Archive for January, 2012

Hungry or angry as hell

I have spent much of the last ten years of my life hungry.  Part of that is because of our fucked up food culture and egregiously tasty desserts, but that’s been the target of many posts so I’ll leave it alone today.  My new target comes in two forms: politics and perfectionism.  I don’t know which one I hate more.

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The health risks of women being– hell, of having –fat have been grossly exaggerated.   Many of the studies conducted on correlations between heart disease risk and being overweight have been conducted on men, and then erroneously applied wholesale to women.  That was unwise.   We know that women have higher body fat percentages than men: but by how much?   How much should they?  What have we lost sight of?  Is it possible to be objective in cultural context?

Women do not just have higher body fat percentages than men, but perform better at even higher levels.  A BMI of 25 is considered “overweight” and 18 is considered the limit for “underweight” in women. 18-21 is considered ideal (by whom and subconsciously conditioned by what I ask you), but menstrual irregularities, sexual dysfunction, and poor mental health are statistically much greater risks at all BMIs less than or equal to 22.   Women at BMIs from 22 all the way up through the high 20s perform equally well in mortality and health statistics.  Additionally, women increase in body fat percentages  as they age, while men decrease.  This is true of ALL cultures, not just Americans.  FINE.   LET’S LET IT BE THAT WAY.

Women are told their entire lives that they need to be thin.  The rational question to ask at this point is “why.”  This is not the healthy ideal.  Where does this idea come from?  Many feminist sociologists point to the history of the 20th century.  As female power has grown, masculine-dominated culture (not men) has searched for ways to harness the power.  How can we keep women under thumbs?  Can we give them ideals?  Can we give them impossible ideals?  Can we take something genuinely beautiful to an extreme, such that young bulimic women are the norm in Calvin Klein ads?  The problem is not that women want to be anorexia twiggy things like models.  They don’t, at least not consciously.  The problem is that they want to be thin, a word we think is perfectly neutral, and even that is in many cases just too far.   The word fit is even positive.  But is a fit women without an ounce of fat on her hips fertile?  Not likely.

This phenomenon has a root in male affinities for visual aesthetics.  Fine, that’s cool, I don’t begrudge them that.

But what happens when a masculine culture that used to arbitrate the distribution of all privileges begins to lose them?  Where does the pressure give?   Lots of people think it gives with hunger.  They make a good case.  People who experience a loss of 25 percent of their body fat (this is a simple drop from a 25 to a 19 BMI, for example… something common and something I have voluntarily done) experience extraordinary psychological distortion.  They ferret away food, keep trinkets, draw obsessive pictures about themselves, become possessive about food, obsess over food, lose sleep over food…. the list of symptoms is endless.  Picture this happening to a group of men.  It has.  It did.  At war, in laboratories.  Not often.  Men can be victims of eating disorders, too.  My point is: think about a man with an eating disorder.  Think about him hunched over a toilet, think about him staggering out of a stall, think about him sitting down at a business lunch and munching on ice and lemon scraping the sauce off of his plate and staring fixedly at the dessert plate, obsessing over what food is an acceptable choice, which one will make him hate himself less… does that horrify you?  It should.  Put a women in his place.  Does that horrify you?  It should.  I bet it’s less surprising.  I bet it feels normal.  I bet it feels even a little bit acceptable.

What.

Is.

Wrong.

With.

Us.  

Problems with body image go beyond politics, of course.  Men and women alike suffer, though women far more so, and to far more deleterious effects.  Only women suffer increased risk for infertility, for ovarian and endometrial cancer, for miscarriage, for low birth weight, and for osteoporosis via having a body fat below ~22 BMI.   Politics and fashion and culture are destroying us.  Our perfectionist ideals are destroying us, too.

Perfectionism is a demon all it’s own.  Who says we have to be perfect?  Why?

Feminists have perhaps even more to say about perfectionism than they do about the politics of food.   Women have gone from being subjugate to demanding perfection in a matter of decades.   This is possibly because of women’s station as the under dog.   Young girls grow up throwing punches, told they really can have it all, but they’ve got to work at it, and like hell, they sure as fuck aren’t going to fail.   Women on college campuses are expected to be perfect without trying.  They might take hours getting ready… dressed in torn up jeans, flip flops, and a sweat shirt.  Ironed hair, perfect, discrete make-up, hundreds of dollars in beauty products on every inch of their body.  This look is sexy and casual.  They’re beautiful and high achievers and you wouldn’t even know it’s killing them.

But it is.  At least 1 in 5 women in colleges experience disordered eating behaviors and thoughts about food, increasingly commonly about bingeing.  That number goes up to 1 in 2 when it’s limited to “food and body image associations” at some elite schools.

Tell me you don’t know what I’m talking about.

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Here are some more types of perfectionism on which to plant your rage:

Perfectionism is destructive in every aspect of our lives.  In order to be perfect, we are obsessive not just about our lives, but about our bodies.  In order to love ourselves, and to feel loved by society, we need to be as perfect as possible.   This fact used to kind of excite me.  Someone kick me, please.

We are perfectionists because we don’t know how to be anything else.   Not only are we totally isolated in a world in which everything is crumbling around us and there is not a drop of security or safety or feelings of home to be found, but there’s a gap of meaning in contemporary culture and we don’t know how to fix it.  With family?  Community?  Like hell!  With spirituality?  Art?  Who has the time?  But with my work?  Sure!  With self-improvement?  With the pursuit of a perfect relationship and perfect love?    It’s as though… look.  We have robbed ourselves of serenity.  We don’t know how to fix this.  We think bettering ourselves is the answer, but it only makes us worse.   In this fast, angry, modern, competitive, meaningless world, we don’t have any other choice.   The quickest, hardest, strongest, sexiest wins the race.  Always.  So we had best get to it.

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I threw away much of my life and well-being to the pursuit of perfection.  I needed to be society’s ideal everything, including ideal body.  I can’t tell you how many nights I went to sleep between the ages of 14 and 23 salivating and agonizing over what I was going to eat the next day.  Fuck off!  Why do you think we are hungry all the time?  In part, it’s contemporary culture, tempting us with indulgences and sweets and all that stuff that we wish so desperately we could have but know we can now.  In another part, it’s contemporary culture pursuing the same aim in a different guise, telling us we need to be thinner than we are.

Here’s some news.  If we aren’t clinically overweight, if we test well, if we don’t have inflammation in our systems, we are healthy.   We do not need to lose weight.  We do not need to be obsess.  What we need is to love ourselves, and to accept our bodies, and to let our hunger regulate itself.

I do a lot of talking on here about how to stop yourself from eating.  In some ways, this makes me a healer.  I really do think that society and all sorts of nasty psychological problems get into our heads, and we need to heal ourselves with practices, food, and lots of mental behaviors.    I have spoken to that a lot on this site, and I hope to the gods that message has been heard.

In other ways, this makes me a part of the machine.  When I walk down the street nowadays, since I have rebelled against perfectionism, when I see women who are deliberately thin–like me–I want to cry with empathy and pain rather than envy.  But before it was easier to justify denying my hunger.   It’s not just porn and anti-feminist norms dictating my behavior, but health officials and sociologists and anthropologists and every single person in between.   Read in a certain light, I am a part of that machine.  This makes me furious.

I am not now, not in any way, shape, or form, an advocate of eating less food unless it’s medically important.  I wasn’t before, either.  But now I mean it, passionately.  Not just for you, but also for me.  There is a crucial difference.  I feel this conviction in my bones.  I mean it, and I will not stand for societal norms in this realm any longer.  I don’t stand for them in other ways.  Time for me to grow up and shed my hypocrisy.

Where does this leave me?

Honestly, I am not sure.  I have a complete wardrobe, an expensive one, ranging from sizes 00-01.  It doesn’t get much bigger than that.  I also don’t know what to do in general, or what I want to do.  I have achieved society’s “ideal” in many ways.  I have gone to elite colleges.  I have mastered several languages.  I have pursued advanced degrees at advanced institutions.  I have travelled the world.  I have worked several jobs.  I have a budding investment portfolio.  And I have been skinny for the last two years, and that very fact made me not just confident, but honestly, very, painfully, tearfully honestly, more attractive to men than I had ever imagined.

I see men as victims in all of this, too.  None of them want to starve women.  None of them want their girlfriends and sisters and mothers to go hungry and to hate themselves.  None of them want to sleep with a bag of bones, either.  BUT very few of them are comfortable dating a “curvy” woman.  When did curves die?!  I am a member of a couple of excellent and fun, hip and–most importantly here–intellectual and activist dating websites.  One of the most popular questions everyone answers is: “What kind of body type would you accept in an ideal mate?”  I have never seen a response that did not say, “I’m sorry, but I can not be attracted to anyone with just a little bit of fat.”

I think I am going to throw up.

It’s not our faults that this is what we idealize, women and men alike.  My heart is breaking just thinking about it.  I don’t know what to do.  How do I continue to be attractive in this society while feeling good about myself?  How do I navigate a world in which my standards are so different from everybody else’s?   How do I behave in a world in which I have previous been employed for having a supermodel body, and in which I have basked in the warmth of all the male attention I get for that body?  What am I going to do?

