Even though this blog is primarily devoted to the kind of infertility found in women, it's important to not forget the men. And…to remember that even if you are a male and aren't interested in having children, the same factors that can cause infertility in men who want to have children can be attributed to low testosterone and its associated symptoms: less strength and endurance when working out, fatigue, low sex drive, feeling sad or grumpy, memory issues, trouble concentrating, and trouble enjoying activities you used to find pleasurable. Reversing andropause is, essentially, restoring your fertility.
And, not surprisingly, all of the factors that exacerbate PCOS, are the same ones that exacerbate male infertility and low testosterone. Everything you read in this blog has pertinence to men as well as women.
The top issues I have seen affect testosterone include:
1. Being a night owl. Not sleeping well interferes with insulin function and can cause weight gain. 2. Not enough exercise. 3. Not managing stress. By this I mean ignoring it or leaning too heavily on things like exercise to manage it. With regards to exercise, it's important to find that place of balance, rather than swing between extremes of too much and too little. 4. Eating too much of the pro-inflammatory fats: safflower, sunflower, soybean, corn, cottonseed 5. Drinking too much alcohol, which interferes with sleep patterns.
Because obesity, overexercising and focus on being"buff", stress, and poor sleep habits are common issues in our culture, men are rendered susceptible to more problems with testosterone levels. And to service this population, clinics offering testosterone replacement are becoming more common. While this is certainly an option, I am struck when reading many of the advertisements for these clinics how they tend to play on mens' insecurities in order to motivate them to come in for treatment. This type of treatment is commonly not reimbursed by insurance. You can see where I'm going here.
"Natural" or bioidentical hormone replacement is truly a buyer beware choice. These therapies are not currently FDA approved, which means adverse effects are not even being reported. That means, no one really knows what the long term consequences of such treatments are. Clinics making money off of this issue certainly aren't going to report problems with their product if they're not required to!
It is worth your time to work with a skilled inCYST practitioner to evaluate your diet, sleep, and stress patterns to see if a few tweaks can pull you back into balance, before taking the next, bigger step.
I'm pasting a link to a nice story done by the Today Show yesterday about male menopause to provide some more information.
Practically every time I hear a health professional explain, on the Internet or in person, why a woman with PCOS has carbohydrate cravings, they blame it on insulin resistance. The rationale is, that because glucose is not getting into cells, the cells are hungry and asking for sugar.
Did you know, as rational as this explanation sounds, research does not support it?
A study published in 2004 (and one of the few I've ever even seen that acknowledged that women with PCOS crave sugar) compared several appetite hormones to appetite measures in 16 pairs of women with PCOS matched with controls. They could find no statistically significant correlation between reported appetite and insulin levels. Rather, it was testosterone levels that seemed to be the problem.
Because insulin resistance has some effect on how much free testosterone is available to affect appetite, it could be argued that the effect is still there, but more indirect. However, another study reported that it is the eating of too much sugar and the resulting change in liver function that ultimately determines free testosterone levels, not insulin. (In this particular study the diet was up to 70% sugar, to be sure the desired metabolic effect was achieved and could be studied.) The resulting fat production by the liver was correlated with reduced levels of sex hormone binding globulin, the blood protein that binds to testosterone and inactivates it.
So while the cravings are there, be sure not to blame their cause on a solution that may not help. Our philosophy at inCYST is that balancing fatty acids helps calm down the nervous system and reduce its need for sugar. It also helps the liver better process fats, thus preventing the testosterone issue described above.
I know, I know, you're getting tired of hearing about fish oil.
I won't belabor the point, today I'll just challenge you to think outside the same old test tube.: )
Hirschberg AL, Naessén S, Stridsberg M, Byström B, Holtet J. Impaired cholecystokinin secretion and disturbed appetite regulation in women with polycystic ovary syndrome. Gynecol Endocrinol. 2004 Aug;19(2):79-87.
Selva DM, Hogeveen KN, Innis SM, and Hammond GL. Monosaccharide-induced lipogenesis regulates the human hepatic sex hormone–binding globulin gene. J Clin Invest. 2007 December 3; 117(12): 3979–3987.
