleep habits and choices.

This doesn't bode well for Jay Leno and David Letterman…unless they team up with TiVo for advertising!

Women whose eggs had been examined and found to be of poor quality had those eggs examined by researchers. It was found that levels of chemicals indicative of oxidative stress were higher in those eggs than they were in the eggs of women whose eggs had been determined to be of good quality.

Taking this one step further, 18 women with low quality eggs were divided into one of three groups and given one of the following 3 regimens: (1) 3 mg melatonin per day, (2) 600 mg vitamin E per day, or (3) 3 mg melatonin AND 600 mg vitamin E per day. Oxidative stress markers were reduced in all three scenarios.

And THEN…in the final phase, 115 women who had not become pregnant with in vitro fertilization (IVF) were divided into two groups. The first group received 3 mg melatonin per day and the second group received no supplement. Melatonin significantly improved the rate of fertilization.

The researchers concluded that oxidative stress (which is what happens when you stress all day and don't sleep well all night), damages the quality of eggs. They also concluded that melatonin supplements can help improve fertilization rate.

Just a note--take melatonin if you want, but don't lose sight of the big picture. If you backed yourself into a corner because you weren't managing your stress and sleep, a pill may not be the complete solution to the entire problem.

Tamura H, Takasaki A, Miwa I, Taniguchi K, Maekawa R, Asada H, Taketani T, Matsuoka A, Yamagata Y, Shimamura K, Morioka H, Ishikawa H, Reiter RJ, Sugino N. Oxidative stress impairs oocyte quality and melatonin protects oocytes from free radical damage and improves fertilization rate. J Pineal Res. 2008 Apr;44(3):280-7.

The following is a guest post reprinted with permission from the blog of Karen Siegel, MPH, MS, RD, LD, LAc. Karen is a registered dietitian and licensed acupuncturist practicing in Houston, TX. If that's your neck of the woods, I highly recommend you take advantage of her knowledge, experience and talent.

Depression, Anxiety, Bi-Polar Disorder & Acupuncture
Questions about acupuncture for mental health issues are one of the most common inquiries I receive after questions about pain.

I actually do quite a bit of “mental health” acupuncture. Because of my nutrition specialty of working with eating disorders (for over 25 years), I have developed a great network with some of the best mental health professionals in Houston.

Acupuncture can help with depression, anxiety, stress and bi-polar disorder. So in terms of various mental health issues, yes, acupuncture can frequently help.

I caution to say that acupuncture is not in lieu of continuing or being in therapy. I do not take patients off of their Western medication if they’re already on it. Medication is a discussion between the patient and their doctor. Acupuncture, and in many cases Chinese herbal formulas, work just fine in conjunction with Western medication as the mechanism of action is quite different. They can complement each other beautifully.

When a patient comes in with a Western diagnosis of depression, anxiety or bi-polar disorder, my job is to determine what the underlying problem(s) are from a Chinese medical perspective. For example, if someone presents with anxiety along with insomnia, excessive worrying, hypervigilance and internalizing feelings, the strategy might be to balance the heart and kidney channels. However, if the main complaints include depression, irritability, sleep disruptions and digestive problems, the approach might focus on smoothing the liver channel.

Usually, a patient will present with a combination of the above plus more. After a thorough evaluation, a point selection is chosen based on the most disruptive concerns working our way in to the deepest and most chronic issues. We as human beings are rarely uni-dimensional, therefore it is more complicated than I have described. However, it gives you an understanding that the treatment strategy is quite individualized.

I have treated bipolar disorder and have found that acupuncture can be stabilizing; but with bipolar, it’s really important to stay on your Western drugs and/or be in regular communication with your therapist. What the acupuncture can do is help balance and stabilize some of the mood swings: the degree, frequency and intensity of the ups and the downs. You might be able to reduce the dosage of some of the medications, but again, that’s between you and your psychiatrist.