I am going to move slowly.  I have learned how to eat a satiating diet and how to be less obsessive with food, particularly in the last several months.  I have been learning to take even better care of myself, mentally as well as physically.   I will stay away from all the shit food I always have.  It’s nasty and that is something of which no one wants to be a part.  I will stay away from contemporary culture like I always have.  Advertisements make people crave food they never knew they wanted.  And I will eat healthful foods until I am full.  I imagine I will not go up to my biggest size– a size nine on a 5’2 body is bigger than I can handle– but I imagine slowly creeping up to a size 1, and maybe some day in several months a size 3, that is something I can handle.

For much of the last ten years, I have been hungry as hell.  I’ve been angry as hell, too, but not at the right things.

Time to stop hating myself, and throw my punches elsewhere.

 

*Statistics all from this wonderful book: The Beauty Myth, by Naomi Wolf.

24

01 2012

Help me keep the site up!

Hi all!

Today, I am going to ask you for money.  Ack!

But I think not for bad reason.  Here’s why:

The license on this website expires in two weeks.   In the 52 weeks during which I have maintained this blog, I have reached thousands of readers, influenced and helped my entire family, and counseled several dozen individual women on body image, disordered eating, and nutrition.   What was perhaps most important, however, was that I made a fair amount of information available.  This kind of conglomeration of info on PCOS especially is pretty rare out there in the blogosphere.  I put a lot of stuff in my brain over the last couple years, and I want it available to the millions of people with hormone problems and food problems.  This kind of disordered eating advice and service is uncommon, too.   A trained and experienced woman listening to and advising others with the same issues for free?

If this site goes does down, none of this information will be available anymore, and I personally won’t be available to the people who email me every week looking for a friend.  I know it’s not a huge contribution to the planet, when you look at the numbers, but this website is the most concrete way in which I reach out with love and service.   This is one of my gifts, if I could possibly consider it as such, and I ask that you help me continue to share it with whomever so needs it.

It’s not much money to keep the site open.  Not for anybody with much of a salary.  But I live on loans and a tight budget, and I’m not sure I can squeeze room out of it to keep this open.

So I’m asking for a small donation.  Tiny.  As much as you might pay for a ride on the subway or for a cup of coffee.   Or whatever you want.  Anything helps.  There’s a link on the bottom of the right-hand column.

Thanks so much.  Cheers for a productive and healthy 2012.

Most humbly yours,

Stefani Elizabeth Pepper Ruper

21

01 2012

Paleo and PCOS

It’s possible (probable) that I have my statistics all wrong, but I think there’s a bit of a link between Paleo and PCOS.   Some women, such as Peggy the Primal Parent, come to paleo eating because they are trying to mitigate PCOS, and this is awesome.  A lot of overweight PCOS patients fall into this category. I think the paleo diet helps them achieve greater weight loss, insulin sensitivity, and reproductive function.  Time and time again we hear about how insanely fertile women become on the paleo diet..  This has a lot to do with reducing inflammation and meeting nutritional requirements, as well as with balancing hormones.   I cannot ignore that.  Paleo is apparently bomb diggity for making babies.

But I also know of a fair number of people who only began showing symptoms of PCOS once they went paleo.  Or that their symptoms worsened.  I would argue that these women have had some sort of underlying problem for a long time, perhaps via exposure to phytoestrogens or endocrine disruptors, but the fact remains that paleo exacerbates their PCOS problems.  What gives?

First, I think this is because of weight loss.  As a mentioned in my post on PCOS etiology, shifting fat mass levels can alter the amount of estrogen in a woman’s system.  If she is overweight, or at least at a higher BMI at the time when she begins her period, she may have trouble ovulating later in life at a lower BMI.   This is royally unfair and doesn’t even really make sense with the literature.  This is because it is usually only endurance athletes and anorexic women who make headlines in this way.  But perhaps this one effect of the paleo diet, the weight loss, is just one part of many that disrupt the hormone balance in women.

Secondly, I have read many assertions that weight lifting shifts the body towards great androgen production.  Greater muscle mass = more testosterone?  According to weight lifting gurus at least, yes.    Additionally, overtraining decreases testosterone levels.  A lot of paleo dieters are careful not to overtrain.  I know this is silly– I’m not telling you to train yourself into the ground– but it’s interesting.  The typical paleo kinds of exercise are testosterone friendly.  Lift heavy things occasionally and spend the rest of your time recovering.

Third, stress decreases testosterone levels.  Related to the point above with overtraining, paleo people often do their best to mitigate stress.  AND YOU SHOULD.   TESTOSTERONE IS NOT BAD.  But an array of different influences can converge on your body in negative ways.   When thinking about stress, consider this: if you have been stressed for a lot of your life, you might have just handicapped all of your hormone production.  If you work hard to reduce stress now, that balance is going to shift.  I am sure it shifts for the better, but still, if you have problematic ovaries, etc, it can be a rocky transition.

Relatedly, drinking and poor sleep both inhibit testosterone production.  If you are abstaining from alcohol and sleeping well, you will see more of this hormonal shift.

Fourth, paleo tends to decrease leptin levels just because the people on it thin out, maybe eat less frequently, and maybe eat fewer carbohydrates.  With less leptin in your system, you can disrupt hypothalamic signalling to your pituitary gland, which I do not recommend.

Fifth, different kinds of paleo diets can influences your hormonal profile in different ways.  For example, a diet heavy in nuts will give you both excess phytoestrogens as well as a lot of omega 6.  This can actually increase your systemic inflammation rather than decrease it.   More strikingly, dairy is phenomenally testosterogenic.  I know personally that I stopped menstruation in November after losing weight on a crash diet, went paleo in March and saw no improvement, and in June, when I started eating a lot of cheese, finally starting breaking out a lot.  Later I put back on some weight, stopped eating dairy and all phytoestrogenic foods, and still did not have any success inducing ovulation.  Clearly I had a number of issues going on.  But the dairy was an exacerbator, no questions about it.  BUTTER was problematic, too.  Many people on paleo eat butter but not other forms of dairy because butter doesn’t contain casein or lactose.  It doesn’t matter; it still has hormonal effects.  If you’re going to eat a paleo diet, especially as a woman, be wary of the way different foods can influence your body chemistry.

Sixth, paleo foods, specifically the animal-source foods and high-fat foods, in and of themselves can exacerbate problems in women with PCOS.  There are several reasons.

Here’s one:  fats are used to synthesize DHEA-S.  DHEA-S is technically an androgen, but it is also generally regarded as the precursor sex hormone.    All hormones derive from DHEA-S, including estrogen.   Women with PCOS often have elevated DHEA-S levels and lower estrogen levels.  This seems to imply that there is a problem with conversion between DHEA-S and estrogen.  If there is in fact an issue with conversion, then when the woman in question eats DHEA-S-stimulated foods, she will continually elevate her DHEA-S while not having success converting it to estrogen.  The result is a worsening of PCOS symptoms.

However, there are many different hormone profiles for PCOS.  If a PCOS patient has low hormone levels across the board, she should try to increase her DHEA-S.

Here’s another: sex-hormone binding globulin (SHBG) binds with androgens in the blood.  If you have high SHBG levels, your androgen level is likely low, and vice versa.  (Know also that if you have high androgen levels, it is probable that you have low SHBG.  There is a direct correlation.)  High levels of insulin-like growth factor 1 decrease SHBG (thereby increasing testosterone levels).   The jury is definitively still out on this, but many researchers have published papers such as this one arguing that a high protein diet increases levels of IGF-1 in the blood.  If you are eating a super high diet like I have for much of the last couple of years, and you are worried about your SHBG levels, consider lowering the protein content of your diet.

*Sidenote: you can increase SHBG by increasing thyroid hormone levels.  (!) (!)

Personally, I think a low-ish protein diet is important not just for adrenal but also for general health.  Lower protein diets are associated with increased life span.   I have argued in many places that protein is necessary both for your health and your satiety, and god damnit of course it is, but don’t go wild.  .5 g/lb of lean body weight for someone who doesn’t exercise excessively is, imho, ideal.  Relatedly, anecdotally, I have also noticed that the satiating effects of protein–again, while crucial–really hit a ceiling.  I can have ten bites and feel full-ish, or I can eat a hundred bites and feel the same way.

Finally, low carbohydrate diets decrease the conversion of T4 to T3 in the liver.  If you eat a low carb paleo diet, you may become hypothyroid over time, depending on the rest of your hormonal profile.  Really, really bad news.

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All this said, paleo is of course awesome for health in general and works wonders for a lot of people.  It’s also a great way to treat PCOS, as Peggy has shown.  BUT for those of us who have different issues, who perhaps over-eat certain foods like dairy or nuts, or who are looking for new ways to play with food and our hormones since what we have already done with a paleo diet has not worked, these are some ideas at least worth throwing around.

 

Compare Health Insurance (!)

17

01 2012

Start here: A comprehensive post on mitigating disordered eating

Hi all.