Important Lab Tests for PCOS Many women who have PCOS have not had the correct blood work done or don't know what blood tests to ask to have done.I would like to post some important labs used to diagnose and monitor PCOS 1. Total testosterone (elevated levels are > 50ng/dl 2. Free testosterone 3. Luteinizing Hormone (LH) (plays a role in ovulation and egg development) 4. Follicle Stimulating Hormone (FSH) (responsible for egg release from the ovaries) 5. LH/FSH ratio (results should be under 2) 6. DHEA-sulfate (this test tells how much androgens or"male hormones" your body is producing) DHEA sulfate converts into testosterone. 7. Prolactin 8. Thyroid Stimulating Hormone (TSH) this test will help to rule out hypo or hyperthyroidism (slow vs fast metabolism issues) 9. Liver Function tests (LFT's). Important since medications pass through the liver, to check for possible damages. Checking every 3-6 months is recommended. 10. Fasting Lipid Profile: Total Cholesterol (<>45 mg/dl is ideal)Low Density Lipoproteins (LDL) (<130 mg/dl is ideal)Triglycerides (fat in blood) (<150 mg/dl is ideal) 11. Fasting Insulin (results should be <10) difficult to do, it needs to be frozen when brought to the lab and tested before it reaches a certain temperature, expensive but would be very beneficial in determining and monitoring insulin resistance. 12. Fasting blood chemistry panel (includes glucose, electolytes and sometimes renal labs) 13. Fasting glucose to insulin ratio (used to diagnose and monitor insulin resistance, ratio under 4.5 usually indicated insulin resistance)
Ellen Reiss Goldfarb, RD 11500 W. Olympic Blvd, Suite 400 Los Angeles, CA 310-408-1770 info@ellenreissgoldfarb.com
Here's a great summary of the effects of a high-fat diet on your hormones. A diet containing greater than 35% of calories from fat, in overweight conditions, in this study, was found to: --disrupt 24 hour rhythms of secretion of thyroid stimulating hormone, luteinizing hormone, testosterone, and to a small extent, progesterone. --lower total levels of thyroid stimulating hormone and testosterone. --increase cortisol levels and disrupt the normal 24 hour cycle of cortisol release. --induce higher blood glucose in relationship to high cortisol levels. --reduced the magnitude of melatonin release.
So if you've got thyroid problems, can't conceive, can't sleep, and/or feel anxious or overly stressed…or have unexplainable angry outbursts…
…maybe one of the very first and most important things you can do to start to feel better…
…is reduce the amount of fat in your diet. And when you DO choose to eat fat, be sure it's the kind you see consistently recommended in our blog--seafood, nuts, canola, avocado, flax, olives.
It's really pretty simple!
Cano P, Jiménez-Ortega V, Larrad A, Toso CF, Cardinali DP, Esquifino AI. Effect of a high-fat diet on 24-h pattern of circulating levels of prolactin, luteinizing hormone, testosterone, corticosterone, thyroid-stimulating hormone and glucose, and pineal melatonin content, in rats. Endocrine. 2008 Apr;33(2):118-25. Epub 2008 May 1.
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
I was recently asked my opinion about whether or not biotin supplementation would help hair loss. Here's a bit of commentary, plus information about melatonin, another supplement that has been studied.
As with any supplement, it's only going to help if you are indeed deficient in that particular nutrient. There are many reasons you could be deficient in biotin. One of the most relevant to PCOS, is the use of medications valproic acid and carbamazepine. These are seizure medications, also used to treat bipolar disorder and migraine headaches, that have been reported to cause or exacerbate PCOS. So if you've ever been on those medications, you may want to consider supplementation.
If your diet has been out of balance in any way (severe dieting, overeating, eating disorder, cutting out entire categories of food (gluten-free, paleo, vegan, etc.) with a focus on what to eliminate rather than on how to be complete, you may be at risk for biotin deficiency.
It's certainly not going to hurt, and it might help. The dose reported in the literature is 5 to 10 mg per day. However, keep in mind, if your hair loss is primarily related to high testosterone levels and you do not adhere to your complete recommended protocol, biotin will not fix what those problems are causing. It's not a miracle cure.
The best food source of biotin is Swiss chard. Which I was happy about because one of my favorite quick meals is a Swiss chard frittata…I actually planned on making one tonight before knowing this. Nice coincidence!
The other supplement I'm a little more versed in, is melatonin. You all know I'm a big fan of sleep, almost more than diet, for its power to heal. About a year ago, I was poking around in PubMed and found the abstract below, specifically looking at using melatonin to treat androgenic alopecia, which is specifically the type of hair loss you all have. I was coming out of a pretty stressful personal period myself, and had started to notice that my hairline was receding…not fun to look at! So I figured I'd try it myself before writing about it. What I do, is take a melatonin pill, dissolve it in my hand with a few drops of water, and then massage it into my skin with coconut oil. Simply using water didn't work, it needed a carrier. I've noticed that my hair is gradually starting to grow in again. It's not thick and lush, by any means, but it IS growing some hair back.
A caveat here, it won't happen in a week, and you have to be consistent with application. If you're going to flake out about it…don't bother even starting. It's taken almost a year to see a difference. But if you're committed and willing to be persistent, it's definitely worth a try.
Here's the article. Fischer TW, Burmeister G, Schmidt HW, Elsner P. Melatonin increases anagen hair rate in women with androgenetic alopecia or diffuse alopecia: results of a pilot randomized controlled trial. Br J Dermatol. 2004 Feb;150(2):341-5.
BACKGROUND: In addition to the well-known hormonal influences of testosterone and dihydrotestosterone on the hair cycle, melatonin has been reported to have a beneficial effect on hair growth in animals. The effect of melatonin on hair growth in humans has not been investigated so far.
OBJECTIVES: To examine whether topically applied melatonin influences anagen and telogen hair rate in women with androgenetic or diffuse hair loss. METHODS: A double-blind, randomized, placebo-controlled study was conducted in 40 women suffering from diffuse alopecia or androgenetic alopecia. A 0.1% melatonin or a placebo solution was applied on the scalp once daily for 6 months and trichograms were performed to assess anagen and telogen hair rate. To monitor effects of treatment on physiological melatonin levels, blood samples were taken over the whole study period.
