The Hemp Connection [Search results for tiredness] 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Is depression an inevitable consequence of PCOS, or any other hormonally related diagnosis, for that matter? We know that the diabetic population experiences a rate of depression nearing 30% overall, which is significantly higher than the rate of depression in the general population. Women tend to suffer from depression, or it's lesser cousin, dysthymia ("depression light"), far more than men. The infertility that results from PCOS is yet another common cause of depression. Looking at all these causative health factors almost makes depression seem like an inevitability if you have PCOS, doesn't it?

However, it's important to remember that depression is not a thing — it is not a particular spot in the brain, an object like a tumor in your body, or even a set of cells that gets activated and can be turned on and off like a light switch. Depression is a concept — a construct that tries to define and systematize a sometimes vague set of symptoms that includes tiredness, loss of energy, loss of interest in things that once brought you joy, weight gain or loss, sleep difficulties, and even thoughts of suicide.

So, even if you have a diagnosis of depression or dysthymia, remember that you are not your symptoms. You are an individual who has a certain set of symptoms, but how you approach the management of those symptoms is subject to your individuality. Just as you must personalize other aspects of your PCOS treatment, you must personalize treatment for depression or dysthymia. This may include individual therapy, group therapy, support groups, mindfulness, meditation, dietary changes that support better brain chemistry, supplements, or perhaps antidepressant medications.

If you are feeling depressed, talk to your primary health care practitioner about your symptoms. They are not necessarily an inevitabile outcome of living with PCOS, and there are many ways to obtain relief. In a future post, I'll be discussing the prevalence of anxiety and anxiety disorders in women with PCOS, how depression and anxiety overlap, and what you can do to decrease your anxiety.

Gretchen Kubacky, Psy.D.
Los Angeles, CA 90064
ph: (310) 625-6083
gretchen@drhousemd.com