Stress is a major variable in just about every health issue we have. I think that stress is the one variable in our life that cannot be controlled in a double-blind, placebo control study. So you can have everything, all variables equal, but how do you really control for stress? Stress definitely triggers mental health issues and it triggers health issues overall.

Because stress is a major factor in all of our lives, acupuncture in and of itself helps with mental health issues because it works to balance the mind, body and spirit. When we are in balance, our emotional and physical health is improved.

Why in the world, the day after Thanksgiving, if I'm trying to de-stress you…would I put up a piece of pie…pie being something you likely don't even want to think about today?

Because my concept of stress is exactly like pie. Life tends to be less stressful if your"pie of life" is divided into more pieces. If your life has only a few facets, and something happens in one part of your life that is stressful, you have fewer places to go that can provide you a diversion while your mind works out a solution.

I'm posting my pie here, so you can see what I mean. I do what I do because I love it. But I can get really hyperfocused on it. And when business is slow…like it was just before the election…that can be very stressful. Fortunately, I also love to garden. There were weeds outside that needed to be pulled, so I started taking a work break every afternoon to clear a small piece of land. And you know what? While I was weeding, some new ideas for my business came to mind that jump started sales again.

It is easy, as hard as I work, to become a little inbred as far as my social life goes. So I decided a few years ago, to volunteer every Friday afternoon at a local no-kill shelter (which you should visit sometime if you're in Phoenix!). I have befriended a whole group of people who have absolutely nothing to do with my business. I love going down there and having a place where I'm Monika the cat adoption counselor, not Monika the nutritionist. (Well, that plus it's impossible to be stressed out after 5 minutes of being in the nursery with a dozen little ones simultaneously using you as a scratch post.)

I love to work out, but on days when it's raining or I'm just not feeling good and need to rest, I love to do calligraphy, read a Presidential bio, or refinish one of my antiques. Again, so many perspectives and ideas come to mind for work and social situations that seem to be locked up when I focus too hard on places where there are problems.

If you're struggling with fertility or weight loss, or any stressful situation, for that matter, the problem can just become larger than life. It can be all you think about. You can find yourself on the Internet, visiting blogs, reading books, etc., focusing entirely on your problem. And all the stress that builds up when you go to places where you only immerse yourself in more of the stuff that bothers you…can make it hard for your body to make progesterone.

Take a minute and look at your own pie. How many slices is it divided into? How many different communities of friends, coworkers, activity parteners, etc., do you belong to? Are you so focused that you have yourself backed into a stress corner?

Could it be…today is the day you have your coffee in a new Starbucks and strike up a conversation with a new person in line, rather than blasting in and out of the same place without looking at a single thing around you? Is it the day you buy that basil plant at Trader Joe's as a starter piece for your new herb garden? Is it the day you sign up for that Italian class you've been wanting to take? I'm so appreciative that you're reading my blog, but I would never expect it to be a complete and total answer to your PCOS, or to substitute for the well-rounded life that you deserve to have.: )

OK, now that THAT has been settled, I am going to paint my dining room today and then finish off that James Buchanan bio I found at the library. But first, I think it's time to head into the kitchen for some leftovers. Yes, I have to admit, leftover pumpkin pie is one of my very favorite breakfasts!

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.

Something that struck me very early on working with PCOS was how often I heard,"Just tell me what to do." It was clear that a big part of the problem women asking for help was having was feeling out of control. In every other part of their lives, it seemed, they'd been rewarded for hard work and diligence.

PCOS just doesn't work that way.

And when the solution isn't always about DOING something to fix the problem, you can feel completely out of control…tied down…trapped…

For a problem solving personality, a doer, this can leave you feeling completely stressed.

Research has actually studied this phenomenon, it's called"restraint stress."

Restraint stress is any kind of condition that leaves you feeling as if nothing you do can alleviate your discomfort, as if you are destined to live with your situation without any relief. It is the most damaging kind of stress, as it is the kind of stress that best elevates blood pressure, blood glucose, and cholesterol, interferes with sleep…

…can you see where this is going? Not only are you living with a seemingly unsolvable problem, but how you perceive that problem has the power to worsen that problem completely.

