Galatians 6:10; NLT
Therefore, whenever we have the opportunity, we should do good to everyone—especially to those in the family of faith.
One of the traps that is so easy to fall into in life is the trap of motivation. We say, "I just don't feel like doing that right now, I'll do it later." Since we are waiting for our feelings to catch up with what we now we ought to do, what ought to be done doesn't get done. That is why people say, "The road to hell is paved with good intentions." We may have had the good intentions, but good intentions don't love other people.
Paul tells us that we should not wait on our feelings. Instead we should make use of the opportunity that is in front of us. Even when we don't feel like doing the task or helping our neighbor we do it because it is an opportunity to show God's love to them. Life is too short to wait around for us to feel like loving, serving, forgiving, and worshipping. We need to buy up the time we have by making the most of the opportunities God sends our way.
The reason this is important is because when we base our actions off of our feelings we are putting ourselves front and center. We are not concerned about loving God and loving people, we are only concerned about loving ourselves. A life which is lived based on our feelings at the moment is a very selfish life.
The discipline of serving others, especially when we don't feel like serving, teaches us what it means to love people. It isn't going to come easy, but if we are intentional about doing it we will soon discover that serving and sacrificing our time to help someone else comes a little bit easier. We will also discover that we love God and we love people just a little bit more.
Tuesday, February 22, 2011
Rejecting grace
"When we embrace bitterness, we reject grace. When we allow a bitter root to take hold of our hearts, we literally miss the grace of God. Bitterness destroys our relationships, impairs our judgment, skews our perspective, and distorts our memories." ~ Erwin McManus, Uprising, p. 124
Ravi Zacharias
"Nothing brings back feelings of being cared for as much as being in a community that feels. There is hurt and loneliness on a rampant scale today. Nothing will speak to our society as much as a community that reaches out with the love of Christ." ~ Ravi Zacharias, Cries of the Heart, p. 55
Repentance
"Repentance is not a welcome idea among many believers today; as a whole, people squirm when confronted with it. No one likes to see himself as a sinner; it is nicer to be a good Christian. Yet don’t all four gospels make it clear that Christ came for sinners – not for saints – and that the way to Christ is humility and poverty of spirit, not human goodness?" ~ J. Heinrich Arnold, Freedom from Sinful Thoughts
Are Polycystic Ovary Syndrome and Eating Disorders Related?
By Angela Grassi, MS, RD, LDN
Today’s Dietitian
Vol. 8 No. 10 P. 32
Life the age-old chicken and egg debate, what comes first: the eating disorder or PCOS? Resarchers theorize that disordered eating could lead to PCOS and vice versa.
The first time I heard of polycystic ovary syndrome (PCOS) was in 1999 while working for an eating disorder treatment facility. A patient named Sarah, age 27, tearfully explained the symptoms she was experiencing: severe acne and hair growth on her face, absent periods, thinning hair, and her weight had been increasing nearly 2 pounds per month for the past year. She hated her body and believed it was out of control. She had been diagnosed with PCOS three weeks prior and her doctor recommended that she try the Atkins diet to manage her insulin and lose weight. Through the tears, Sarah admitted that she had tried to follow the diet but just kept bingeing on carbohydrates and felt so guilty afterward that she purged to get rid of them. Sarah also had a long history of bulimia nervosa (BN).
What Is PCOS?
PCOS is perhaps the most complex endocrine disorder, affecting 5% to 10% of reproductive-age women, and is the No. 1 cause of infertility.1 It is characterized by high levels of androgens (male hormones such as testosterone) from the ovaries as well as elevated follicle-stimulating hormone (FSH) and low levels of luteinizing hormone (LH). Tiny cysts, hence, “polycysts,” usually, but not always, surround the ovaries, appearing on ultrasound as a strand of pearls. The cysts are a result of hormonal imbalances, not the cause of them.
An estimated 50% to 70% of women with PCOS are also insulin resistant and experience weight gain in the abdominal area, difficulty losing weight, hypoglycemic episodes, and intense cravings for carbohydrates.2,3 In addition, many women with PCOS are overweight or obese and are at risk for developing diabetes and heart disease. Other signs and symptoms of PCOS may vary among individuals both in intensity and type and include excessive hair growth on the face and body (hirsutism), alopecia, acne, skin problems, and irregular or absent periods. Because most of these signs and symptoms have a direct effect on body image, not to mention struggles with weight and intense carbohydrate cravings, many researchers have questioned the theory that a relationship exists between PCOS and eating disorders.
Menstrual Disturbances
It is widely accepted that women with eating disorders, including anorexia nervosa, BN, or a combination of several symptoms of eating disorders commonly referred to as eating disorder not otherwise specified (EDNOS), have menstrual disturbances.4-6 And much like with PCOS, these menstrual disturbances include anovulation and oligomenorrhea (menstrual cycles longer than 40 days).7
In a recent study, researchers examined the hormonal dysfunctions associated with improper eating habits among 14 subjects with BN and 22 subjects with EDNOS.7 They found decreased levels of FSH and LH among both groups, and the EDNOS group had the lowest levels of the two hormones as well as higher amounts of testosterone than subjects in the control group. The researchers suggest that a reason why many women with BN and EDNOS may have menstrual disturbances is related to low levels of LH, which is a sensitive variant affected by dramatic changes in eating habits.7 Thus, crash dieting or restricting—common behaviors for individuals with BN and compulsive eating habits—may cause low levels of LH, resulting in an insufficient luteal phase and producing oligomenorrhea or anovulation.