This is my attempt at a post which will serve as a disordered eating “start here” post.  It’s not everything, and it’s not tailored to people’s particular needs–of course it can’t be–but it will certainly give you a feel for my ideas and philosophy.  Start here, and email me afterwards if you think it would be helpful.  I’d be happy to hear your story.  There’s no question that you will find in me someone to support you unconditionally.

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If you are a disordered eater, you are not alone.  I know that you know this fact, but it never hurts to be reminded.  People always seem comforted by that thought when they email me.  Know that lots of people email me, and hundreds here at this site still don’t, and millions more in America struggle with the same issues.  Know that you keep pretty specific company, too.  I have spoken with smatterings of men and smatterings of older people, but the vast majority have been intelligent, ambitious young women.  This demographic is perfectionist in a big way.  This means that we expect our bodies to be perfect, and our diets, and our health, and when they’re not, things go wrong in a big way, too.   If you’ve noticed this pattern in your life, and if you think it contributes to your disordered eating, welcome to the club.

I don’t say that flippantly.  I have recently learned how to laugh at some of my disordered behaviors and coping mechanisms, and it’s been awesome, I recommend it, but disordered eating of course isn’t funny.  It’s hard and painful and sorrowful and full of loathing, and I’m so, so sorry you feel this way.  Gods, am I ever.  It’s a world of pain, and there are no ways about that fact.

Fortunately, there are some things you can know and practices you can adopt that will help you move forward towards a more serene, positive, and loving future.

If you are a disordered eater, know:

1.   Certain foods make you feel satiated and others do the opposite

Human beings have a protein requirement.  Eat it.  At the low end, eat .5 g/lb of lean body weight per day.  At the high end, eat 1g/lb of lean body weight.  I have 100 pounds of lean body weight, so I eat 50-100 g of protein each day.

Fat is uniquely satiating.  I would argue that you cannot err with a high fat diet.  Eat lots of animals, olive oil, coconut oil, and avocadoes.  Some of my favorite, most energetic days start with four avocadoes, and I end up barely nibbling at dinner time because I’m still not hungry.

Many people think eating starches is ideal for health, and I recommend you to www.perfecthealthdiet.com if you want to learn more about that.   In my case, they certainly are.  For all disordered eaters, it’s a matter of personal experience.   In general, I recommend that if you are obsessive about food that you try to limit your carbs, specifically fructose,  for a while.  Perhaps around 50 grams per day.  It’s up to you whether or not you go into ketosis.  There’s a lot more to that debate than I have space to cover here.

Of all the carbohydrates, fructose is really the only one so demonic to appetite.  It directly inhibits leptin’s interaction with your hypothalamus and stimulates hunger, rather than suppressing it.  Just one or two servings of fruit throws me off for an entire couple of days.  Once I switched to a paleo, high fat diet, I was so amazed and relieved at how much less I thought about food.

Know also that there are a lot of different theories for why we have cravings.  JS has a fascinating series on hunger, liking, and how poor nutrition might lead to a lack of satiety over at gnolls.org.  Educate yourself about it as best you can, and learn that your hunger is not your fault.  The Jaminets also have a thematically related theory about hunger and why people overeat: nutrient deprivation in lean tissue.

That isn’t to say it still isn’t a struggle.  That’s what the rest of the post is about.

2.  You have a chemical problem, like an addiction.

There’s no question about it.  Sugar produces very real withdrawal symptoms in rats fed high sugar versus high fat diets.  (They binged on both foods, but did not experience withdrawal with the fat.)  Sugar acts on the same dopamine receptors that other addictive substances do.  What’s so hard about food addiction, however, is that we cannot go cold turkey.  We must keep eating.  In any case, the important thing to remember is that there is something going on in your metabolism and your brain that is making this phenomenon happen to you.

3.  In addition, we live in a fucked society It makes more money the more you eat, and you eat more the worse you feel about yourself.

4.  Given points 1, 2, and 3, therefore, disordered eating is NOT. YOUR. FAULT.

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It’s not.  But it still haunts you.  What do you do?

  1.  Practice forgiveness.  Because it is not your fault, because disordered eating is a hell of a demon, and because you would grant forgiveness to anyone other than yourself, you must learn to forgive yourself for negative eating episodes.  You are doing your absolute best to cope with a horrible problem, so don’t drown yourself in guilt.  It’s painful and not productive at all.  In fact, it’s counter productive, because the more guilt you feel, and the more you beat yourself up, the more you want to eat.  Breathe deeply, let go, and love yourself as unconditionally as you can.  Forgive yourself as you would forgive others.  It is not your fault.
  2. Treat each negative eating episode as a learning experience.  This and forgiveness are the two crucial elements for getting better.  You have to learn about yourself—you have to understand why you binge, what your triggers are, and how you react to your bingeing—in order to begin mitigating your problems.  In this way, each bingeing episode isn’t worthless.  It’s teaching you something.  Even if it’s something you’ve done a million times before, each situation is unique and can give you unique insights into your psyche.  Forgive yourself for not being able to cut off the binge before it started, and learn from the experience.
  3.  In this way, you are always moving forward.  Learn from each experience, but do not dwell upon it.  Forgive yourself for each experience, and move on.  Love yourself always, and keep your eyes on the future.  What’s important about looking at the future, however, is to stop shooting for perfection.  Shoot for progress.  Disordered eating is nothing something you will ever be cured of.  Instead, it is something that will get better and better throughout time.  Sometimes you will stumble.  The progress is slow.  But even while you struggle, you are learning about yourself.  Two steps forward, one step back.  That’s okay.  Inching forward is the name of the game.
  4. Never have ridiculous expectations.  Don’t expect yourself to get better fast.  I’ve been working on this for years and years.  Expect yourself to get better.  Ask yourself to challenge yourself, but never too far outside of your comfort zone.  Know your limits, and push them gently.  Have as much patience as possible.
  5. Move on as quickly as possible.  After an eating episode, don’t let yourself get sucked into the vicious cycle of depression and eating.  Instead, figure out ways to move on and regain mental balance as quickly as possible.  Many people write to me expressing that their biggest problem is getting back on their feet.  With forgiveness, learning about yourself, and a steadfast refusal to dwell on negativity in your life and in your self image, you can do this easier and easier.
  6. Love.  Love yourself as you love others.  Love others as you love yourself.  Don’t ignore the negative, but instead consider it a part holistically of who you are as a beautiful, very real, and very human, human.  Know that it is a part of you, but it does not define you.  Love yourself as holistically as possible.
  7.  Fix the other crap in your life.  For real.  Stressors are a big part of disordered food behavior.  Resolve your stress, quit your shitty job, see a therapist.  Figure out what you need to be happy and go for it.  One of my readers moved to Mexico for a while, and came back and got a new job, and started seeing a therapist and taking some medications.  She’s doing lightyears better.  Take action to make your life better.  Fuck!  Not a single person in the world cares more about your happiness.  They are not going to do it for you.  You are.
  8.  See a doctor.  Get a blood test.  You never know if there’s something wrong.  I started taking thyroid medication a couple of weeks ago, and it has helped enormously.  There are also psychiatric agents and dopamine type things you can take to assist you feeling satiated.  You would get these from a psychiatrist, normally.
  9. Eliminate as best you can the deprivation attitude.  If we feel deprived, we want the things of which we are deprived far more than we would otherwise.  Not having oreos, you are not deprived.  We all have friends who can eat six whoppers in a day and not gain a pound, but that’s simply not you and you are probably better off for it.  Don’t let people and phenomena like that make you feel deprived. Instead, feel blessed for the opportunity to eat real, healthful, natural food.
  10. Get your mind off of food.  Find something else in life worthy of your devotion.  Throw yourself into your work, your relationships, a new hobby, or volunteering.  Have a sense of purpose and move towards it.  There is not a single thing in the world better for mitigating disordered eating than making something other than food the most important thing in your life.  I remember very clearly the first day I didn’t have the thought, “I’d rather be eating!” sitting at the back of my head for the entire day.  What I wanted was to be doing exactly what I was doing.

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What I listed above are what I think are the most important mental behaviors and ideas for mitigating disordered eating.  In the meantime, and while you work on those issues, there are a lot of trick type things you can do to help ease the pain of bingeing.  Sometimes the best thing isn’t to try to STOP a binge—that can lead to worse things down the road, especially if you fail—but rather to harness your need to overeat and direct it in less harmful directions.  THEN, when you feel as though you aren’t being as harmful with your eating, you will naturally feel less guilt, and your desire to eat might be less and less.