Sometimes what I see, is that a person focuses so completely on the problem that they perceive, that they lose perspective with regard to just what they CAN control.

They CAN make healthy food choices.
They CAN be more physically active.
They CAN set boundaries with people and limit their stress.
They CAN surround themselves with positive, supportive people.
They CAN turn the computer off and engage in activities other than surfing and reading about the problem.
They CAN be kind to themselves.

I find that those clients who are most creative at finding ways to repaint their picture, are the ones with the best chance of succeeding in the long run.

It's ironic, but then PCOS is ironic.

Stop focusing on the problem, stop thinking of yourself as an unfixable pathology, start believing you are a whole person with many talents and ideas to contribute to making our planet a great home…and all of a sudden things that felt so elusive start showing up when you least expect it.

Here is some interesting information from the world of sleep research that may have pertinence to those of you trying to conceive--and avoid miscarriage.

Even though we consider exercise to be a healthy behavior, technically, it is a stress. One of the types of stresses it induces, is thermal stress, or a rise in body temperature.

In this study, it was found that injecting melatonin helped to reduce the level of stress hormones found in the goats' blood samples. As melatonin levels rose, so did immune activity.

What does this mean to you?

1. If you're overexercising, your chronically (even if marginally) elevated blood pressure may be causing you to use your melatonin to restore balance. It may be interfering with your ability to get a good night's sleep.

2. Women whose melatonin levels are imbalanced have been found to be able to conceive, but to have trouble implanting the embryo.

3. Even if you're not overexercising, but you're not managing your stress, you may be channeling your important sleep hormone into a function that keeps it from being available for important reproductive-related functions.

4. Diet and exercise are important…but even more important is BALANCE in your life!

5. If you find that emotionally you cannot cut back on your exercise, let us help you. Sometimes the underlying reason has a very workable solution when addressed with the guidance of a trained professional.

Bottom line, it's important to exercise, but to not overdo it. And be sure that you're not compromising in the sleep department because you have underestimated the value of what happens while your eyes are closed.

Sejian V, Srivastava RS. Pineal-adrenal-immune system relationship under thermal stress: effect on physiological, endocrine, and non-specific immune response in goats. J Physiol Biochem. 2010 Aug 17.

Given the fact that so many people initially find this site when looking for dietary measures to increase their progesterone, I am always on the lookout for information on the topic.

This particular piece caught my eye because yesterday I included a reference in a presentation on eating disorders and PCOS, reporting that social phobias are more common in women with PCOS than they are in other women. It can be tempting to isolate if you feel your appearance is not acceptable. Paying more attention to your menstrual cycle and your lab tests than your spouse can so easily become what your PCOS is all about.

DON'T LET THIS DISEASE STEAL AWAY WHAT COULD BE ONE OF YOUR MOST IMPORTANT PIECES OF AMMUNITION!

Make time for friends, family, spouses…and on bad days, if all it can be is your dog…so be it.

Isolation is not the answer and it may be part of the problem.

Feeling Close To A Friend Increases Progesterone, Boosts Well-being And Reduces Anxiety And Stress

ScienceDaily (June 3, 2009) — Why does dishing with a girlfriend do wonders for a woman's mood?

A University of Michigan study has identified a likely reason: feeling emotionally close to a friend increases levels of the hormone progesterone, helping to boost well-being and reduce anxiety and stress.

"This study establishes progesterone as a likely part of the neuroendocrine basis of social bonding in humans," said U-M researcher Stephanie Brown, lead author of an article reporting the study findings, published in the current (June 2009) issue of the peer-reviewed journal Hormones and Behavior.

A sex hormone that fluctuates with the menstrual cycle, progesterone is also present in low levels in post-menopausal women and in men. Earlier research has shown that higher levels of progesterone increase the desire to bond with others, but the current study is the first to show that bonding with others increases levels of progesterone. The study also links these increases to a greater willingness to help other people, even at our own expense.