The Emotional Toll
Like my patient Sarah, the symptoms many women with PCOS endure can have a direct effect on their body image and self-esteem and may lead to the development of distorted eating habits or eating disorders.8 Although there does seem to be a genetic component to PCOS development, with studies indicating that some girls are even born with cysts on their ovaries, most symptoms do not appear until the onset of puberty—another factor in common with eating disorders.9
For example, at a time when a young woman’s self-esteem is vulnerable, she may start to experience acne, excessive hair growth on her face and other parts of her body, and weight gain in her midsection—setting her apart from her peers. Not knowing she has PCOS or why her body is reacting the way it is, she may begin to blame herself and hate her body. Struggling with these issues at such a vulnerable time can lead many young women to deal with emotional distress through unhealthy dieting practices such as taking laxatives and diet pills, fasting, and engaging in excessive exercise and vomiting—all of which could set the stage for a lifetime of eating issues and body hatred.
Researchers have investigated the relationship between monozygotic and dizygotic twins with PCOS and BN by using the BITE (Bulimia Investigation Test, Edinburgh) questionnaire, a self-rating scale used to diagnose BN that includes 30 questions about dieting and binge behaviors such as, “Does your pattern of eating severely disrupt your life?” “Do you ever experience overpowering urges to eat and eat?” and “Do you ever fast for a whole day?”10
They found that 76% of twins with PCOS had elevated scores on the BITE, suggesting that a relationship does exist between BN and PCOS. Other studies conducted using the BITE questionnaire support a relationship between PCOS and binge eating, with one third of women with PCOS in one study having binge eating behavior.11
Jessica Setnick, MS, RD, LD, creator of Eating Disorders Boot Camp and a specialist in eating disorder treatment, has noted the connection between binge eating and PCOS. She says, “Many women with PCOS are so frustrated with their diagnosis. They feel immense pressure because they really want to lose weight and improve their symptoms, so they’ll restrict carbohydrates in order to lose weight.” But, she adds, “sometimes they eat such little amounts of food and, combined with their carbohydrate cravings, they end up bingeing and feeling even more horrible about themselves.” Thus, a vicious cycle ensues.
In addition, women with PCOS, because of their hormonal imbalances, may be more prone to mood swings and depression than women without PCOS. Elevated testosterone may make women with PCOS more aggressive, angry, anxious, and depressed, but many women with PCOS may also have mood disturbances from dealing with the symptoms associated with their diagnosis.12 Codiagnosis of other mental health problems is common among people with eating disorders.
The Insulin Effect
It is understandable that women with PCOS may become more susceptible to developing an eating disorder and suffer from body image disturbances, but can women with eating disorders develop PCOS?
Researchers have proposed that insulin may have an appetite-stimulating effect and can perpetuate binge behavior.4 For example, during an eating binge when large quantities of food are consumed over a relatively short amount of time, there is a surge of excess insulin—much more than experienced during a normal meal. Constant bingeing could, therefore, result in a chronic state of elevated insulin and when insulin levels become elevated, androgen levels can become elevated as well.4 As a result, women with PCOS who engage in binge eating will further increase insulin levels and cause a worsening of their PCOS symptoms.
Researchers have investigated whether women with BN are insulin resistant and examined the relationship between insulin and androgen levels, ovarian morphology, and severity of bulimic behavior.4 Although their study did not find that women with BN had insulin resistance, they did find that they were chronically hyperinsulinemic, with 10 of 12 normal weight subjects having polycystic ovaries.4 This leads researchers to speculate that hyperinsulinemia may be one reason why BN and PCOS are connected, with the bulimic pattern of bingeing followed by starvation and/or vomiting perpetuating the insulin response and leading to the development of polycystic ovaries.4 It may also suggest why some women who are overweight or obese develop PCOS through overfeeding.
There is some encouraging news: It appears that when women with PCOS and BN can return to normalized eating patterns with treatment involving cognitive behavioral therapy, it can result in improved ovarian morphology.6 Thus, chronic bingeing can worsen the appearance of polycystic ovaries, but ovarian morphology does seem to resolve when bingeing ceases and normal eating patterns are established.
The Cholecystokinin Connection
New research suggests that women with PCOS also have impaired secretion of the hormone cholecystokinin (CCK), resulting in a reduced feeling of satiety.3 CCK is released from the small intestine in response to the presence of food and plays an important role in regulating appetite. It was previously believed that women with BN also have impaired CCK secretion, which could also explain the tendencies of women with PCOS, BN, or EDNOS to crave sweets, binge eat, or be overweight because of their impaired ability to feel full.13 It is not known why women with PCOS have impaired CCK secretion following meals, but researchers have suggested that like individuals with BN and diabetes, women with PCOS may have delayed gastric emptying.3
Nutrition and Lifestyle Management
Although studies are lacking on the best dietary and lifestyle treatments for PCOS, the most commonly agreed upon recommendations to improve insulin levels and other symptoms in PCOS are to consume a diet low to moderate in carbohydrates with an emphasis on low-glycemic index foods and to engage in regular exercise.2 However, because women with PCOS may be more prone to binge eating, it is imperative that dietitians screen patients with PCOS for eating disorders first before recommending dieting or changes in eating behavior. Effective questions to ask during the initial assessment include the following:
• “How do you feel about your weight?”
• “Do you ever feel out of control with food?”
• “Are you able to tell when you are physically satisfied with food or full?”
• “How do you feel about eating foods containing carbohydrates?”
• “Have you ever dieted, vomited, or taken laxatives or diuretics to control your weight?”