RESULTS: Melatonin led to a significantly increased anagen hair rate in occipital hair in women with androgenetic hair loss compared with placebo (n=12; P=0.012). For frontal hair, melatonin gave a significant increase in the group with diffuse alopecia (n=28; P=0.046). The occipital hair samples of patients with diffuse alopecia and the frontal hair counts of those with androgenetic alopecia also showed an increase of anagen hair, but differences were not significant. Plasma melatonin levels increased under treatment with melatonin, but did not exceed the physiological night peak.
CONCLUSIONS: To the authors' knowledge, this pilot study is the first to show that topically applied melatonin might influence hair growth in humans in vivo. The mode of action is not known, but the effect might result from an induction of anagen phase.
Castro-Gag M, Pérez-Gay L, Gómez-Lado C, Castiñeiras-Ramos DE, Otero-Martínez S, Rodríguez-Segade S. The influence of valproic Acid and carbamazepine treatment on serum biotin and zinc levels and on biotinidase activity. J Child Neurol. 2011 Dec;26(12):1522-4. Epub 2011 Jun 3.
Wolf B. EditorsIn: Pagon RA, Bird TD, Dolan CR, Stephens K, editors. Biotinidase Deficiency. SourceGeneReviews [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2000 Mar 24 [updated 2011 Mar 15].
Zempleni J, Hassan YI, Wijeratne SS. Biotin and biotinidase deficiency. Expert Rev Endocrinol Metab. 2008 Nov 1;3(6):715-724.
Yesterday I reported on research suggesting that myoinositol was effective in creating more viable eggs than d-chiro-inositol, but qualified that the study was performed on women with PCOS whose insulin function was normal. Guess what…myoinositol does that too!
Again, this experiment was conducted in conjunction with the administration of folate, so realistically re-creating this in your own home laboratory may require both.
Forty-two women with PCOS were treated in a double-blind trial with myoinositol plus folic acid or folic acid alone by itself. The myoinositol group, at the end of the study, experienced lower serum total testosterone, serum free testosterone, plasma triglycerides, systolic blood pressure, diastolic blood pressure, and area under the plasma insulin curve after oral administration of glucose. And insulin sensitivity increased. 16 out of 23 women given myoinositol group ovulated, compared to 4 out of 19 in placebo group.
When this information is combined with the information I wrote about yesterday, what it seems to say is that myoinositol creates an environment where a pregnancy is not only more likely to occur and but also to sustain itself. One of the frustrations I have expressed here before is that while metormin helps to increase ovulation rate, it doesn't transfer to babies at the end of the path. I don't have to tell you how frustrating it is to know you've got half the system up and running and nothing you try seems to make the other half cooperate.
Costantino D, Minozzi G, Minozzi E, Guaraldi C. Metabolic and hormonal effects of myo-inositol in women with polycystic ovary syndrome: a double-blind trial. Eur Rev Med Pharmacol Sci. 2009 Mar-Apr;13(2):105-10.
Genazzani AD, Lanzoni C, Ricchieri F, Jasonni VM. Myo-inositol administration positively affects hyperinsulinemia and hormonal parameters in overweight patients with polycystic ovary syndrome. Gynecol Endocrinol. 2008 Mar;24(3):139-44.
In my last post, I talked about the relationship between depression and PCOS; this post addresses anxiety and PCOS. Although we may tend to think of anxiety and depression as two different and distinct conditions or diagnoses, in fact, there's a lot of overlap. As a therapist, I end up assessing to see whether depression or anxiety is the more dominant condition, but I almost always end up treating some degree of both conditions.
Women with PCOS are well aware that their state of well-being is affected by their hormonal balance. Estrogen, progesterone, testosterone, melatonin, and cortisol all play vital roles in mood regulation as well as physical well-being. Depression is often a symptom of estrogen deficiency. Irritability and anxiety can be indicators of progesterone deficiency or estrogen excess. Likewise, testosterone deficiency can contribute to symptoms of anxiety, not to mention reduced energy and initiative (which is where you can start to see the overlap with depression symptoms). Melatonin deficiency contributes to anxiety and nervousness and disrupts sleep, which can further contribute to development of insomnia and depression. Inadequate cortisol as a result of too much stress can also result in symptoms of anxiety and depression.
The endocrine system is so complex, and PCOS patients typically are managed with hormone-affecting medications such as birth control pills and diabetes medications. If not properly balanced, side effects of such medications may include moodiness, irritability, and other symptoms that either mimic or exacerbate anxiety conditions. Medications that are prescribed for treatment of anxiety may include special anti-anxiety medications, but anxiety symptoms are often treated with depression medications, like the SSRIs (Zoloft, Celexa, etc.). Some anti-anxiety medications can be addictive if overused or misused.