  1.  Get distracted.  This is related to the last point above.  You can engage your hands in other things, like knitting or drawing or fidgeting, but you can also engage your mind in other things.  Engaging your mind is even more effective, because it actually gets to the root of your problem.  Don’t just watch TV–that leaves your hands and mouth idle.  Play a game, go for a walk, talk to a friend.  The list is endless.
  2. Banish negative thoughts about food or yourself immediately.  IMMEDIATELY.  Hating ourselves is almost a habit.  Get out of it and shift your mind into thinking about more positive things.
  3. Get happy neurotransmitters another way: exercise and have sex.  These are excellent means by which to improve the chemical environments of our brains.  Get to it!  Life is short.  What do you think you’re going to regret more on your deathbed?  That you didn’t eat enough oreos, or that you didn’t try reverse cowboy?
  4. Never look in the mirror, good or bad.  Ideas about food are tied up with body image.  As they should be, in some way, since what we eat is directly related to our health.  But this association means that when we look at ourselves, we often think about food right away.  If I look good, I think “boy I can go eat!” and if I look bad, I think “boy I can’t eat at all!” and that’s awful, it makes me feel deprived.  Instead, just keep fitting into your regular clothes and trust you look the same as always.  Don’t dwell on your body image, there’s no reason to.  Really.  Can you think of one?
  5. Recognize trouble foods and keep them away.  Really.  Don’t make excuses for your families.  They should support you.  And if they insist on eating foods you normally binge on, or have unhealthy thoughts about, try having separate food storage locations.  Have separate shelves, or drawers in the fridge, or pantries.  Make it your habit to NEVER open their cabinets.  When I am home with my mother, I do this with the fruit drawer, and it works quite well.  I just don’t look in there, I don’t know what’s there, and that’s great for all of us.
  6. Recognize your habits and try to break them.  A lot of our eating behavior is just a conditioned habit.  Do you always eat when you get home, even if you’re not hungry?  Try to change that.  It only takes a couple of days for our ghrelin to respond to new eating schedules.  It might suck at first, but it could really help you in the long run.  On the other hand, there are a few other ways to mitigate the problem: try moving a meal to the time you arrive home, or make sure what you eat when you arrive home is just a low calorie snack like six heads of broccoli.
  7. When you can’t keep them away, just let yourself go.  Seriously.  Don’t go nuts, but I have found that resisting for short periods of time works, but for long periods of time can build up intense cravings that leads to really unhealthful binges.  In these cases, if you know that you are being exposed to a problem food for a short period of time, forgive yourself ahead of time for anything you might do.  Try and keep your hands off of the food, but if you don’t, just nibble slowly, and acknowledge that you’re doing your best.  This might not work for everyone.  It’s important to constantly over time learn what is the best way to handle the presence of trouble foods for you.
  8. Don’t eat carbohydrates.   Fructose.  Really.  Don’t.
  9. Take a nap.  Get good sleep every night.  Often I eat because I am tired.  People who sleep less are more overweight than well-rested adults.  Presumably this is because being tired inhibits satiation signaling.  Our bodies think they need more food for energy, even though they really don’t.
  10. Call someone.  Often I eat because I am lonely or bored.  Recognize these kinds of mental states, and mitigate them as best you can with different activities or thoughts.
  11. Drink tea.  A great way for flavor and consumption without the calories or self-loathing!  Switch up the kinds of tea you drink so you don’t over-do it on certain herbs.  That can be problematic.
  12. Chew gum.  It’s not the best solution, because it’s sweet and can make you crave more foods, but some people swear by it and it’s better than eating a whole cake.
  13. Eat vegetables.  Move your bingeing from the tastiest to less tasty foods over time.  This is one of my favorite techniques.  People often binge on desserts and highly processed, nasty, addictive foods.  One way to satisfy our bingeing needs is to substitute in different foods.  It might be hard to switch right to cabbage from oreos, but what you might want to do is put in a slightly more healthful alternative each time.  When you’re craving HoHos, ask yourself if four pounds of sweet potatoes would be equally as delicious and satiating.  Or try citrus fruits (a bit harder to overeat), or berries, or even something like protein or Lara bars.  Then move into the vegetables.  Try sweeter ones like carrots, and then cabbage and Brussels sprouts.  It can take you an hour to eat a head of cabbage, and it’s only a few hundred calories.  It might make you feel sick—bingeing always does—but it’s a hell of a lot better for your physical and mental health then downing a whole cake.  This method helps you satisfy your need to EAT while minimizing the nasty effects.  I still do this, if not in full “binge” mode, on a regular basis.
  14. Eat all you want of paleo foods.  It’s better to be overweight or an overeater on paleo foods than to not be paleo at all.   Calories are important but are not the most important for our health (usually).  It’s better to eat a whole chicken than a slice of pie.  I mean that.  DO IT.
  15. Fast.  Fasting is a great way to decrease hunger.  It’s a bit of a paradox, but it’s true.  Give it a try.  The longer I go without eating, the less I usually feel like I need to.  Fasting is also a great way to recover from a binge.  If you can go all the way to dinner the next day, you’ve spent all day burning what you ate before.  You are also spending that time clearing up your cells from any garbage from your eating episode, and resetting your metabolism to more optimal levels.
  16. Establish a satisfying routine.  This takes a while,but keep on troubleshooting and don’t give up.  Figure out what kind of meal plan and what kinds of foods make you feel good about your eating habits and are still satiating.  I enjoy eating a big fat rich meal in the morning which opens me up to nibble on veggies and protein at night.  Of course I leave room for unique situations like dinner with my housemates, but generally my life runs by a good routine, so why not my food, too?  An added bonus here is that the more routine you are, the less you have to think about what and when you are going to eat.
  17. Be poor.   Having to keep a tight budget did wonders for my eating.  Or you could start saving up for something.  If you’re trying to save money, you might go grocery shopping less often, and naturally start eating less.
  18. Clean your room.  Living in a clean space is important.  I don’t know why, but I and a lot of my clients experience the power of clean living.  If I am in a beautiful space that I feel proud of and comfortable in, I feel more serene.  I feel more productive.  I feel less like a typical slob, and therefore less like eating.  I light candles and read books with tea and generally create a beautiful narrative around my life.  It makes me feel so positive.  Showering regularly and wearing flattering clothes that I love is a huge part of this, too.
  19. Get momentum and hold onto it as best you can.  Momentum is about a million times easier to hold onto than to achieve.  Once you’ve got it, run with it.  Don’t question it or dwell on it, just do.
  20. Spend time with people who affirm you.  This is a no brainer, but it’s amazing how many people I talk to who live with people who put them down, consciously or not.  You are awesome.   Don’t let anyone tell you otherwise.  I mean that.  Try to spend time with positive people in general, too.  The more positively you think about all things, the more positively you will think about food and yourself.  Psychological literature has shown that positive thinking and gratitude are two of the greatest happiness generators in contemporary lives.
  21. Don’t read magazines or watch TV.  Have your own standard of beauty, for God’s sake.  When I am living abroad, I always feel comfortable, if not beautiful.  The second I set food on American soil, however, I feel lowly and sluggish and silly.  There are billboards all over, magazines, TV commercials, people themselves with bleached blond hair and perfect skin and bodies, and WTF.  Turn off the ‘TV.  Don’t look at them.  The more you focus on the beauty of others, the more you are exposed to it, the more you compare yourself to it.  Why must I be as beautiful as Scarlet Johannson?  Because I am a perfectionist, and society says she is perfect.  No!  Fuck!  I am equally perfect, and I’ll be damned if anyone is going to convince me otherwise.
  22. Fake it ‘til you make it.  Put on a smile.  Flirt.  Wink until you develop a tick.   Gods.  Guys, I’ve walked around much of the two years with cystic acne on my face, and absolutely, I cover it up with make up, but it still shows and I feel hideous a lot of the time.  All that said, because I demanded of myself to not let my confidence slide, and to still act like I owned a bar every time I went in it, I have actually increased the rate at which people are interested in me.  Hugely!  It’s so hard to grasp, gods, it’s so hard, but what’s so important for being attractive is being friendly and having a warm, confident smile.  Put it on, try it, and see what happens.  Then you’ll get affirmed, and you’ll have confidence naturally.  And you might not care so much, or at least hate yourself so much, for how you look.   Don’t waste your time worrying about your looks.  (Do you care all that much about what other people look like when you meet them?)  Instead, do your best to make good connections with people.  If they turn out affirming you physically or sexually or whatever, that’s great.  More often than not they won’t.  But if you put on that smile, if you strut, if you dress to impress, you will impress.  You will have confidence, and it will grow.  You are not your body image or your relationship with food.  You are an empowered human being.  Be that, and damn everyone to hell who might stand in your way.
And that…that’s about it for now.  Please leave more ideas in the comments if you got ‘em.  I’d love to hear from you, with your own ideas or otherwise.
As the lovely soul JS says, live in peace, live in beauty.

 

16

01 2012

PCOS treatment options

What you can do to treat your PCOS

Please refer to my previous post for a description of PCOS pathologies.  What follows is a brief layout of different treatments.   Going through them all, and experimenting and finding what works best, and talking to your doctor and doing your own research is all critical.   This is just what I have found, both on the web and in my body.   Note that the section on diet does not stand alone.  There is more information on the role different foods play in PCOS is in the post to which I just linked.  Below is the Rock to get us started.  Woop!

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Diet

If you are an overweight PCOS patient, I recommend that you eat low carbohydrate (specifically fructose) to decrease insulin and testosterone levels.  Try and stick to glucose and safe starches when you do eat carbohydrates.  These include potatoes, sweet potatoes, yams, and white rice.  Fixing the metabolic syndrome that may be the causative root of your PCOS is a bit more complicated than this, but people seem to have success with this method across the board.  Low carbohydrate diets tend to mitigate insulin signalling problems, which in turn helps with PCOS.