If you suspect the client may have an eating disorder, your first focus should be to help her normalize eating patterns to control insulin levels and prevent bingeing and weight gain. Even without weight loss, ovarian morphology and insulin levels may improve by the restoration of normal eating patterns.6 Clients need to be educated on the importance of eating regular meals and snacks throughout the day to stabilize blood sugar levels and prevent cravings and hypoglycemic episodes. This may include eating every three to five hours with the addition of at least one to two protein exchanges with meals and snacks.2 In addition, I have noticed that many clients with PCOS who take insulin-lowering medications such as Metformin or Avandia report little or no hypoglycemic episodes, less carbohydrate cravings, and reduced interest in food overall.
“Dieting is a losing battle with PCOS,” says Setnick, “as patients have to cut back drastically in comparison to their peers in order to achieve any weight loss.” And because of their struggles in maintaining weight through dieting, many women with PCOS may have lost their internal ability to regulate food. For example, they may not be able to effectively distinguish when they are hungry, which could result in unnecessary eating or waiting long periods to eat. Or, if they do use food to cope with emotions, perhaps they are unable to distinguish when they are physically satisfied with food, leading them to eat more than they need.
Part of establishing lifelong normalized eating patterns should involve education on self-care and mindful eating. The use of food logs to rate hunger and satisfaction levels before and after meals can be an effective technique for promoting self-awareness in addition to conscious eating exercises used with clients in nutrition sessions and at home.
Most of all, women struggling with PCOS and eating disorders need to learn effective ways to deal with their emotions without abusing food. Dietitians can help clients identify possible alternative coping skills other than food and should support clients to apply these new skills in their life.
For example, I encourage my clients to make a list of things they can do when they have urges to binge, such as walking, reading, writing in a journal, calling a friend, surfing the Internet, or taking a bath. Clients are encouraged to apply some of the activities on the list to overcome urges and find the ones that work best for them. In addition, working with a psychotherapist may help individuals identify their emotional triggers and encourage mindfulness and behavior change.
Once normalized eating patterns have been established and clients are able to respond to internal cues of hunger and satiety without using eating disorder symptoms, further recommendations on diet and exercise may be advised with caution and should focus more on continuing to improve metabolic fitness rather than weight loss.14,15
— Angela Grassi, MS, RD, LDN, is a speaker, an author, and a consultant in Haverford, Pa. She specializes in polycystic ovary syndrome and eating disorders and is currently working on her first book, The Dietitian’s Guide to PCOS. Visit her Web site at www.pcosnutrition.com.
--------------------------------------------------------------------------------
References
1. Azziz R, Woods KS, Reyna R, et al. The prevalence and features of polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab. 2004;89(6):2745-2749.
2. Marsh K, Brand-Miller J. The optimal diet for women with polycystic ovary syndrome? Br J Nutr. 2005;94(2):154-165.
3. Hirschberg AL, Nassen S, Stridsberg M, et al. Impaired cholecystokinin secretion and disturbed appetite regulation in women with polycystic ovary syndrome. Gynecol Endocrinol. 2004;19(2):79-87.
4. Raphael FJ, Rodin DA, Peattie A, et al. Ovarian morphology and insulin sensitivity in women with bulimia nervosa. Clin Endocrinol (Oxf). 1995;43(4):451-455.
5. Michelmore KF, Balen AH, Dunger DB. Polycystic ovaries and eating disorders: Are they related? Hum Reprod. 2001;16(4):765-769.
6. Morgan J, McCluskey SE, Brunton JN, et al. Polycystic ovarian morphology and bulimia nervosa: A 9-year follow-up study. Fertil and Steril. 2002;77(5):928-931.
7. Resch M, Szendei G, Haasz P. Bulimia from a gynecological view: Hormonal changes. J Obstet Gynaecol. 2004;24(8):907-910.
8. McCluskey S, Evans C, Lacey JH, et al. Polycystic ovary syndrome and bulimia. Fertil Steril. 1991;55(2):287-291.
9. Bridges, NA, Cooke A, Healy MJ, et al. Standards for ovarian volume in childhood and puberty. Fertil Steril. 1993;60(3):456-460.
10. Jahanfar S, Eden JA, Nguyent TV. Bulimia nervosa and polycystic ovary syndrome. Gynecol Endocrinol. 1995;9(2):113-117.
11. McCluskey S, Lacey JH, Pearce JM. Binge-eating and polycystic ovaries. Lancet. 1992;340(8821):723.
12. Weiner CL, Primeau M, Ehrmann DA. Androgens and mood dysfunction in women: Comparison of women with polycystic ovarian syndrome to healthy controls. Psychosom Med. 2004;66(3):356-362.
13. Geraciotti TD Jr, Liddle RA. Impaired cholecystokinin secretion in bulimia nervosa. N Engl J Med. 1988;319(11):683-688.
14. Morgan JF. Bulimic eating patterns should be stabilised in polycystic ovarian syndrome. BMJ. 1999;318(7179):328.
15. Moran L, Norman RJ. Understanding and managing disturbances in insulin metabolism and body weight in women with polycystic ovary syndrome. Best Pract Res Clin Obstet Gynaecol. 2004;18(5):719-736.
By Angela Grassi, MS, RD, LDN
Today’s Dietitian
Vol. 8 No. 10 P. 32
Life the age-old chicken and egg debate, what comes first: the eating disorder or PCOS? Resarchers theorize that disordered eating could lead to PCOS and vice versa.