To further complicate matters, your physician may not be aware of the complex interaction and possible healing benefits of proper nutrition and PCOS-specific supplementation that can dramatically lessen symptoms, and even eliminate the need for some medications. All of our neurotransmitters (those things in the brain that help generate the happy, sad, and anxious feelings) can be positively affected by the proper fuel as well as mind/body treatments that include stress management, meditation, mindfulness, exercise, yoga, hypnotherapy, etc. Just as the body yearns for homeostasis, so does the brain. The brain actually reshapes itself in response to stress, trauma, and our interactions with other people — that's true for the good as well as the bad.
So even if you have experienced a lot of negative things that are contributing to feelings of being anxious, there are many ways to approach the problem — and medication is only one of the possibilities in a big bag of therapeutic tools. Although your hormones are powerful influencers of mood and anxiety, so are nutrition, supplementation, and a proactive approach to therapy and other forms of support.
Here's a study about lean women with PCOS--the women who I like to call"the forgotten cysters". I have lost track over the years of the number of women who have written me to share that they went to their physician asking for help with a list of PCOS symptoms they had…only to be told they couldn't possibly have PCOS because they were not overweight. Up to 70% of women who have this disorder are not overweight!!!
My belief is that many women who have adopted extreme eating and exercise behaviors to manage their weight, quite possibly many women who have been diagnosed with and who are being treated for eating disorders, actually have undiagnosed PCOS.
We need to get over this belief that thin equals healthy, and that a person cannot have PCOS if her BMI and weight are within normal limits. If you have to adopt extreme measures to stay within your recommended weight range, that is a serious problem and your physician needs to listen to you.
Now for this study to illustrate. Eight lean women who actually had been diagnosed with PCOS ("cysters") were compared to 7 lean women without PCOS. The cysters had higher testosterone, and prolactin levels. They also had lower sex hormone binding globulin levels (this protein binds and inactivates testosterone).
There you have it. You can be thin AND out of balance. Sisters…and cysters…it is your right to be heard and to not be told that nothing is wrong with you when you know there is. That is where my program name, inCYST, came from. You have the right to inCYST on the appropriate treatment for the appropriate problem and not to be told you do not need treatment just because you may not fit the common profile for PCOS, or for any disorder.
Grimmichová T, Vrbíková J, Matucha P, Vondra K, Veldhuis PP, Johnson ML. Fasting insulin pulsatile secretion in lean women with polycystic ovary syndrome. Physiol Res. 2008 Feb 13 [Epub ahead of print]
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 atwww.drhousemd.com, or e-mail her atGretchen@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.
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.
I recently had an animated discussion on our Facebook Fan Page with a woman about protein for vegans. Her argument is that women with PCOS simply need to eat less carbohydrate and that their protein intake is adequate.
I challenged her on that. First of all, if she is vegan, she has PCOS, and she is a member of our Facebook page, it suggests that maybe there is a piece she is missing. I am not telling anyone who is vegan with PCOS that it is wrong or impossible to have and do both…but if that is your choice, it is super important that you be informed and diligent in order that the choice not backfire on you.
Here is why I say that.
Women with PCOS are insulin resistant; most of them are going to be diabetic at some point in their lives. We know that insulin resistance makes it hard to maintain muscle mass. Diabetics as they age, in fact, lose their muscle mass twice as rapidly as people who are not diabetic.
Part of the way to maintain muscle, is to regularly exercise muscles. You all have a nice friend, your testosterone levels, that can help you out in that department…PROVIDED YOU DON'T OVERDO IT.
The other part you need, because all of the strength training in the world is pretty useless if you're not eating enough protein for your muscles to incorporate with those workouts, is protein.
If you are losing muscle mass at twice the rate of the average person, the amount of protein you need to eat in order to account for that accelerated loss has got to be higher. I'd love for us to study this someday when we've raised the funds to do so.
For now, assume that the recommendations made for vegans are made for healthy vegans, not vegans who are struggling with a complicated hormone balance.
I can tell you, from my experience, women who come for help with their PCOS are not eating enough protein. And the vegans I work with, as well-intended as they are, are often not eating in a way that accounts for the fact that most vegan protein sources are also high in carbohydrates. You really have to know what you are doing and look specifically at your own eating to see if the balance is good.
We have also noticed here at inCYST, that a pretty high percentage of women we work with, at some point in their lives, were vegan. There is clearly something about eating vegan that sets your hormones up to rebel. Don't let assumptions get in the way of making your vegan eating a component of your path to health.
If you're getting your vegan information from someone who doesn't work with PCOS, it may not be the right information.
You need more protein than you may be aware of. If you're not sure if you're getting it, let us work with you to figure it out.
This past Wednesday, Sasha Ottey of PCOS Challenge interviewed Walter Futterweit, MD, a longtime PCOS researcher and advocate. He provided a great summary of the laboratory tests you should be getting and why. I'm providing that summary here.
If you'd like to listen to the interview with Dr. Futterweit in its entirety, please visit Sasha's Blog Talk Radio page.
Adrenal hormones--these test rule out an adrenal problem, necessary to do to be sure it's actually PCOS
17 hydroxy progesterone (drawn between 5 and 9 of a menstrual cycle)--rules out the diagnosis of nonclassic congenital adrenal hyperplasia.