"It's important to find the links between biological mechanisms and human social behavior," said Brown, is a faculty associate at the U-M Institute for Social Research (ISR) and an assistant professor of internal medicine at the U-M Medical School. She is also affiliated with the Ann Arbor Veterans Affairs Hospital."These links may help us understand why people in close relationships are happier, healthier, and live longer than those who are socially isolated."

Progesterone is much easier to measure than oxytocin, a hormone linked to trust, pair-bonding and maternal responsiveness in humans and other mammals. Oxytocin can only be measured through an invasive spinal tap or through expensive and complex brain imaging methods, such as positron emission tomography scans. Progesterone can be measured through simple saliva samples and may be related to oxytocin.

In the current study, Brown and colleagues examined the link between interpersonal closeness and salivary progesterone in 160 female college students.

At the start of the study, the researchers measured the levels of progesterone and of the stress hormone cortisol in the women's saliva, and obtained information about their menstrual cycles and whether they were using hormonal contraceptives or other hormonally active medications.

To control for daily variations in hormone levels, all the sessions were held between noon and 7 p.m.

The women were randomly assigned to partners and asked to perform either a task designed to elicit feelings of emotional closeness or a task that was emotionally neutral.

In the emotionally neutral task, the women proofread a botany manuscript together.

After completing the 20-minute tasks, the women played a computerized cooperative card game with their partners, and then had their progesterone and cortisol sampled again.

The progesterone levels of women who had engaged in the emotionally neutral tasks tended to decline, while the progesterone levels of women who engaged in the task designed to elicit closeness either remained the same or increased. The participants' cortisol levels did not change in a similar way.

Participants returned a week later, and played the computerized card game with their original partners again. Then researchers measured their progesterone and cortisol. Researchers also examined links between progesterone levels and how likely participants said they would be to risk their life for their partner.

"During the first phase of the study, we found no evidence of a relationship between progesterone and willingness to sacrifice," Brown said."But a week later, increased progesterone predicted an increased willingness to say you would risk your life to help your partner."

According to Brown, the findings are consistent with a new evolutionary theory of altruism which argues that the hormonal basis of social bonds enables people to suppress self-interest when necessary in order to promote the well-being of another person, as when taking care of children or helping ailing family members or friends.

The results also help explain why social contact has well-documented health benefits---a relationship first identified nearly 20 years ago by U-M sociologist James House.

"Many of the hormones involved in bonding and helping behavior lead to reductions in stress and anxiety in both humans and other animals. Now we see that higher levels of progesterone may be part of the underlying physiological basis for these effects," Brown said.

University of Michigan (2009, June 3). Feeling Close To A Friend Increases Progesterone, Boosts Well-being And Reduces Anxiety And Stress. ScienceDaily. Retrieved June 5, 2009, from http://www.sciencedaily.com­ /releases/2009/06/090602171941.htm

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.

I got a little sidetracked with things, sorry for not getting to this sooner.

Progesterone is a topic I've covered before in other posts. Rather than repeat myself, I'll just link you to each part in that 5 part series.

Important things to remember about progesterone:

The basic building block for making progesterone, is cholesterol. Cholesterol is also the building block for testosterone and cortisol. If your body's balance is shifted in the stress management direction, it is likely that any cholesterol you might have had to make progesterone…was used up to make cholesterol.

One of the absolute most important things you can do to improve your progesterone levels, therefore, is to manage your stress.

I noticed after writing the original five part series that traffic to this blog increased significantly. The most common keywords were,"foods to enhance progesterone". Unfortunately, simply adding foods or supplementing with progesterone is not going to be the answer. If you really, truly want to have good progesterone balance, a commitment to better stress management is going to be a very important part of the solution. Some days it will be easy to do that, other days you will be challenged. Being gentle with yourself and accepting the best you can do on any given day…is what you deserve to give yourself credit for!

Here are the other five links with more information.