The first time I heard of polycystic ovary syndrome (PCOS) was in 1999 while working for an eating disorder treatment facility. A patient named Sarah, age 27, tearfully explained the symptoms she was experiencing: severe acne and hair growth on her face, absent periods, thinning hair, and her weight had been increasing nearly 2 pounds per month for the past year. She hated her body and believed it was out of control. She had been diagnosed with PCOS three weeks prior and her doctor recommended that she try the Atkins diet to manage her insulin and lose weight. Through the tears, Sarah admitted that she had tried to follow the diet but just kept bingeing on carbohydrates and felt so guilty afterward that she purged to get rid of them. Sarah also had a long history of bulimia nervosa (BN).
What Is PCOS?
PCOS is perhaps the most complex endocrine disorder, affecting 5% to 10% of reproductive-age women, and is the No. 1 cause of infertility.1 It is characterized by high levels of androgens (male hormones such as testosterone) from the ovaries as well as elevated follicle-stimulating hormone (FSH) and low levels of luteinizing hormone (LH). Tiny cysts, hence, “polycysts,” usually, but not always, surround the ovaries, appearing on ultrasound as a strand of pearls. The cysts are a result of hormonal imbalances, not the cause of them.
An estimated 50% to 70% of women with PCOS are also insulin resistant and experience weight gain in the abdominal area, difficulty losing weight, hypoglycemic episodes, and intense cravings for carbohydrates.2,3 In addition, many women with PCOS are overweight or obese and are at risk for developing diabetes and heart disease. Other signs and symptoms of PCOS may vary among individuals both in intensity and type and include excessive hair growth on the face and body (hirsutism), alopecia, acne, skin problems, and irregular or absent periods. Because most of these signs and symptoms have a direct effect on body image, not to mention struggles with weight and intense carbohydrate cravings, many researchers have questioned the theory that a relationship exists between PCOS and eating disorders.
Menstrual Disturbances
It is widely accepted that women with eating disorders, including anorexia nervosa, BN, or a combination of several symptoms of eating disorders commonly referred to as eating disorder not otherwise specified (EDNOS), have menstrual disturbances.4-6 And much like with PCOS, these menstrual disturbances include anovulation and oligomenorrhea (menstrual cycles longer than 40 days).7
In a recent study, researchers examined the hormonal dysfunctions associated with improper eating habits among 14 subjects with BN and 22 subjects with EDNOS.7 They found decreased levels of FSH and LH among both groups, and the EDNOS group had the lowest levels of the two hormones as well as higher amounts of testosterone than subjects in the control group. The researchers suggest that a reason why many women with BN and EDNOS may have menstrual disturbances is related to low levels of LH, which is a sensitive variant affected by dramatic changes in eating habits.7 Thus, crash dieting or restricting—common behaviors for individuals with BN and compulsive eating habits—may cause low levels of LH, resulting in an insufficient luteal phase and producing oligomenorrhea or anovulation.
The Emotional Toll
Like my patient Sarah, the symptoms many women with PCOS endure can have a direct effect on their body image and self-esteem and may lead to the development of distorted eating habits or eating disorders.8 Although there does seem to be a genetic component to PCOS development, with studies indicating that some girls are even born with cysts on their ovaries, most symptoms do not appear until the onset of puberty—another factor in common with eating disorders.9
For example, at a time when a young woman’s self-esteem is vulnerable, she may start to experience acne, excessive hair growth on her face and other parts of her body, and weight gain in her midsection—setting her apart from her peers. Not knowing she has PCOS or why her body is reacting the way it is, she may begin to blame herself and hate her body. Struggling with these issues at such a vulnerable time can lead many young women to deal with emotional distress through unhealthy dieting practices such as taking laxatives and diet pills, fasting, and engaging in excessive exercise and vomiting—all of which could set the stage for a lifetime of eating issues and body hatred.
Researchers have investigated the relationship between monozygotic and dizygotic twins with PCOS and BN by using the BITE (Bulimia Investigation Test, Edinburgh) questionnaire, a self-rating scale used to diagnose BN that includes 30 questions about dieting and binge behaviors such as, “Does your pattern of eating severely disrupt your life?” “Do you ever experience overpowering urges to eat and eat?” and “Do you ever fast for a whole day?”10
They found that 76% of twins with PCOS had elevated scores on the BITE, suggesting that a relationship does exist between BN and PCOS. Other studies conducted using the BITE questionnaire support a relationship between PCOS and binge eating, with one third of women with PCOS in one study having binge eating behavior.11
Jessica Setnick, MS, RD, LD, creator of Eating Disorders Boot Camp and a specialist in eating disorder treatment, has noted the connection between binge eating and PCOS. She says, “Many women with PCOS are so frustrated with their diagnosis. They feel immense pressure because they really want to lose weight and improve their symptoms, so they’ll restrict carbohydrates in order to lose weight.” But, she adds, “sometimes they eat such little amounts of food and, combined with their carbohydrate cravings, they end up bingeing and feeling even more horrible about themselves.” Thus, a vicious cycle ensues.
In addition, women with PCOS, because of their hormonal imbalances, may be more prone to mood swings and depression than women without PCOS. Elevated testosterone may make women with PCOS more aggressive, angry, anxious, and depressed, but many women with PCOS may also have mood disturbances from dealing with the symptoms associated with their diagnosis.12 Codiagnosis of other mental health problems is common among people with eating disorders.
The Insulin Effect
It is understandable that women with PCOS may become more susceptible to developing an eating disorder and suffer from body image disturbances, but can women with eating disorders develop PCOS?