If you are an overweight PCOS patient, also, try fasting.  Fasting, especially for people with overburdened metabolisms who are trying to lose weight, increases insulin sensitivity and helps the weight slide off.

If you are a thin PCOS patient, eat high carbohydrate.  Carbohydrates elicit a greater leptin response than fat.  Leptin is responsible for telling your hypothalamus that you are well fed.  If you are someone who often feels hungry or who recently lost weight, you may want to seriously consider this idea.  If your body thinks it is starving, it will not perform reproductive functions.

Similarly, if you are a thin PCOS patient, do not fast.  Fasting decreases leptin levels.

If you are a hypothyroid PCOS patient, eat a high carbohydrate diet, at least 50 percent of calories, a la Ray PeatChris Kresser and PHD.  This is because glucose is necessary for the conversion of T4 into T3 in the liver.  Without glucose, less T3 is synthesized, such that many cellular functions, such as reproduction, slow down.

Don’t eat fructose.  For overweight PCOS patients, fructose can inhibit leptin signalling and make you hungrier.  Fructose is significantly, insidiously implicated in weight gain.  For thin PCOS patients, fructose directly inhibits the reception of leptin in the hypothalamus.  This is another factor that makes it difficult for the body to perceive whether or not it is being fed.

Don’t eat soy.  Soy is the most potent phytoestrogen.  Not only does soy beget PCOS by hindering the production of true estrogen, but it is also implicated in reproductive cancers.

Don’t eat legumes, which also contain phytoestrogens.  This means all forms of beans and peas.

Don’t eat dairy.  It’s androgenic.   Having too many androgens in the bloodstream is one of the primary drivers of PCOS.

Lower the amount of cruciferous vegetables you eat (if you eat them a lot).  Brassica plants activate an enzyme (cytochrome P450) in the liver which clears estrogen out of the body.  Additionally, if cruciferous vegetables are consumed often in the raw form, they act as goitrogens and can decrease thyroid function.

Eat plenty of fat.  Fat is crucial for the production of hormones.   And cholesterol.  Cholesterol is one of the root molecules in endocrine production.  Good fats to focus on are the monosaturated fats–olive oil, avocado, and macadamia oil–and saturated fat in the form of coconut oil or organic animal products.

Steer clear of Omega 6 PUFAs.  Omega 6 fats are associated with increased testosterone levels in both women and men, in addition to causing excessive inflammation.  This means limiting soy, canola, rapeseed, vegetable, and corn oils.  Nuts in their natural form should also be avoided because they are primarily omega 6 fats, and also because they contain phytoestrogens.

Eat grapefruit.  Grapefruit inhibits the cytochrome P450 I mentioned above that clears estrogen out of the body.  This is a nice trick to increase estrogen levels, but note also that it is not a permanent fix, and that the activity of cytochrome P450 is still crucial for your health.

Eat magnesium rich foods to increase insulin sensitivity.

Eat beta carotene containing foods to increase progesterone levels.  The corpus luteum has the highest concentration of beta-carotene of any organ in the body, suggesting that this nutrient plays an important role in reproductive processes.

Eat foods good for the liver.  The best are high in choline, such as eggs and organs.

Eat organic meat or wild game, not factory farmed meat, as often as possible.  The hormone levels are guaranteed to be natural and to disrupt your system as little as possible.

Drink spearmint tea.  It’s fairly highly regarded as a testosterone blocker.

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Supplement

Honestly, in my personal experience, I have rarely witnessed benefits from supplements.   In fact, the biggest changes I experience are usually negative and from overdoses, probably because I eat a rich enough diet already.  So if you eat a range of vegetable and animal products, supplementation should not be too much of an issue.    If you want to supplement for general health, I recommend checking out the Jaminet’s list of supplementation in their book, or which can be figured out over at their blog.   Please use the organic (that is, carbon-based), chelated forms of any mineral supplements you take.  Magnesium oxide, for example, is something you do not want to take because it’s basically eating crunched up metals.  Instead, take a form of magnesium that is “bio-available,” or “chelated,” which means that it is a part of a molecule your body can actually use.

Supplementation to correct specific deficiencies, however, can be very helpful.  If you’re worried specifically about your ovaries and your fertility, here is a list of supplements I have witnessed being efficacious:

Iodine
On his podcast, Robb Wolf  recommends that women with PCOS or androgen-dominant type symptoms try to boost their thyroid functioning with iodine supplementation.  His clients are apparently satisfied and ‘healed’ by taking iodine.  If you really suspect your thyroid in your pathology, however, I recommend getting your blood tested for levels of TSH, T3, and T4 at least before proceeding.   Iodine can help with hypothyroid, especially if its an iodine deficiency causing the problem, but iodine can also hinder thyroid functioning in clinical hypothyroid cases, especially if the underlying problem is the autoimmune disease Hashimoto’s thyroiditis rather than a simple iodine deficiency.

Chromium 
Chromium helps to encourage the formation of glucose tolerance factor which is a substance released by the liver and which is required to make insulin more efficient. A deficiency of chromium can lead to insulin resistance.  Because of this, it is the most widely researched mineral used in the treatment of overweight.

Selenium
Selenium is crucial for thyroid functioning.  Try eating one or two brazil nuts each day– they are supposed to be better supplements than the pills themselves.

B vitamins
Vitamins B2, B3, B5 and B6 are particularly useful for controlling weight, and here’s why: Vitamin B2 helps to turn fat, sugar and protein into energy. B3 is a component of the glucose tolerance factor (GTF), which is released every time blood sugar rises, and vitamin B3 helps to keep the levels in balance. Vitamin B5 has been shown to help with weight loss because it helps to control fat metabolism. B6 is also important for maintaining hormone balance and, together with B2 and B3, is necessary for normal thyroid hormone production. Any deficiencies in these vitamins can affect thyroid function and consequently affect the metabolism.

The B vitamins are also essential for the liver to convert your ‘old’ hormones into harmless substances which can then be excreted from the body.

Zinc
Unfortunately, because our soil has been depleted by overfarming, there is very little natural zinc found in our food. Furthermore, processing and refining strip out what little might be remaining. So no matter how good your diet, you may not be getting anywhere near the levels of zinc that you need. There are two approaches to this: you can eat whole organic food, which has much more rigorous controls on farming methods, or you can add a zinc supplement to your diet. But why is it so important?

Zinc is an important mineral for appetite control and a deficiency can cause a loss of taste and smell, creating a need for stronger-tasting foods.  Zinc is necessary for the correct action of many hormones, including insulin, so it is extremely important in balancing blood sugar. It also functions together with vitamins A and E in the manufacture of thyroid hormone.

Magnesium
Magnesium levels have been found to be low in people with diabetes and there is a strong link between magnesium deficiency and insulin resistance.

Co-Enzyme Q10
This is a vitamin-like substance that is contained in nearly every cell of your body. It is important for energy production and normal carbohydrate metabolism.  Co-Q10 has also been proved useful in controlling blood sugar levels.

Boron?
Word of mouth recommends taking boron, or eating apples, which contain boron, to boost estrogen levels, but I can’t find any scientific research endorsing this is a solid idea.

Herbs 

Agnus castus (Vitex/chastetree berry)
Chasteberry anecdotally helps to stimulate and normalise the function of the pituitary gland, which controls the release of LH and FSH, which signal the menstrual cycle.

Saw Palmetto (Serenoa repens) 
Saw palmetto is an herb that is traditionally considered in light of its success in treating prostate problems caused by an imbalance of hormones (including excess testosterone). It is a small palm tree found in North America and the berries of the tree are used in tinctures or capsule form.  Research has shown that saw palmetto works as an anti-androgen, which can be very helpful given the high levels of testosterone in PCOS.

Milk Thistle (Silybum marianum)
This is one of the key herbs for the liver. It helps to protect your liver cells against damage and to promote the healing of damaged cells, so improving the general functioning of the liver and all its detoxifying properties.

Spearmint tea also counts.  The mechanism is unknown, but spearmint tea has been shown to significantly reduce circulating free testosterone levels in women with hyperandrogenism.

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Exercise

Exercise is an excellent way to increase insulin sensitivity and promote metabolic fitness.

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Sleep

A great deal of healing and hormone production takes place.  During the night, when cortisol levels are low, and when the body is recharging, enables the hypothalamus and pituitary glands to send their signals to reproductive tissues uninterrupted.

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Optimize thyroid function

If you have hypothyroid, or even subclinical hypothyroid, try addressing this issue before getting on different PCOS medications.  Hypo- or subclinical hypo- thyroidism os often the underlying cause of reproductive failure.  To understand more about hypothyroid and PCOS, see my recent post on PCOS pathology.   

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Blood sugar medication: Metformin

Metformin is for many people a wonder drug.  Most everyone on the standard American diet I believe could take the drug and see an improvement in metabolism.  Metformin prevents the uptake of sugars in the gut, and it improves the efficiency of the insulin response, thereby creating greater insulin sensitivity and reduced testosterone levels.  Metformin is great for overweight women with PCOS who also tend to be insulin resistant.  Metformin is usually used to treat diabetes.