Watch out for environmental estrogens
Tackling insulin resistance
Enjoying food
Stress management
Physical activity

Not long ago, Renata Mangrum (who you'll soon see more of on our blog, she's studying to be an inCYST provider) forwarded me a note from a discussion list for lactation consultants. Someone on that list wanted to know if excessive vomiting during pregnancy (hyperemesis) was common with PCOS. The person asking the question had a patient who was experiencing that problem. There didn't seem to be much information about it in the scientific literature, but when this person lurked on a few PCOS listserves, it seemed to be commonly accepted as an issue.

LESSON ONE: Be sure to report all your unusual symptoms to your physician. When they start to see trends, that is when they can research the problem…the first step toward finding a solution.

I wrote Renata back and told her I'd never heard about it, but I did know that there was a very strong correlation between PCOS and bulimia, another medical diagnosis including vomiting. I did post about two weeks ago to see if any of inCYST's readers had experiences to share with their own pregnancy. One reader did write back to say that yes, she did experience vomiting, and was told it was due to having a low progesterone problem.

LESSON TWO: inCYST is as much about our readers sharing their experiences for us to learn from as it is about our giving advice. It's important that this be an interactive forum with communication moving in both directions.

Curious, I went into the National Library of Medicine database and used the keywords"bulimia" and"progesterone". It turns out, there were several articles reporting progesterone imbalances in bulimia. And, a correlation between imbalanced progesterone and binge eating. (References below.)

Hmmmmm…

What I know from my eating disorders work is that bulimia has many different colors. Sometimes it's induced. Sometimes it just happens. Sometimes women binge specifically so they can induce vomiting. Sometimes they overeat, and induce vomiting to relieve the discomfort that overeating produced. I learned that it is very important to get as much detail about how, why, and when the vomiting occurs, and not just lump all of it into one symptom with one cause and one motivation.

What I know from my PCOS work is that cysters have a low stress threshold. Meaning it takes less stress to activate the stress response. If you are prone to vomiting, that means you might be prone to feeling more nauseous with less stress than the average person. You may have learned over time that throwing up is a quick way to relieve discomfort other people quite simply never feel.

Here are some new insights I'd like to share and propose that all of you consider.

1. If you have bulimia, whether or not you have been diagnosed, and you honestly believe you are doing everything you possibly can to not vomit, and it's still coming, ask your physician if s/he might be amenable to checking your progesterone level. Correcting that (and natural ways to do so are written about elsewhere in this blog), may make it easier to stop vomiting.

When I worked in an eating disorder treatment center, I always felt for women I knew were doing their best to stay in recovery, who couldn't, who were considered by treatment teams as somehow being noncompliant or rebellious. I'm not saying you don't have a responsibility to work on challenging behaviors to the best of your ability, but I do think there may be an important physiological factor being overlooked that may be undermining the very best efforts of some of you.

2. The very first thing I thought of when I envisioned how these pieces fit together, was the poor woman who'd worked her tail off to get out of an eating disorder, finally became pregnant, and despite everything going seemingly well, having vomiting come back, with a vengeance. It might cross your mind to just silently live with it, thinking the first thing your treatment team is going to think is that you've relapsed. Which is why physicians may not be hearing about this.

Don't freak out…be proactive! Tell your physician, tell them your fears, and ask for help. Your problem may be low progesterone, and hyperemesis. And a susceptibility to low progesterone may actually have been the loaded gun that set you up as a candidate to get into bulimia in the first place.

If you have PCOS, with a history of an eating disorder, have become pregnant, and have found yourself all of a sudden vomiting or wanting to vomit again…we're here to help you find solutions. And we very much look forward to that.

LESSON THREE: inCYST needs to continue to challenge itself to think in a hugely interdisciplinary fashion. We are best at that when our readers are comfortable sharing their PCOS stories with us, trusting that we aspire to be inquisitive and scientific, not judgmental and shaming.