Researchers have proposed that insulin may have an appetite-stimulating effect and can perpetuate binge behavior.4 For example, during an eating binge when large quantities of food are consumed over a relatively short amount of time, there is a surge of excess insulin—much more than experienced during a normal meal. Constant bingeing could, therefore, result in a chronic state of elevated insulin and when insulin levels become elevated, androgen levels can become elevated as well.4 As a result, women with PCOS who engage in binge eating will further increase insulin levels and cause a worsening of their PCOS symptoms.
Researchers have investigated whether women with BN are insulin resistant and examined the relationship between insulin and androgen levels, ovarian morphology, and severity of bulimic behavior.4 Although their study did not find that women with BN had insulin resistance, they did find that they were chronically hyperinsulinemic, with 10 of 12 normal weight subjects having polycystic ovaries.4 This leads researchers to speculate that hyperinsulinemia may be one reason why BN and PCOS are connected, with the bulimic pattern of bingeing followed by starvation and/or vomiting perpetuating the insulin response and leading to the development of polycystic ovaries.4 It may also suggest why some women who are overweight or obese develop PCOS through overfeeding.
There is some encouraging news: It appears that when women with PCOS and BN can return to normalized eating patterns with treatment involving cognitive behavioral therapy, it can result in improved ovarian morphology.6 Thus, chronic bingeing can worsen the appearance of polycystic ovaries, but ovarian morphology does seem to resolve when bingeing ceases and normal eating patterns are established.
The Cholecystokinin Connection
New research suggests that women with PCOS also have impaired secretion of the hormone cholecystokinin (CCK), resulting in a reduced feeling of satiety.3 CCK is released from the small intestine in response to the presence of food and plays an important role in regulating appetite. It was previously believed that women with BN also have impaired CCK secretion, which could also explain the tendencies of women with PCOS, BN, or EDNOS to crave sweets, binge eat, or be overweight because of their impaired ability to feel full.13 It is not known why women with PCOS have impaired CCK secretion following meals, but researchers have suggested that like individuals with BN and diabetes, women with PCOS may have delayed gastric emptying.3
Nutrition and Lifestyle Management
Although studies are lacking on the best dietary and lifestyle treatments for PCOS, the most commonly agreed upon recommendations to improve insulin levels and other symptoms in PCOS are to consume a diet low to moderate in carbohydrates with an emphasis on low-glycemic index foods and to engage in regular exercise.2 However, because women with PCOS may be more prone to binge eating, it is imperative that dietitians screen patients with PCOS for eating disorders first before recommending dieting or changes in eating behavior. Effective questions to ask during the initial assessment include the following:
• “How do you feel about your weight?”
• “Do you ever feel out of control with food?”
• “Are you able to tell when you are physically satisfied with food or full?”
• “How do you feel about eating foods containing carbohydrates?”
• “Have you ever dieted, vomited, or taken laxatives or diuretics to control your weight?”
If you suspect the client may have an eating disorder, your first focus should be to help her normalize eating patterns to control insulin levels and prevent bingeing and weight gain. Even without weight loss, ovarian morphology and insulin levels may improve by the restoration of normal eating patterns.6 Clients need to be educated on the importance of eating regular meals and snacks throughout the day to stabilize blood sugar levels and prevent cravings and hypoglycemic episodes. This may include eating every three to five hours with the addition of at least one to two protein exchanges with meals and snacks.2 In addition, I have noticed that many clients with PCOS who take insulin-lowering medications such as Metformin or Avandia report little or no hypoglycemic episodes, less carbohydrate cravings, and reduced interest in food overall.
“Dieting is a losing battle with PCOS,” says Setnick, “as patients have to cut back drastically in comparison to their peers in order to achieve any weight loss.” And because of their struggles in maintaining weight through dieting, many women with PCOS may have lost their internal ability to regulate food. For example, they may not be able to effectively distinguish when they are hungry, which could result in unnecessary eating or waiting long periods to eat. Or, if they do use food to cope with emotions, perhaps they are unable to distinguish when they are physically satisfied with food, leading them to eat more than they need.
Part of establishing lifelong normalized eating patterns should involve education on self-care and mindful eating. The use of food logs to rate hunger and satisfaction levels before and after meals can be an effective technique for promoting self-awareness in addition to conscious eating exercises used with clients in nutrition sessions and at home.
Most of all, women struggling with PCOS and eating disorders need to learn effective ways to deal with their emotions without abusing food. Dietitians can help clients identify possible alternative coping skills other than food and should support clients to apply these new skills in their life.
For example, I encourage my clients to make a list of things they can do when they have urges to binge, such as walking, reading, writing in a journal, calling a friend, surfing the Internet, or taking a bath. Clients are encouraged to apply some of the activities on the list to overcome urges and find the ones that work best for them. In addition, working with a psychotherapist may help individuals identify their emotional triggers and encourage mindfulness and behavior change.
Once normalized eating patterns have been established and clients are able to respond to internal cues of hunger and satiety without using eating disorder symptoms, further recommendations on diet and exercise may be advised with caution and should focus more on continuing to improve metabolic fitness rather than weight loss.14,15
— Angela Grassi, MS, RD, LDN, is a speaker, an author, and a consultant in Haverford, Pa. She specializes in polycystic ovary syndrome and eating disorders and is currently working on her first book, The Dietitian’s Guide to PCOS. Visit her Web site at www.pcosnutrition.com.
--------------------------------------------------------------------------------
References
1. Azziz R, Woods KS, Reyna R, et al. The prevalence and features of polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab. 2004;89(6):2745-2749.