(Normal levels are 15-70 ng/dl prior to ovulation, and 35-290 ng/dl during the luteal phase. )
DHEAS (dehydroepiandrosterone sulfate)
Typical normal ranges, according to NIH, for females, are:
Prolactin levels, which rule out a prolactin producing tumor, as well as the effects of some medications such as Risperdal, which can elevate prolactin levels
•Non-pregnant females: 2 — 29 ng/mL
•Pregnant women: 10 — 209 ng/mL
Tests to monitor thyroid function
T4
A typical normal range is 4.5 to 11.2 micrograms per deciliter (mcg/dL).
TSH
Normal values are 0.4 — 4.0 mIU/L.
SHBG (sex hormone binding globulin) — helps to evaluate how much of your testosterone is bound/inactive and how much is free and available to cause androgen-related symptoms.
Normal values:
Follicular phase of menstrual cycle 24 — 200 nmol/L Luteal phase of menstrual cycle 48 — 185 nmol/L Contraceptive use 89 — 379 nmol/L Postmenopausal 46 — 200 nmol/L
Insulin function
Fasting insulin level Normal values: less than 13 mIU/ml
2 h glucose tolerance test Depends on the laboratory's protocol. Typical values can be found at the link directly above.
***************************************************************************** Dr. Futterweit did not mention vitamin D testing but since low vitamin D levels are commonly found in women with PCOS, I'd recommend that as well.
Last week on the PCOS Challenge Radio Show, I was asked about the relationship between CoQ10 and fertility. I promised Sasha I would investigate the issue, since I did not have an informed answer on the tip of my tongue. Here is that answer!
My gold standard for information is peer-reviewed literature in the National Library of Medicine database. When I used the keywords,"CoQ10" and"PCOS", there were no studies listed. When I used the keywords,"CoQ10" and"fertility", 16 different references appeared, but none of those references were about fertility in women. Two studies did report an association between low CoQ10 levels and miscarriage.
When I used the keywords,"fertilization" and"CoQ10", abstracts from the list of studies done on men were all that appeared.
Bottom line: CoQ10 could be important for conception and maintaining pregnancy, but there have been very few studies on the topic, and none of them that I found had a recommended dose. It may be important with this particular supplement to consider the father's regimen as well.
What is CoQ10, anyway? CoQ10 is an antioxidant made by our own bodies. As the Mayo Clinic writes, CoQ10 levels are reported to decrease with age and to be low in patients with some chronic diseases such as heart conditions, muscular dystrophies, Parkinson's disease, cancer, diabetes, and HIV/AIDS. Since PCOS is a pre-diabetic, inflammatory condition, it makes sense that there would be interest in its role in this diagnosis as well. The link I provided above also evaluates the strength of the evidence supporting the use of CoQ10 for a variety of medical conditions.
For adults, Mayo also reports a dose 50-1,200 milligrams of CoQ10, in divided doses, by mouth, to be what was commonly reported.
Even though CoQ10 may help prevent miscarriage, it has also been known to reduce blood glucose levels. This can be a plus…but when another life is being taken into consideration, and the detailed effects of exactly how blood glucose responds to CoQ10 in supplemental amounts, given the fact that the use of CoQ10 has not really been studied during pregnancy, my first inclination is to not recommend it for women with PCOS who are trying to conceive and who may be pregnant without knowing it.
CoQ10 levels have been found to be lower in people using certain medications, such as statins (which lower cholesterol), beta-blockers (which stabilize heart rate), and blood pressure medications. If you are not trying to conceive and you are on medications in any of these categories, it wouldn't hurt to ask your pharmacist and physician about the potential benefits of supplementation.
CoQ10 is an antioxidant. It makes sense to me that in an inflammatory condition such as PCOS, there would be a risk of lower levels. But rather than view this as a situation where you have PCOS because you have low levels of CoQ10, I encourage you to consider whether your CoQ10 levels are lower than they should be, because of choices you are making that promote inflammatory processes. This blog is full of information about ways to slow down inflammation (which, in essence, is accelerated aging). There are many things you can do which can head off the need for even needing a supplement.
And you thought this potentially magical compound was going to replace the need for healthy eating, activity, stress management, and sleep hygiene choices. Cyster friends, if that was true, you wouldn't have spent all that money on all that CoQ10 and still be here looking for another answer. Dang!
Mancini A, Leone E, Festa R, Grande G, Silvestrini A, de Marinis L, Pontecorvi A, Maira G, Littarru GP, Meucci E. Effects of testosterone on antioxidant systems in male secondary hypogonadism. J Androl. 2008 Nov-Dec;29(6):622-9. Epub 2008 Jul 17.
Littarru GP, Tiano L. Bioenergetic and antioxidant properties of coenzyme Q10: recent developments. Mol Biotechnol. 2007 Sep;37(1):31-7. Review.
Li W, Li K, Huang YF. [Biological function of CoQ10 and its effect on the quality of spermatozoa]. Zhonghua Nan Ke Xue. 2006 Dec;12(12):1119-22. Review. Chinese.
Mancini A, De Marinis L, Littarru GP, Balercia G. An update of Coenzyme Q10 implications in male infertility: biochemical and therapeutic aspects. Biofactors. 2005;25(1-4):165-74. Review.