Pirke KM, Fichter MM, Chlond C, Schweiger U, Laessle RG, Schwingenschloegel M, Hoehl C. Disturbances of the menstrual cycle in bulimia nervosa. Clin Endocrinol (Oxf). 1987 Aug;27(2):245-51.

Pirke KM, Dogs M, Fichter MM, Tuschl RJ.Gonadotrophins, oestradiol and progesterone during the menstrual cycle in bulimia nervosa. Clin Endocrinol (Oxf). 1988 Sep;29(3):265-70.

Schweiger U, Pirke KM, Laessle RG, Fichter MM. Gonadotropin secretion in bulimia nervosa. J Clin Endocrinol Metab. 1992 May;74(5):1122-7.

Edler C, Lipson SF, Keel PK. Ovarian hormones and binge eating in bulimia nervosa. Psychol Med. 2007 Jan;37(1):131-41. Epub 2006 Oct 12.

Klump KL, Keel PK, Culbert KM, Edler C. Ovarian hormones and binge eating: exploring associations in community samples. Psychol Med. 2008 Dec;38(12):1749-57. Epub 2008 Feb 29.

Thought I would bring a psychotherapist's perspective to treating PCOS. In the past few months I have attended three scientific conferences and one practitioners conference on PCOS. The one unanimous and certain recommendation from every one of them was 'lifestyle, lifestyle, lifestyle'. But what does that mean? Does it mean eat less and exercise more? Does it mean feel shame when you indulge in holiday egg nog this season? No. Lifestyle to me means just that…style your life. Make changes to honor your life and take care of your chronic condition. Attached is an outline I wrote to help me explain and promote 'Lifestyle' to my clients.

Treating PCOS: Lifestyle for Success A Psychotherapist's Approach Stacy Korfist, LMFT
L is for the lifestyle change that is critical to make. No more diets, no more ‘someday’. Lifestyle change obviously includes nutrition and exercise, but it also includes stress management, adopting a new way of living, a new way of coping and a new way of playing that is essential.

I is for Identity. This is your sense of self; your self esteem. This includes facing anxiety and depression. Setting appropriate boundaries helps you to claim yourself. I is also for Integrity. No more broken promises to yourself or others. They only lead to self deprecation and more shame and depression. Be a person of your word.

F is Food & Feelings. Eat when you are hungry; stop when you are full. Understand the thoughts and ideas which fuel eating behaviors. Learn all you can about insulin resistance. Don’t be fooled into another diet that is too difficult to sustain. See a dietitian that knows about polycystic ovarian syndrome.

E is the Education and knowledge that you must obtain in order to take care of yourself. PCOS is a chronic condition, not one that requires only medication. YOU must be your own case manager. PCOS involves almost every organ in your body. Learn about lab work and what your results mean. Don’t assume your treatment team is aware of your ‘whole self’. Trust yourself. Don’t be afraid to speak up. Remember, PCOS is a syndrome, a squirrely disorder which pops up in many places.

S is for Support and Healthy Environment. Surround yourself with encouraging people and rid yourself of as much conflict and chronic stress as possible. Pay a little more for organic food and avoid false estrogens in plastics and cleaning products.

T is Teamwork. You can’t do this alone. Ask for help, make plans ahead and let others help you. Being strongly-weak will get you so much farther than being weakly-strong. Assess your treatment team. Are you being seen by too many providers; broken up into too many pieces? Are you taking too many medications?

Y is for YES! Yes is the attitude to have. In order to avoid deprivation backlash, it’s important to focus on what you can have versus what you cannot have. Live with full passion. Y is also for Yesterday. Let go of yesterday and focus on today and tomorrow. Having a positive future-focus will help achieve successful endeavors.

L is for Lower Threshold, not lower calories. Although weight loss is important for some, reducing calories too much can prove counter-productive. People with PCOS can have a lower threshold for oxidative stress. It doesn’t take as much to put the body in stress mode. Exercising too much or restricting too little are stressful on the body. When you do this, you often experience backlash and yo-yo weight gain.