2. Marsh K, Brand-Miller J. The optimal diet for women with polycystic ovary syndrome? Br J Nutr. 2005;94(2):154-165.
3. Hirschberg AL, Nassen S, Stridsberg M, et al. Impaired cholecystokinin secretion and disturbed appetite regulation in women with polycystic ovary syndrome. Gynecol Endocrinol. 2004;19(2):79-87.
4. Raphael FJ, Rodin DA, Peattie A, et al. Ovarian morphology and insulin sensitivity in women with bulimia nervosa. Clin Endocrinol (Oxf). 1995;43(4):451-455.
5. Michelmore KF, Balen AH, Dunger DB. Polycystic ovaries and eating disorders: Are they related? Hum Reprod. 2001;16(4):765-769.
6. Morgan J, McCluskey SE, Brunton JN, et al. Polycystic ovarian morphology and bulimia nervosa: A 9-year follow-up study. Fertil and Steril. 2002;77(5):928-931.
7. Resch M, Szendei G, Haasz P. Bulimia from a gynecological view: Hormonal changes. J Obstet Gynaecol. 2004;24(8):907-910.
8. McCluskey S, Evans C, Lacey JH, et al. Polycystic ovary syndrome and bulimia. Fertil Steril. 1991;55(2):287-291.
9. Bridges, NA, Cooke A, Healy MJ, et al. Standards for ovarian volume in childhood and puberty. Fertil Steril. 1993;60(3):456-460.
10. Jahanfar S, Eden JA, Nguyent TV. Bulimia nervosa and polycystic ovary syndrome. Gynecol Endocrinol. 1995;9(2):113-117.
11. McCluskey S, Lacey JH, Pearce JM. Binge-eating and polycystic ovaries. Lancet. 1992;340(8821):723.
12. Weiner CL, Primeau M, Ehrmann DA. Androgens and mood dysfunction in women: Comparison of women with polycystic ovarian syndrome to healthy controls. Psychosom Med. 2004;66(3):356-362.
13. Geraciotti TD Jr, Liddle RA. Impaired cholecystokinin secretion in bulimia nervosa. N Engl J Med. 1988;319(11):683-688.
14. Morgan JF. Bulimic eating patterns should be stabilised in polycystic ovarian syndrome. BMJ. 1999;318(7179):328.
15. Moran L, Norman RJ. Understanding and managing disturbances in insulin metabolism and body weight in women with polycystic ovary syndrome. Best Pract Res Clin Obstet Gynaecol. 2004;18(5):719-736.
Sunday, February 20, 2011
1 John 4:8
God loves you not because of what you do, but because of who He is.
God is love (1 John 4:8). God doesn't have to pretend to love you; He can't not love you, because He is love.
In fact, the very actions of God exemplify what love is. The apostle John explains that this is how we know what love is: Jesus Christ laid down his life for us (1 John 3:16). Only a few verses later, he further defines love: This is love: not that we loved God, but that he loved us and sent his Son as an atoning sacrifice for our sins (1 John 4:9).
Notice that God's love for you is independent of how you behave, who you are, or how you respond to that love.
Romans 5:6-8 reminds us that God loves us regardless of where we are: You see, at just the right time, when we were still powerless, Christ died for the ungodly. Very rarely will anyone die for a righteous man, though for a good man someone might possibly dare to die. But God demonstrates his own love for us in this: While we were still sinners, Christ died for us.
Jesus represents God's love for us in what we now call the Parable of the Prodigal Son (see Luke 15:11-24). In that allegory, the father openly and lovingly receives his son even though the son had run away, squandered all of his money, and insulted the father. In the same way, God loves us unconditionally.
There is nothing you can do to get God to love you -- He already does. There is nothing you can do to deserve God's love, because, by sinning, you have turned your back on God and are fundamentally no different than the prodigal son. That parable is a clear reminder that God loves you not because of what you do, but because of who He is.
God is love (1 John 4:8). God doesn't have to pretend to love you; He can't not love you, because He is love.
In fact, the very actions of God exemplify what love is. The apostle John explains that this is how we know what love is: Jesus Christ laid down his life for us (1 John 3:16). Only a few verses later, he further defines love: This is love: not that we loved God, but that he loved us and sent his Son as an atoning sacrifice for our sins (1 John 4:9).
Notice that God's love for you is independent of how you behave, who you are, or how you respond to that love.
Romans 5:6-8 reminds us that God loves us regardless of where we are: You see, at just the right time, when we were still powerless, Christ died for the ungodly. Very rarely will anyone die for a righteous man, though for a good man someone might possibly dare to die. But God demonstrates his own love for us in this: While we were still sinners, Christ died for us.
Jesus represents God's love for us in what we now call the Parable of the Prodigal Son (see Luke 15:11-24). In that allegory, the father openly and lovingly receives his son even though the son had run away, squandered all of his money, and insulted the father. In the same way, God loves us unconditionally.
There is nothing you can do to get God to love you -- He already does. There is nothing you can do to deserve God's love, because, by sinning, you have turned your back on God and are fundamentally no different than the prodigal son. That parable is a clear reminder that God loves you not because of what you do, but because of who He is.
Stealing Joy
It's not our circumstances that steal our joy; it's our attitude during our circumstances.
It is easy to think "If I could just get a new car, a bigger house, a better job, or more money, then I'll be happy." We tend to view happiness as a commodity attainable by wealth. However, as the old saying goes, "money cannot buy happiness."