Li K, Shi Y, Chen S, Li W, Shang X, Huang Y. Determination of coenzyme Q10 in human seminal plasma by high-performance liquid chromatography and its clinical application. Biomed Chromatogr. 2006 Oct;20(10):1082-6.
Sheweita SA, Tilmisany AM, Al-Sawaf H. Mechanisms of male infertility: role of antioxidants. Curr Drug Metab. 2005 Oct;6(5):495-501. Review.
Balercia G, Mosca F, Mantero F, Boscaro M, Mancini A, Ricciardo-Lamonica G, Littarru G. Coenzyme Q(10) supplementation in infertile men with idiopathic asthenozoospermia: an open, uncontrolled pilot study. Fertil Steril. 2004 Jan;81(1):93-8.
Mancini A, Milardi D, Conte G, Bianchi A, Balercia G, De Marinis L, Littarru GP. Coenzyme Q10: another biochemical alteration linked to infertility in varicocele patients? Metabolism. 2003 Apr;52(4):402-6.
Balercia G, Arnaldi G, Fazioli F, Serresi M, Alleva R, Mancini A, Mosca F, Lamonica GR, Mantero F, Littarru GP. Coenzyme Q10 levels in idiopathic and varicocele-associated asthenozoospermia. Andrologia. 2002 Apr;34(2):107-11.
Ducci M, Gazzano A, Tedeschi D, Sighieri C, Martelli F. Coenzyme Q10 levels in pigeon (Columba livia) spermatozoa. Asian J Androl. 2002 Mar;4(1):73-6.
Palmeira CM, Santos DL, Seiça R, Moreno AJ, Santos MS. Enhanced mitochondrial testicular antioxidant capacity in Goto-Kakizaki diabetic rats: role of coenzyme Q. Am J Physiol Cell Physiol. 2001 Sep;281(3):C1023-8.
Sinclair S. Male infertility: nutritional and environmental considerations. Altern Med Rev. 2000 Feb;5(1):28-38. Review.
Alleva R, Scararmucci A, Mantero F, Bompadre S, Leoni L, Littarru GP. The protective role of ubiquinol-10 against formation of lipid hydroperoxides in human seminal fluid. Mol Aspects Med. 1997;18 Suppl:S221-8.
Lewin A, Lavon H. The effect of coenzyme Q10 on sperm motility and function. Mol Aspects Med. 1997;18 Suppl:S213-9.
Angelitti AG, Colacicco L, Callà C, Arizzi M, Lippa S. Coenzyme Q: potentially useful index of bioenergetic and oxidative status of spermatozoa. Clin Chem. 1995 Feb;41(2):217-9.
Mancini A, Conte B, De Marinis L, Hallgass ME, Pozza D, Oradei A, Littarru GP. Coenzyme Q10 levels in human seminal fluid: diagnostic and clinical implications. Mol Aspects Med. 1994;15 Suppl:s249-55.
Noia G, Littarru GP, De Santis M, Oradei A, Mactromarino C, Trivellini C, Caruso A. Coenzyme Q10 in pregnancy. Fetal Diagn Ther. 1996 Jul-Aug;11(4):264-70.
Noia G, Romano D, De Santis M, Cavaliere AF, Straface G, Alcaino S, Di Domenico M, Petrone A, Caruso A, Mancuso S. [The antioxidants (coenzyme Q10) in materno-fetal physiopathology][Article in Italian] Minerva Ginecol. 1999 Oct;51(10):385-91.
Our blog statistics have shown over time, that we get quite a bit of regular traffic from the other side of the world. I have to admit, my advice is hemisphere-centric, since I've never been south of the Equator. So I invited a friend from Australia, Olwen Anderson, who works with PCOS in her part of the world, to share a little bit of advice. Here's hoping for our Aussie readers, it introduces you to someone close to you who can help you, and that what Olwen has to say, is helpful!
Legumes are a girl’s best friend… when you have PCOS
Olwen Anderson is an Australian Nutritionist-Naturopath who specialises in treatment of hormone imbalances and gut disorders. Her blog contains lots of PCOS-friendly recipes: Visit www.olwenanderson.com.au
Been diagnosed with PCOS? Meet your new nutritional “best friend” – legumes.
When you think about food as medicine, legumes should almost be a compulsory prescription for good health. These amazing little vegetables are packed to the brim with nutrition that can help moderate your hormones. They taste great; and once you learn how to prepare and use them, they will open up a whole new culinary world for you.
Legumes include chick peas (or garbanzo beans), black eyed beans, haricot, lima beans, kidney beans, soy beans and many other dried beans that are a staple food in many countries. In fact, legumes are one of the powerful plant foods common in countries where people routinely live happy, productive lives to 100 plus.
Phytoestrogens and fibre are two outstanding features of legumes that will benefit you. Phytoestrogens are naturally occurring plant chemicals that have a molecular shape similar to estrogen. When digested, they ‘latch on’ to the estrogen receptors of cell membranes, and effectively block real estrogen molecules from connecting with the cell. This means that when you have plenty of the right fibre in your diet, you’re automatically reducing the effects of excess circulating estrogen.