E is for Energy and Experiential Therapies. Learn mindfulness skills. Occupy your body. Achieve mind-body congruity. Change requires an awakening. We awaken in movement, awaken in relationship and awaken in journaling and art. This allows us to be with ourselves, in our own space. It teaches us self monitoring and self regulation, which slows down reactivity.

Stacy Korfist, LMFT
Redondo Beach, California
(310) 720-6443
info@pcosnetwork.com

Polycystic Ovary Syndrome (PCOS) is a complicated, often frustrating condition that affects many women who are experiencing infertility, or may even be a primary cause of infertility. Symptoms typically include recurrent ovarian cysts, excess hair growth (or hair loss similar to male pattern baldness), acne, skin darkening, difficulty losing weight, and, of course, trouble getting pregnant. Often, the condition is not accurately diagnosed until failure to get pregnant results in referral to a reproductive endocrinologist, who has specialized training in PCOS and other endocrine disorders.

Any of these conditions taken singly are difficult to deal with – but the combination is often overwhelming for patients who have been diagnosed with PCOS. PCOS is particularly difficult because it’s under-diagnosed, so you may have years of vaguely troubling symptoms before the diagnosis is made and treatment begins. The physical side effects are unattractive and visible to the world — “I’m fat, pimply, and hairy,” as one of my clients stated tearfully. Friends and relatives may assume that you’re lazy or eat too much, and that’s why you aren’t losing weight. As a result, depression and low self-esteem are very common among women with PCOS.

I was diagnosed with PCOS in my early twenties, and, as both a patient and a professional, I have learned that there are many things you can do to improve the quality of your life and your health with PCOS. You can take control of your health and mood now by doing the following:

Get educated: Do some research on the web, ask your doctor a lot of questions, join a support group and use it, read the RESOLVE newsletter, and stay on top of developments in treatment.

Obtain skilled medical help: Although an internist or general practitioner may diagnose PCOS, it is more likely that a gynecologist, endocrinologist, or reproductive endocrinologist will do so. If you have PCOS, you will most likely want to have an endocrinologist who will prescribe appropriate medications, monitor you for the potential development Type II diabetes, and coordinate with your reproductive endocrinologist while you are trying to get pregnant. Because it is common to experience higher rates of thyroid disorder and heart disease when you have PCOS, it is a good idea to have frequent monitoring.

Your physician can also:

help you lose weight with the assistance of certain medications, and/or referral to a skilled dietician, who can teach you how to eat in a way that contributes to balancing your hormones and managing your symptoms;

refer you to a good dermatologist, who can help to control or eliminate skin conditions related to PCOS, such as skin darkening and acne, and even help with treatments for hair loss;

suggest a therapist or support group to help you cope with the stress of infertility, symptoms of depression, and frustration of dealing with a chronic disease;

Exercise: Yoga will resynchronize your brain, produce deep relaxation, reduce stress, and enhance your acceptance of your body, just as it is in the moment. The cross-lateral motion of walking is also highly effective in regulating PCOS-related insulin resistance, controlling weight – and, surprise! – resynchronizing your brain waves.

Look better so you feel better: In addition to seeking the help of a dermatologist for skin and hair conditions, you might want to actively manage excess hair growth cosmetically. There are many ways to do this, but electrolysis is the only method that has been proven permanent. A licensed electrologist will have a great deal of experience with PCOS patients. Your dermatologist can provide you with a reliable referral.

Although weight gain around the middle is frustrating and hard to overcome when you have PCOS, you can learn how to dress well, no matter your size or shape – and you deserve to do so! Seek out current fashions that are figure-friendly, and get help when you need it – if you’re just not good at putting outfits together, ask a friend who is good at it to go shopping with you, use the free services of a department store personal shopper, or spring for a stylist who will help you figure out what works on you.