Indeed, no amount of money or things will ever give you lasting joy or contentment; that's because joy and contentment are not based on circumstances. Therefore, if you're not content with what you have, you won't be content with what you want.
Although at first it may seem difficult, it is very possible to be content even during harsh circumstances. Paul said, in Philippians 4:11-12, "I have learned to be content whatever the circumstances. I know what it is to be in need, and I know what it is to have plenty. I have learned the secret of being content in any and every situation, whether well fed or hungry, whether living in plenty or in want."
In those two verses, Paul is saying that he could be content—that is, have joy—regardless of his circumstances. Joy should not be dependent on circumstances; it should be present regardless of them.
When Paul said that he could be content "in any and every situation," he truly meant everything—even the tough times of testing. In 2 Corinthians 11:24-27, he lists some of the tough times that he has endured: "Five times I received from the Jews the forty lashes minus one. Three times I was beaten with rods, once I was stoned, three times I was shipwrecked, I spent a night and a day in the open sea, I have been constantly on the move. I have been in danger from rivers, in danger from bandits, in danger from my own countrymen, in danger from Gentiles; in danger in the city, in danger in the country, in danger at sea; and in danger from false brothers. I have labored and toiled and have often gone without sleep; I have known hunger and thirst and have often gone without food; I have been cold and naked."
Even in all these things, Paul had "learned to be content." Clearly, it's not our circumstances that steal our joy. You, too, can learn "to be content whatever the circumstances."
Stop thinking that you will have joy after you buy a new house, after you get married (or have children), after you buy a better car, after your in-laws treat you right. Don't put off joy until after everything goes your way; decide to have joy now! For you can have joy whatever the circumstances!
It is easy to think "If I could just get a new car, a bigger house, a better job, or more money, then I'll be happy." We tend to view happiness as a commodity attainable by wealth. However, as the old saying goes, "money cannot buy happiness."
Indeed, no amount of money or things will ever give you lasting joy or contentment; that's because joy and contentment are not based on circumstances. Therefore, if you're not content with what you have, you won't be content with what you want.
Although at first it may seem difficult, it is very possible to be content even during harsh circumstances. Paul said, in Philippians 4:11-12, "I have learned to be content whatever the circumstances. I know what it is to be in need, and I know what it is to have plenty. I have learned the secret of being content in any and every situation, whether well fed or hungry, whether living in plenty or in want."
In those two verses, Paul is saying that he could be content—that is, have joy—regardless of his circumstances. Joy should not be dependent on circumstances; it should be present regardless of them.
When Paul said that he could be content "in any and every situation," he truly meant everything—even the tough times of testing. In 2 Corinthians 11:24-27, he lists some of the tough times that he has endured: "Five times I received from the Jews the forty lashes minus one. Three times I was beaten with rods, once I was stoned, three times I was shipwrecked, I spent a night and a day in the open sea, I have been constantly on the move. I have been in danger from rivers, in danger from bandits, in danger from my own countrymen, in danger from Gentiles; in danger in the city, in danger in the country, in danger at sea; and in danger from false brothers. I have labored and toiled and have often gone without sleep; I have known hunger and thirst and have often gone without food; I have been cold and naked."
Even in all these things, Paul had "learned to be content." Clearly, it's not our circumstances that steal our joy. You, too, can learn "to be content whatever the circumstances."
Stop thinking that you will have joy after you buy a new house, after you get married (or have children), after you buy a better car, after your in-laws treat you right. Don't put off joy until after everything goes your way; decide to have joy now! For you can have joy whatever the circumstances!
Tuesday, February 15, 2011
Theme song
I've posted this before but I really think the William Tell Overture should be the theme song for infertility. I'm serious. Someone should create some sort of parody to go with it, because my heavens it definitely is what I hear when there is something going on.
Lets think about it. With PCOS and infertility we have....
Lets think about it. With PCOS and infertility we have....
- bloodwork
- scheduled intercourse
- temping
- charting
- analyzing
- testing
- ultrasounds
- full body physicals
- ovary chat
- more bloodwork
- planning
- worry
- anxiety
- excitement
- hope
- frustration
- more testing
The list could go on and on. It's just on the go go go.
Friendships
Yesterday I also received a lovely note from my friend Emily, another gal I've befriended through this blog and social networking. I'm so blessed to have such wonderful women in my life. We help one another through the ups, the downs, the gains, the losses, the waiting, the joys and the sorrows.
Friendships are so important to me. I often find myself frustrated when people claim they are too busy. Too busy to be a friend? Too busy to send a note of care? Too busy to simply say "hello"... Everyone is busy. I'm no angel, I admit ... sometimes it takes weeks to set a date to get together but it does happen! We're all on such a busy journey to begin with filled with appointments, logging, reflecting, and of course bd-ing. I admit I sometimes struggle especially with being a full time special education teacher, a wife, a sister, a daughter, a graduate student, a patient, etc. The point is though, my friends always know how I feel for them. They know they are important to me. And hey, they're busy, too! We all wear many hats. But it is important to treasure the relationships in your life.
When I was in Ireland, our tour guide, Michael had said, "You can always tell who is from America in Ireland." We said, "How can you tell?" He said, "Because Americans have no shame getting their coffee or tea 'to go'....Americans are always in such a hurry that they forget the sanctity in taking the time to sit down, relax, sip, and enjoy a cup of tea with yourself or a friend."
Baby dust from Cali!
Yesterday, I received some really neat mail.BABY DUST!!!