Metformin has also been shown to decrease testosterone levels even in PCOS patients who don’t test positive for insulin resistance.  Metformin may directly impede the production of testosterone in the ovaries.   Personally, I am a lean woman who doesn’t test positive for insulin resistance.  I took metformin for six days and ovulated for the first time in a year.

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Birth control pills

Yaz, Yasmin, and Ortho-try-cyclen are popular choices.  But there’s a lot out there on birth control and I will write about the various options and implications of them all as soon as I can.  Birth control is effective in “treating” PCOS by increasing either estrogen or progesterone levels, though usually both.  However, birth control doesn’t solve the underlying issue.  In fact, many women experience even greater dysfunction in their cycles once they go off the pill.   As one popular example, some women began taking birth control as teenagers.  They continued taking it until they want to have babies, yet once they got off the pill, they found themselves breaking out for the first time in decades and unable to conceive.    Birth control pills are great for mitigating PCOS symptoms, but they will never make you more fertile, and they rarely restore hormonal balance.

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Progesterone

Women who don’t menstruate are proscribed progesterone medications by their doctors in order to induce menstruation.   How it works is that these women take progesterone pills for ten day.  A week later, as the progesterone levels fall, estrogen levels rise, and the pituitary and ovaries read this as a signal to shed the corpus luteum.

Because amenorrhea increases the risk for endometrial cancer, amenorrheic women are advised to induce menstruation every few months.   Some go years without ill effects, and this depends on each individual’s PCOS pathology and hormone levels.  Progesterone also might help jumpstart your system back into more normal health, such that you can take it for a while and then afterwards have achieved enough of a cycle to continue functioning without progesterone. This is a good thing to do if you are trying to balance your  hormones via a more natural method, such as eliminating soy from your diet or losing weight.

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Antiandrogens

 These are my favorite medications, mostly because they have served as a great crutch while I work on the rest of my issues.  Metformin is technically one of these, but other good options are spironolactone and flutamide.  Spironolactone is the safer and more efficacious of the two, so almost everyone pursues this option first.

Antiandrogens act to block or inhibit testosterone activity in the body.  For this reason, they are often proscribed for acne or hirsutism, helping women cope with these nasty issues while they try to sort out the rest of their endocrine health.

Spirionolactone, in particular, is interesting.  It is normally proscribed for high blood pressure, but it is proscribed off label to help women reduce their testosterone levels.  Spiro is shaped very similarly to testosterone, so it sits in receptor sites and blocks activity.  This is why it’s so effective against acne.  Additionally, it helps prevent testosterone production itself by inhibiting 17α-hydroxylase and 17,20-desmolase, which are enzymes in the testosterone biosynthesis pathway.

With Spiro, estrogen levels increase via enhancing the peripheral conversion of testosterone to estradiol and by displacing estradiol from sex hormone-binding globulin (SHBG).  Spiro actually decreases serum testosterone and increases serum estrogen levels.  I really can’t speak more highly of it.  The one great issue is that it creates birth defects, since testosterone is completely blocked, so Spiro absolutely cannot be taken during pregnancy.

Perhaps most importantly, Spiro has an excellent success rate with getting women to ovulate.   In this study, 11 out of 13 women began ovulating after a few months of treatment.

Spiro decreases testosterone activity in the body.  For this reason, it is an excellent treatment for hyperandrogenic symptoms such as hair loss and hormonal acne.

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Ovarian Drilling

        Ovarian drilling is exactly what it sounds like—in this course of treatment, a woman lays on a table and a doctor inserts a microdrill through her abdomen and into the ovaries, creating tiny holes.  These holes puncture the thick endometrium of amenorrheic women and reduce testosterone production.  Ovarian drilling to me seems like a great option, but the complications if something goes wrong include permanent infertility.  For this reason, many people leave this option as a last resort.

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For more information on PCOS, I would direct you first to Pubmed, to the Journal of Endocrinology, and also to some PCOS support forums such as soulcysters.net or www.hormonehelpny.com.

A final relevant point is that OB/GYNs are decent doctors for PCOS, but the best specialist to see is a reproductive endocrinologist.   This is my personal area of expertise, but I cannot provide you with the full range of testing that certified reproductive endocrinologists can.

I’ve read a lot about PCOS, but not everything, and this is really a summary of everything, more or less, that I’ve discovered.  In any case, my hope is you’ll hop on google and figure out how to tailor my starting points to your own needs.  That has been my greatest lesson with PCOS.    It’s all about experimentation, your own body, diligence, and patience.   


11

01 2012

What causes and influences PCOS?

What causes PCOS?

 

Many of the PCOS “experts” out there do not understand the connection between the endocrine system and the reproductive system.  Because of this, they miss a very important link between metabolic syndrome and PCOS.  I have read maybe a dozen books about PCOS that recommend nothing but taking birth control pills in response.  This puts a patch on a problem that is, in the authors’ views, a simple result of genetics. Some idiots go so far as to recommend a low fat, low carbohydrate, moderate protein diet.  WTF is left?

Others—the real doctors, not the one’s publishing books—understand that PCOS is a disorder of the endocrine system.  It is not just an ovarian problem, but is rather a problem of hormone signaling to and within the ovaries.  This means that ovarian hormone production, pituitary action, and even hypothalamic action are all crucial for proper reproductive health.  Check out the Journal of Endocrinology’s 681 articles on PCOS if you want to know more about that.

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What makes PCOS so hard for doctors to figure out is not just 1) the grab bag of symptoms but also 2) the heterogeneity of its population.  There are two primary groups of PCOS patients.  In the first group are about 60 percent of the patients, all of whom are overweight.  More importantly, they are insulin resistant.  High levels of insulin in these patients shift hormonal balances away from estrogen and towards testosterone.  Insulin directly stimulates testosterone production.  It’s pretty clear to endocrinologists how to fix this problem.  Lose weight, and create better insulin sensitivity.  Low carb (specifically low fructose!) diets, exercise, and intermittent fasting are all excellent means by which to do this.  The issue is much more complicated than this–really, it is, and many overweight women still have some issues when they lose weight–but it can more or less be boiled down to these steps.  On the other hand, the problem is a fair bit more complicated for the other 40 percent, the “thin cysters.”   If it’s not overt insulin resistance causing their issue, what is it?

It’s a lot.  I’m a thin cyster, and, by gods, have I tried everything to shake this damn condition or what.  For the last couple of years I have spent the majority of my free time researching PCOS.  This was mostly because I wanted to get rid of my acne, but infertility, insulin resistance, diabetes, heart disease, and ovarian and endometrial cancer aren’t risks to laugh at, either.  Up to this point I have learned a shit ton about the endocrine system (but certainly not everything and I am NO expert), and I want to share with you as much as I can.

Things that give people PCOS and why

 Overweight, metabolic derangement and/or insulin resistance

        Like I just mentioned, metabolic derangement is the single greatest cause of reproductive derangement in women.  Insulin makes ovaries produce testosterone.  This is bad news.  We all need testosterone—it’s the crucial hormone for generating sensation in the clitoris!—but too much can entirely derail that.

 

Dramatic weight loss

        Fat cells are major players in endocrine systems.  This means that any kind of weight fluctuation can significantly disrupt endocrine function.  Primarily, this is an estrogen problem.   Estrogen is produced in fat cells.  When people gain weight, their estrogen levels increase (obese PCOS patients might have elevated testosterone AND estrogen).  When they lose weight, they decrease.  I have discussed androgenicity a lot so far, and it is the most universal element in diagnosing PCOS, but estrogen levels are crucial for proper reproductive signalling with the pituitary gland.  Moreover, higher levels of estrogen can “block” harmful effects of androgens, such as acne.  For these reasons,  it may be more important to have proper balance between testosterone and estrogen rather than having good absolute value of both hormones.  For example, when I was first tested for PCOS, my testosterone was slightly elevated and my estrogen was slightly depressed.  These weren’t alarming numbers in either case, but combined they spelled serious issues.

The jury is still out on the long term impact of weight loss.  Can someone lose weight slowly and maintain reproductive health?  Does the speed with which she loses weight matter?  If someone loses a significant amount of weight, will her ovaries ever “learn” to make up for the estrogenic load her fat cells used to give her?

From what I can tell from my own experience and talking with others, the answer to each of those questions is “sort of.”  I used to be at a BMI of 25 (5’2, 130 pounds).  In three months I dropped to approximately 18 (105 pounds) and today sit around a BMI of 20, perhaps, 113ish pounds.  I prefer not to know.  In any case, I am not malnourished and I certainly look healthy—much more so than I did before when I was supermodel thin–but this has not increased my estrogen levels at all.  In fact, they have continued to drop.  This is probably due to some other factors, which I’ll get to later, but putting on weight hasn’t been the answer.   If it were, I would have seen a bit of normalization with my increase from 105 to 115 pounds.   In this time period, my estrogen has dropped but my testosterone dropped, too, which is good, and LH and FSH remained normal.  Moreover, I have been experiencing irregular periods and symptoms of low estrogen such as insomnia and hot flashes since I was a young girl, and I have also been amenhorreic at 137 pounds.  Clearly my issue goes deeper than simple weight loss and weight gain.    Weight fluctuations trigger the surfacing of some my problems, but it is not what planted them there.