Don’t forget your brain: Education is only one element of what your mind needs to effectively cope with the stress of PCOS. Sometimes friends, partners, and physicians aren’t quite enough to help you work through your anger, frustration, irritability, and sadness about having PCOS, not being able to get pregnant, or the difficulty you experience losing weight in spite eating well and exercising regularly. A licensed counselor or therapist can help you decrease stress, develop personalized coping methods, enhance your support group, and identify additional resources. Many therapists utilize mind/body methods that include meditation, guided visualization, mindfulness, and other ways of supplementing your good health practices.

By actively taking care of your physical and mental health and appearance, you can learn to feel better by knowing that you are doing the best you can with a challenging condition.

Dr. Gretchen Kubacky is a licensed clinical psychologist in private practice in West Los Angeles. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders. If you would like to learn more about Dr. HOUSE or her practice, please visit her website at www.drhousemd.com, or e-mail her at Gretchen@drhousemd.com.

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

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.

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The term"anti-inflammatory" has been floating around Facebook, the blogosphere, and Twitter recently. It has, apparently, become the new buzzword. It's an important term, so before it overexposes itself out of your consciousness, I thought it would be good to tackle with regards to what it means to hormone balance.

What is inflammation? It is a condition that exists when the metabolic cost of what you are doing is not adequately balanced with activities that allow for adequate repair and maintenance.

A friend once bought a brand new car. It served her faithfully for a few years…and then, one day, in the deepest cold of winter, it just stopped. After visiting with the mechanic, she asked me what I knew about oil changes. I told her I had them once every 3,000 miles, just as the owner's manual recommended. Through her sheepish facial expression, she shared that she had never once changed or even checked the oil level. Her car died because it had run completely out of oil.

Just like your car, your body will give out on you if you do not balance normal life activities and stresses with repair and maintenance. You need to take time out of your day and spend money in order to keep your car…and yourself…running efficiently and to remain standing over time…but if you don't, the time, money, ad loss you potentially have to spend will be even more.

What are some pro-inflammatory (inflammation-promoting) activities to be aware of?

Any kind of activity that raises your metabolism is pro-inflammatory.

**If you're stressed and not addressing that stress to reduce its influence, you're pro-inflammatory.
**If you're not sleeping, which allows your body's metabolism to slow down for a few hours, you're pro-inflammatory.
**If you're dealing with a chronic medical condition, THAT can be pro-inflammatory. And that can be a double-whammy if the reason you're sick to begin with, is that your body has started to give out from your not making good self-care choices.
**If you're eating a high-carbohydrate diet, or bingeing on sweets, that is pro-inflammatory. Carbohydrates need more of your body's oxygen to be metabolized than do other calorie sources.
**If you're using stimulants, legal or otherwise, to compensate for not sleeping well, that is pro-inflammatory.

Believe it or not, exercise is pro-inflammatory! The trick to using it to your benefit is to use it with respect.
**If you exercise every single day without taking a day off, or if you do the same exercise every time instead of changing it up and resting different muscle groups, it becomes pro-inflammatory.
**If you do not eat enough to fuel the exercise you are doing, that is pro-inflammatory.
**If you exercise so much that you cannot sleep adequately, that is pro-inflammatory.
**If you cut your sleep short in order to get to the gym, that is pro-inflammatory.

If your exercise helps you to manage your stress (provided it is not your ONLY outlet for stress), helps you to sleep, is countered with downtime, and is fueled with an adequate, varied diet, it can be anti-inflammatory. It is HOW you use exercise that matters.

If you are binge eating, not eating, swinging back and forth between the two, eating a limited variety of foods, your nutrition program is pro-inflammatory. It's not just about omega-3's, blueberries, and supplements. It's how everything you eat fits into the big picture that counts.

I think the guys in today's photos are saying it best. It's as much about what you DON'T do…as what you DO do.

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

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

Insulin has a lot to do with it.

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

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

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

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

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

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

And thus the cycle starts, all over again.

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

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

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

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

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

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

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

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

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

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

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

But I digress. Back to prolactin.

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

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

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

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

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

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

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

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

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

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