Its good bacteria in your intestines that convert plant phytoestrogens to their active form. These good bacteria feed and breed on soluble and insoluble dietary fibre. Fortunately legumes are packed with fibre, so your intestinal bacteria will love them. When there’s plenty of fibre in your diet, your body produces more sex hormone binding globulin. This transporter molecule travels through your bloodstream, picking up and removing excess hormones, including excessive androgen hormones like testosterone. Exactly what you want to happen in your body.
Even better, legumes are packed with nutrients: Some protein, a little of the good fats, and complex carbohydrates. They’ll take ages to digest, resulting in smoother blood glucose management; and they’re packed with minerals too.
But won’t they make me flatulent?
Many women worry that if they start enjoying legumes, they will become windy. To prevent this, start with small quantities (about one tablespoon) and build up over a few days to half a cup so your intestinal bacteria have a chance to adjust.
It’s easy to incorporate legumes into your diet every day:
- Sprinkle chick peas (garbanzo beans) through your salad
- Enjoy some home made baked beans for breakfast with poached salmon
- Fresh broad beans, steamed and mashed, make a great vegetable side dish
- Include legumes in your stews, casseroles and soups. Like minestrone soup; or lentil stew.
You can buy legumes canned; but the dried variety, cooked, taste so much better. (Also, avoiding canned food helps you avoid suspected endocrine-disrupting chemicals like BPA). Buy dried legumes, soak for a few hours, boil until cooked, (firm but not crisp), then freeze in portion size containers.
I always keep containers of cooked legumes meal-ready in the freezer. Then, if I want a quick meal, I can take one out, stir-fry in a hot pan with garlic, spices, some kangaroo fillet, a few baby tomatoes and a handful of baby spinach leaves. Fast, healthy, one-pot cooking.
Looking for recipe inspiration to enjoy legumes?
- Visit my web site at www.olwenanderson.com.au (recipes tag on the blog)
- Look at recipe books for cultures where legumes are part of the daily diet: South American, Mediterranean, Indian.
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
If your PCOS has you struggling with weight, chances are, you have an ongoing battle with the scales. I encourage you to give up that battle.
First of all, when you are in good shape, chances are you are going to be able to carry more weight than a woman without PCOS and look leaner than someone without PCOS. As the photo here suggests, the only thing the scales tells you, at any given point in time, is how much you happen to be resisting gravity at the moment you measure yourself. It really is not an indication at all, of who you are as a person.
Secondly, if you haven't exercised much in awhile, because of your testosterone levels, when you start to exercise, you will put on muscle more easily than the average woman. This is going to work in your favor, over time, because muscle mass is your very best weapon against insulin resistance. If you freak out and stop exercising because you have gained weight early on…you have missed the point! If you have gained weight but lost inches, you are on the right track. Hang in there. It will all fall together, if you are consistently exercising.
Thirdly, something your body will do, as an adaptation to regular exercising, is start to store glycogen to fuel that exercise. Glycogen is a stored carbohydrate that your body becomes proficient at storing to help your blood sugar and energy levels stay stable during your runs/swims/spin classes. Every gram of glycogen that you store in your muscles and liver is stored with 3 grams of water. This water is important water, as it is released while you exercise and it helps keep you from becoming dehydrated while you're working out. A well-trained athlete can carry about 10 extra pounds of glycogen and water that simply is not there if you are not regularly training. But it is not fat, and it is not bad weight, and without it, you likely will feel miserable because you are not well fueled or hydrated.
If you have been restrictive with your diet, and you work out pretty hard…and then you go have a regular meal…of course the scale will jump! Your body is doing what it is supposed to do, start storing fuel and water for the next workout. The absolute worst possible thing you can do is try to control these fluctuations by cutting your calories.
Honestly, I can't even remember exactly when I last weighed myself…I think it was sometime last summer and I can't even tell you what the scales said when I did. I know my clothes fit pretty much the same as they usually do, and when they have been a little tight it's been right before my period and it resolves after about a week, and I know that is normal so I don't stress about it.
If you're not at that level of comfort with body yet, if you can't envision even being there, I'd like to ask you to do at least this:
-If you must weigh yourself, only compare Sundays to Sundays and only compare Sunday mornings to Sunday mornings.
- Once you have enough data points, only compare the Sunday after your period to another Sunday after your period.
The surest way to set off unnecessary exercising, or restrictive eating that is sure to set off a binge later, and to sabotage your overall progress in the long…is to weight yourself multiple times daily and assume that the numbers you see are 100% based on calories in and calories out. Anything you do in response to multiple daily weigh ins, is not based in proven exercise science or nutritional math. It is emotional and disordered.
The more you hear that from us, and the more you recognize that anything you do in response to disordered ideas about nutrition, calories, and exercise, the better chance you have at recognizing that these thoughts and feelings are based on anxiety. When you fight anxiety with responses that can help the anxiety, rather than behaviors that may actually DRIVE the anxiety cycle (think playing with the dog, participating in a hobby, reading a book that has absolutely nothing do do with self help, food, infertility, or hormones) that is when your weight actually starts to stabilize.