 

Excessive exercise or super low body fat– or maybe even just weight loss in sensitive individuals

        This issue is virtually the same as the one above, except the literature on it is more extensive, and it relies less on the actual production of estrogen in fat cells and more on being in starvation mode.  When you burn calories at a high rate, and when you consume a low calorie diet (and also if you’re consuming too much fructose!) your leptin response is restricted.  This means that less satiety is reaching your hypothalamus.  The hypothalamus is in charge of telling the rest of the body how nourished it is, and whether or not it should be running on “conserve” mode and shutting down peripheral systems such as reproduction.  To do this, it releases Gonadotropin Releasing Hormone, which signals to the Pituitary to release FS and LSH, the hormones that tell the ovaries to produce sex hormones.  Without leptin, GRH is impeded, and the entire neuronal cascade is impeded.  No proper balance of pituitary hormones is produced.

It is absolutely crucial to convince the body that it is not starving in order to mitigate PCOS.  The problem comes with how exactly to do that.  There’s no formula.  Exercise less, eat more.  Eat different foods.  Not fruit.  Seems as though other carbohydrates — glucose — have the highest of all leptin responses.  I’m not sure, and I’ve spent a hell of a lot of time trying to figure it out.  It has been my experience that a higher carbohydrate diet, even though it makes me want to eat more and puff up a little bit, increases my sex drive and vaginal lubrication (both indicators of estrogen production).  As I mention below in the diet section, this result cannot be truly trusted, however, since legumes (containing phytoestrogens) were included in my high carbohydrate diet experiments.

       

Stress

        Sex hormones are produced in our bodies via two axes: the first is the specifically reproductive axis which includes the pituitary gland and the ovaries, and the second is the adrenal system.  If a body has fatigued adrenals in any significant fashion, it’s hormone cascade can be seriously disrupted.  Cushing’s disease, an adrenal disorder that causes abnormal cortisol production, often causes PCOS in its patients.

Literature seems to show, however, interestingly, that cortisol hinders testosterone function.    When women present to evolutionary medicine folks (and regular medicine folks) with symptoms of estrogen dominance, such as PMS or abdominal fat, they are advised to reduce stress.  So then: should you stress yourself out because you want your testosterone to decrease?  No, Crazies.  What is ideal is hormonal balance, and the endocrine system is so complicated and our understanding of it so limited that reducing stress should be the number one on everyone’s health agenda, period.

 

Metabolic derangement during puberty

        Check out the book Ancient Bodies, Modern Lives by Wenda Trevathan for an excellent book on fertility in general.  It’s where I first read this theory, that whatever physiological state a girl is in in when she begins menstruating can affect her cycle for the rest of her life.  Trevathan proposes that conditions of famine and bounty are determined by this metabolic state, such that deviating from the start-of-puberty norm triggers famine or bounty responses in a woman’s body.  For example, many rail thin women in the world, particularly in developing countries, menstruate their entire lives.  But when someone who has a BMI of 25 loses 15 pounds, or maybe has less of certain micronutrients in her system, and also has some metabolic derangement from other sources, her hypothalamus might think this is a period of starvation and turn off her reproductive response.

A lot of evidence in the pathogenesis of PCOS, specifically in thin women, points to problems during puberty, childhood, and even the womb (if someone’s mother’s hormones are messed up, hers will be, too.)  Menstruation is kicking into gear earlier and earlier in young girls.  The middle teen (~14-16 years old) menarche that used to be the norm is now considered “late,” and the average age of menarche in American girls is 11 years old.  Evolutionarily, this is quite young.  This is partly because young girls are heavier than they used to be.  Menstruation starts when a certain estrogen level is reached in the body, and estrogen is not just produced in the ovaries but also in fat cells.  The problem therefore is that the ovaries sometimes start out with a handicap, as I touched on above.  They are dependent on the fat cells.  So any time weight fluctuates, ovaries necessarily have to adjust, and often do so poorly.

Another factor is related: childhood insulin resistance.  Having high testosterone levels at a young age primes the body to always act in that fashion.  This spells trouble for the entire endocrine system.  Please feed your children real food.

 

Hypothyroidism

        I explored the link between hypothyroid and PCOS for a while last year, and I wrote about it here.  I abandoned my quest when I didn’t see much improvement and may have overdosed on iodine, unknowingly taking upwards of 2000 percent of the daily allowance for a significant amount of time, but I have remained aware of how important the thyroid hormone is for reproductive function.  If you want to really learn about thyroid functioning, visit www.chriskresser.com.  His work is brilliant and thorough.

Thyroid hormone is made in the thyroid gland.  First, however, thyroid stimulating hormone, TSH, is produced by the pituitary (after being signaled by the hypothalamus) and sent to the thyroid gland.  This instructs it to make T4.  T4, though it accounts for 99 percent of the thyroid hormone in the bloodstream, is inactive, and rather just floats around in until the body needs more of it.  T4 is converted to T3, which is then used by every cell in the body.  In this way, T3 is the hormone of primary interest.  Things can go wrong at any step in this process.  TSH can be underproduced, and either or both of thyroid hormones can go missing.  T4 can be underconverted to T3.  Someone can be dealing with an inflamed system, menopause, or Hashimoto’s thyroiditis (accounting for approximately 90 percent of hypothyroid cases), and in each case the functioning of every cell in the entire body is impaired.  T3 is as crucial for cellular function perhaps as ATP, so you had best have your thyroid health in mind no matter what your presenting condition.  This can be bolstered by proper iodine intake, high dose iodine in the form of iodoral, or supplementation with T3 or T4.  Whichever step one takes depends on where her endocrinologist sees the problem occurring.

Because every cell is dependent on T3, and because bodies try to optimize its T3 resources, peripheral systems such as reproduction can be shut down in favor of protecting other systems.  If the thyroid is malfunctioning, the hypothalamus may reduce signalling to the pituitary gland in order to protect the thyroid system as much as possible.  This is analogous to the phenomena of starvation.   Another possible point at which hypothyroidism influences PCOS is at the level of cellular functioning.  If there isn’t enough thyroid hormone in a cell, it will shut down or become sluggish independently.  Reproductive tissues, such as those in the ovaries, might therefore not have enough energy or resources to produce estrogen at the proper rates.

PCOS patients who present with subclinical levels of thyroid hormone begin ovulating once regular thyroid functioning is achieved.  One of my favorite articles (because it gives me hope) reports that thyroid hormone replacement therapy achieves a “significant reduction in total as well as free testosterone,” and also states that “ovarian volumes of patients with hypothyroidism were significantly great compared with controls, and their magnitudes diminished significantly during thyroid hormone replacement therapy.”

BPA, environmental toxins, and endocrine disruptors

        I mentioned before that thin women with PCOS present with greater gland and endocrine dysfunction than overweight women.    What is the root of this malfunction?

One plausible answer is environmental toxins. The primary ones about which we should be concerned are pesticides and BPA.  Almost all fruits and vegetables are covered in chemicals that act as phytoestrogens in the body, and over time, specifically when young, these can have a major impact on reproductive physiology.  Some foods are worse than others.   This information is easily accessed via google.  The way to mitigate this is to eat organic, to peel your vegetables, or to wash them.  A great way to wash them to make sure the endocrine disruptors get mitigated is by soaking them in vinegar for several minutes.  Vinegar binds with some of these toxins and will help chelate them off of the skin of your vegetables.

A second endocrine disruptor, perhaps the most prevalent one in American lives today, is BPA.  BPA is a polymer leached from plastics that disrupts endocrine function in a way not entirely yet understood, but appears to have “estrogenic” effects.

When rats are exposed to BPA, their male offspring have decreased fertility, and only after exposure to small doses.  Of the male rats, one study concludes:

“The BPA exposed males had a suite of reproductive deficiencies that collectively created subfertility in the rats. Some of these included lower sperm counts, poor sperm motility and cellular defects within the testes. Circulating levels of testosterone, estrogen and other reproductive hormones were also significantly lower.

The BPA exposed males were also significantly heavier than unexposed controls.

Mating behavior was also negatively impacted. The BPA-exposed males took longer to copulate with females and a few failed to copulate at all. These observations suggest that the males had lower sexual motivation.

Potentially most concerning, is that the sons and grandsons of the exposed males were also subfertile, indicating that the germ line itself was damaged by the initial exposure to BPA. The mechanism for this transgenerational effect is unclear.”

Female rats are affected just as strongly, if not worse.  THEY GET PCOS.    Not only do they present with cystic ovaries, but they have increased testosterone and estrogen levels, and also decreased progesterone.  Recall that progesterone is THE crucial hormone for menstruation.   They also have lowered fertility and higher BMIs than non-exposed rats.

If that doesn’t convince you BPA is bad, note that this result has also been reported in human females.  A high correlation has also been shown between mothers with high levels of BPA having children with mood, behavior, and personality disorders.

Moreover, women with PCOS, both lean and overweight women, have 40 percent higher levels of BPA in their blood than those without.  However, the levels are even more markedly increased in thin women with PCOS.  In thin women, PCOS patients had 1.6 times ordinary BPA levels, and in overweight women the ratio was just 1.3.  Some researchers speculate that this is because BPA is being stored in fat cells, while other posit that BPA causes brain-related hormone signaling dysfunction, which could explain why thin people end up having PCOS at all.  The question of causation rather than just correlation remains, however: does BPA cause increased testosterone levels or do increased testosterone levels inhibits the body’s ability to clear BPA out of its system?  Erring on the side of caution, I decided to eliminate all of my consumption of BPA-touching foods, and specifically to stop drinking (and microwaving!) ALL OF MY WATER out of a plastic mug.  Idiocy, I know.  The result?  One week later the bumpy acne on my forehead disappeared, after having been persistent for years.  While other factors are always at play, I didn’t change anything else.  It was as controlled an experiment as I was going to get.

All that said,

Hard plastics, the polycarbonate plastics such as #7, are worse than soft plastics.  Plastics 1, 2, and 4 seem to be BPA free.  Heated plastics leach at much higher rates than cold ones (such that buying frozen vegetables is not as scary as one might originally imagine.)   However, just because a plastic is free of BPA does NOT mean it is free of estrogenic activity.  All plastics have EA–Estrogenic Activity–just from different chemicals and in different amounts, with not any of them yet measured significantly.  Finally, research has shown that BPA gets into bodies in even higher doses from eating out of aluminum cans than out of plastic.  Cans are lined with BPA on the inside, so viritually everything you eat out of a can is swimming in BPA.   Here’s a  list of consumer tips if you’re interested:  http://www.ewg.org/bisphenol-a-info.

Another source of environmental estrogens is body applications.  Parabens are phytoestrogens and are one of the most common elements in lotions and soaps.  Consume organic here, or check labels, or, even better, stop washing altogether.  I promise I don’t smell.  Also importantly, there’s a fuckton of BPA in receipts. I know!  So if you’re a cashier, seriously, you can ask your boss to let you wear gloves and she had best say okay.

 

Liver dysfunction

        Glands get hormones pupming into the bloodstream, but the liver filters them.  I’ll talk more about what one can do with a liver below.

 

Pituitary or hippocampal tumors

        This speaks for itself.  If your LH, FSH, TSH, or Gonadotropin Releasing Hormone levels are significantly impaired, tell your doctor you want an fMRI.

 

Diet

1)        Limit insulin responses, especially if you are overweight or insulin resistant.  Lowering insulin decreases testosterone production.  How to do this is really complicated, though fasting and low carbohydrate diets seem to do the trick.  Be careful, however:  Notably for paleo and low carb dieters: low carbohydrate diets can reduce the conversion of T4 to T3 in the liver, inducing hypothyroidism.  Look out for this if you’ve been low carb for a significant period of time, if you have a low body temperature, and/or if you are a thin PCOS patient.

2)        DON’T EAT SOY.   Soy is a phytoestrogen.  Phytoestrogens resemble– but are NOT THE SAME as– estrogen in the body.  This leads to confusion in the endocrine system (and, significantly, breast cancer.)   Remarkably, soy may play a greater role in endocrine disruption than BPA.  Phytoestrogens can help mitigate some side effects of low estrogen levels such as hot flashes, but they cannot perform the proper signaling functions of true estrogen.  This means that exposure to BPA results in a body totally devoid of proper estrogen.  When the body detects “estrogen” in its bloodstream, it stops producing it on its own.  In this way, phytoestrogen consumption decrease estrogen levels at the time of ingestion.  Perhaps more importantly, however, it might also impair the body’s ability to produce estrogen, since the ovaries essentially get out of practice.  This is similar to the issue of gaining or losing weight.  Soy, like excess weight, is a “crutch” for the ovaries.  But it goes beyond that simple role in that it is a malfunctioning crutch, only working in certain circumstances.

One study done measured phytoestrogen levels of different foods, and while some vegetables had an order of magnitude greater than others, soy itself has 10,000 units per gram, rather than 4 or 5 hundred like other potent vegetables.  (I just spent a half hour looking– I know it’s on ScienceDirect– I’m sorry!)  Soy is the number one food you want to avoid if you have PCOS.

3)        Legumes, nuts, and seeds also act as phytoestrogens.

4)        Don’t eat dairy.   Pregnant cows produce a protein that inhibits testosterone blocking within our own systems, such that dairy is the most androgenic food out there.  Don’t eat dairy if you have PCOS or if you are worried about your androgen levels at all, especially if you want to decrease your acne.  I mean it.  Dairy also has a significant insulin response, which can irritate acne and PCOS.

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Other foods have less dramatic impacts but may be important to consider for hypersensitive PCOS patients.  My hormone levels probably wouldn’t be all that different if I ate a more varied diet, but because I am so careful to avoid androgenic and phytoestrogenic foods, I have managed to get my acne under pretty good control while I begin playing with clinical methods of treating my PCOS.   I seem to be quite sensitive, so it’s definitely worth a shot if you think you are.

 

5)        Factory farmed meat is injected with Bovine Growth Hormone, which can increase insulin-like growth factor 1 in humans.  This is bad.  Other hormones such as estrogen and testosterone are approved by the FDA for injection into the animals via an earpiece each animal is implanted with at birth.  The FDA claims that even with supplementation the animal’s hormonal profile falls within normal ranges, but I’m skeptical.   Aside from noticing that my acne gets worse whenever I eat meat, chicken, or any other farmed animal (not fish), I also noticed that while in Taiwan I rarely got new cysts, except for one day I ate hamburger meat from Costco.  I don’t know if they put anything nefarious in the meat, but I had volcanoes all over my face the next morning.  It’s also possible that natural levels of hormones in all meat affect me just as much as the factory-farmed sort.  I haven’t done any experiments to check.

6)        Cruciferous vegetables.  These veggies not only act as goitrogens and can decrease thyroid functioning when eaten raw, but they also promote the activity of cytochrome P450 enzyme CYP1A2.  This enzyme resides mostly in the liver and is responsible for clearing estrogen out of the system.  People often say that “excessive consumption” of cruciferous vegetables should be avoided, but that didn’t stop me from eating a pound or two raw per day.  It was hard not too, considering how limited my own diet is  (I eat primarily vegetables and fish, and wild game when I can get my hands on it).  In any case, my estrogen levels have continued to plummet over the last year, despite putting on a bit of weight, and I think this might have something to do with it.

The one food that has been found to reverse this “on” effect on cytochrome P450 enzyme CYP1A2 of cruciferous vegetables in the liver is grapefruit.  This is well documented in the medical literature.  Grapefruit is the only food that promotes estrogenic activity without acting as a phytoestrogen, so far as I can tell.   Be careful since this enzyme also inhibits the processing of a wide variety of drugs, but if you’re low on estrogen, don’t eat soy, eat grapefruit.

7)  Experiment with low carbohydrate (fructose!) and high carbohydrate diets.   Carbohydrate elicits a greater leptin response than fat.  Leptin is the hormone responsible for signalling to the hypothalamus that the body is sufficiently fed.  Without leptin, the body feels very hungry and might think it is living in a time of starvation.  This is one of the primary causes of amenorrhea and PCOS, presumably, as I described above.  That said, if you are a thin PCOS patient and are not insulin resistant, you might want to try eating a high carbohydrate (Safe starch!  Potato, taro, sweet potato, yam, white rice!) diet.  If you are an overweight PCOS patient, you probably want to eat a lower carbohydrate (again, most importantly, fructose) diet to limit insulin in your body as much as possible.

This past fall I experimented with higher carbohydrate diets.  I experienced greater vaginal discharge and sex drive when I ate a higher carbohydrate diet.  However, there were legumes involved in this diet, so there are too many variables to draw proper conclusions.  I remember one night in particular in which I ate a lot of potatoes, and I felt great,  wanting-to-skip-down-the-hall-to-my-room-every-thirty-minutes aroused, hah, for the rest of the next day.  But that’s all I’ve got so far as anecdotes go.

8) Experiment with fasting.  Fasting decreases leptin levels.  If you are overweight, intermittent fasting can really help you increase your insulin sensitivity and lose weight.  It can help you decrease testosterone.  Yet if you are thin, fasting might further convince your body that you are starving.  I really love to fast, but I have begun experimenting with addressing my hunger immediately.  Unfortunately I have nothing concrete to report on this point: it’s too soon to tell.

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What can somebody with PCOS eat?  Whatever they want, I suppose.  EXCEPT FOR SOY AND DAIRY AND SUGAR, holy crap it’s just not worth it.  In any case, it entirely depends on the patient, how much of a perfectionist she is, and how she reacts to certain foods.  It depends on her medication, her doctor, and her choices.  Experimentation is key. It’s taken me ages to figure out what I can eat to minimize my acne and to maximize the function of my ovaries.  With the drugs I’ve started taking, I imagine I’ll be able to start integrating in other foods such as cruciferous veggies, meat, and maybe even a bit of dairy in a few months.  This is a part of why PCOS treatment is important.  It enables you to eat a diet rich in all of the nutrients.  In the next post I’ll expound a bit more on food and on the different treatment options for PCOS.

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01 2012