It's not uncommon to read blog posts, tweets, and chat room conversations in which women with PCOS describe their depression, and attribute it to the weight gain and appearance that their PCOS has promoted. It can be easy to blame the discomfort, fatigue, restless, and anxiety that depression provokes, on tangible and unwanted physical changes
A recent study helps to verify what I've believed all along…that depression, like hirsutism, weight gain, and infertility, is another condition that PCOS has potential to create. It is not the result of other symptoms associated with PCOS.
Here's the study.
Thirty women with PCOS and thirty women without PCOS participated in this study. All subjects had similar BMI's/weights. Only women who were not on any psychotropic medication were included. Women with PCOS scored higher on an anxiety scale than women without PCOS. They also slept less, worried more, and experienced more phobias than women without PCOS. Weight was not associated with any of the symptoms, except for sleep.
In other words, regardless of your weight, you can be depressed if you have PCOS.
If you attach or blame your depression on your weight, your appearance, or your infertility:
--you can set yourself up for an eating disorder…if you actually lose weight and discover it didn't change how you feel. --you can feel even worse if you spend time and money on cosmetic surgery, only to realize you don't feel as good as you hoped you would. --you can put yourself through the tremendous stress of infertility treatment, and get the baby, only to discover that you still feel depressed, and now you've got a baby who isn't sleeping through the night who is dependent on you.
That's the bad news. The good news is that the inCYST program is very helpful at reducing anxiety and depression. So in addition to helping you normalize your weight, reducing the progression of testosterone-related programs, and increasing your fertility, it helps you to feel better. It literally rebuilds your nervous system so it can reduce the influence depression can have. And in rebuilding the nervous system, it helps to balance hormones so that symptoms can lessen.
We like to focus on feeling better, since we know that in women who do, the other problems tend to fall into place. That's not to say that being anxious about your PCOS doesn't worsen when you focus on your symptoms, and that when you learn better coping skills you won't feel even better. Gretchen Kubacky has done a great job of discussing that here, on her blog, and on PCOS Challenge.
It's just that you want to be sure you're tackling the core cause of the problem, and not simply putting band-aids on the symptoms. Nothing can be more frustrating than investing all your time, resources, and money into diets and medical procedures, only to feel the same or even worse once you've done so.
Anxiety and depression symptoms in women with polycystic ovary syndrome compared with controls matched for body mass index
REFERENCE E. Jedel1, M. Waern2, D. Gustafson2,3, M. Landén4, E. Eriksson5, G. Holm6, L. Nilsson7, A.-K. Lind7, P.O. Janson7 and E. Stener-Victorin8,9 Anxiety and depression symptoms in women with polycystic ovary syndrome compared with controls matched for body mass index
1 Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden 2 Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 3 Rush University Medical Center, Chicago, IL, USA 4 Department of Clinical Neuroscience, Section of Psychiatry, Karolinska Institutet, Stockholm, Sweden 5 Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 6 Department of Metabolism and Cardiovascular Disease, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 7 Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 8 Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 434, 40530 Gothenburg, Sweden
You may know of melatonin as a potent sleep aid. So much so, that if you took melatonin and you did not experience an enhanced ability to sleep, you stopped taking it.
Did you know, melatonin is a very powerful antioxidant as well? Some of the benefits of this compound relevant to PCOS include:
--lowered blood pressure --improved memory --reduced adrenal gland activity and cortisol secretion --reduced cortisol response to stress --reduced blood glucose, insulin levels, and insulin response to a glucose load --reduced cholesterol and triglycerides --reduced testosterone levels --increased progesterone synthesis --slows gastric emptying (which can help you to feel fuller, longer)
That's a lot of stuff! And it's not just not sleeping well that interferes with melatonin metabolism. So does fasting and starvation…which includes any kind of radical diet, including the medically supervised ones and the HCG ones. Melatonin levels in all three types of eating disorders, anorexia, bulimia, and binge eating disorder, are disrupted. Obesity suppresses normal melatonin daily rhythms. Omega-3 deficiency reduces melatonin synthesis and total tissue levels.
Vitamin deficiencies such as B12, zinc, and magnesium, can interfere with good melatonin status. When I read that, I immediately thought of the many vegetarians reading this blog, as those are common deficiencies when vegetarian eating is not proactively balanced.
Normal melatonin metabolism may be dependent on physical activity.
I'm well aware that many people reading this blog are looking for a magic supplement to erase the need for making healthy lifestyle choices. If you choose to supplement with melatonin, it likely will not hurt you, and it may help you to restore normal sleep patterns, but it will never replace the power of regular, adequate sleep. Just sayin'.: )
If you've never used melatonin before, and you decide to start, you may want to try it on a night when it's not essential that you be up and functioning early the next day. It can have a paradoxical reaction in some people.
And, if you happen to be a professional pilot, the FAA advises against using melatonin while on duty. It certainly wouldn't hurt on your days off, especially if you've been on some grueling red eye flights, just beware of this disclaimer while officially on duty.
I have an extensive list of references I've collected from which this blog post was derived. If you would like them you can contact me directly.
Bottom line, if you don't value sleep, your body is going to have a really, really, really hard time being healthy.