The above card is from my friend Jennifer. I call her "friend" but we haven't even met in person... YET! I'm very excited about her move from California to Ohio as I would LOVE to meet her in person. I can't believe that through this blog and the power of social networking, I've been able to meet so many wonderful ladies, my "cysters" as we all battle PCOS to some extent whether we are trying to conceive or not.
I'm truly grateful for the ability to write, network, connect, help and witness with these incredible women. :)
Monday, February 14, 2011
4 years 9 months
Today is Valentine's Day and it is our tradition that we go to HOOTER's for Valentine's Day. This restaurant is highly misunderstood mainly because of how the girls dress there.
It's the best chicken in the whole wide world and the best service.
We started going to Hooter's a few years ago when hubby was trying to wine and dine me for Valentine's Day. The restaurant we were at (my choice) was sooooo crowded and they didn't do reservations and the wait was forever. Finally, after much rumbly in our tumblies, I said, "Take me there" and across the street we went and thus the Hooters tradition began.
We've been together for almost ten years and we're incredibly blessed. We'll be married for six years this May and we've been trying to conceive a living baby since our one year wedding anniversary, hence the title of this entry.
Monday, February 7, 2011
What a cycle, yikes!
I am so glad my period is finally coming to an end.
TMI? Sorry! But this IS a blog on infertility!
Anywhoo, between the thyroid and this months cycle, I am up FOUR pounds which I hope to have off in a week or two. I've been doing SO well with the new weight watchers but I'm feeling frustrated by this gain even though I essentially did nothing wrong. For two or three weeks the scale stood still and now it is moving - just not in the direction I'd like.
The good news is that my husband has finally joined the YMCA with me which is really exciting for me. It means that we can start setting a schedule for both of us to exercise and it means we can have more time together. Sometimes my struggle is just GETTING to the Y and then I can end up staying there for two or more hours easily.
We need to take this month off from TTC so I'm going to use this month as an excuse to lose as close to 10lbs as possible. I know I can do it now - especially now that I have the appropriate resources to do so. Sometimes its just rough being a woman!
Hopefully everyone else is doing well. I don't get many comments on this blog but I know I have several readers.
TMI? Sorry! But this IS a blog on infertility!
Anywhoo, between the thyroid and this months cycle, I am up FOUR pounds which I hope to have off in a week or two. I've been doing SO well with the new weight watchers but I'm feeling frustrated by this gain even though I essentially did nothing wrong. For two or three weeks the scale stood still and now it is moving - just not in the direction I'd like.
The good news is that my husband has finally joined the YMCA with me which is really exciting for me. It means that we can start setting a schedule for both of us to exercise and it means we can have more time together. Sometimes my struggle is just GETTING to the Y and then I can end up staying there for two or more hours easily.
We need to take this month off from TTC so I'm going to use this month as an excuse to lose as close to 10lbs as possible. I know I can do it now - especially now that I have the appropriate resources to do so. Sometimes its just rough being a woman!
Hopefully everyone else is doing well. I don't get many comments on this blog but I know I have several readers.
Saturday, February 5, 2011
Belinda's miracle
If you read my tags for "Belinda" you will read that she too, has struggled.
She is a dear friend of mine and I couldn't be happier than I am right now to share this link of her miracle baby. Miracles happen everyday, I know ours is coming eventually.
She is a dear friend of mine and I couldn't be happier than I am right now to share this link of her miracle baby. Miracles happen everyday, I know ours is coming eventually.
Tuesday, February 1, 2011
Reproductive Crisis
Before reading on, please know I'm WAITING on the results as of this time. NOTHING is confirmed but lots is suspected.
On January 26th, I went in to the doctors to have my bloodwork done to determine if I am indeed ovulating. For the past week or two, my feet have been REALLY cold and my weight loss has been at a standstill/plateau so I added on a thyroid check. Thank God I did that.
Thursday, the 27th, I began having some intense pain in the ovary area. It was to the point where standing up was the most comfort for me. I figured something good must be happening in there because I've never felt that before.
Flash forward to 3am today (1-31-11) when I woke up choking on my vomit. Lovely. I threw up quite a bit this morning (I'll spare you the details) and just wasn't feeling well. I called off work considering the nausea lasted for a while and I just wasn't feeling 100%.
The doctors office called with my test results from the 26th. I was glad to be home for the call because I just CRIED over them. I'm so upset about this because really no one is going to understand this best unless you are a fellow PCOS-er (no offense).
My results came back that I did ovulate, however, my progestrone was at level 6 and it needs to be 10 or higher for a SUCCESSFUL and viable pregnancy. In addition to the 6, my thyroid came back BAD. Dr. P is completely puzzled as to WHY my thyroid went from awesome to BAD during this cycle. My thyroid was at 3.35 which explains the plateau and the cold feet. I know my body well and I know if my weight isn't moving and if my feet are cold (even though it is winter), that my thyroid is off. A healthy thyroid range is 0.2-5 HOWEVER, a woman trying to have a baby needs a number less than 2. With the combination of the 6 and the 3.35 this means that if I am in fact pregnant right now, the possibility of chemical pregnancy and/or miscarriage is HIGH.
The nurse asked me when I was due for my period and I told her it has been coming religiously on the 4th of the month. She talked to me about my options for a bit. I could have a month off of TTC and get my thyroid under control OR I could get my thyroid under control and then opt for chlomid or femara for a stronger ovulation. Dr. P indicated that he will be taking over my charts from here on out for my thyroid now as well as for my pcos and infertility. This is the good news. He absolutely refuses to put me through a miscarriage on his watch if he can help it. The nurses all read the letter I wrote him before Christmas and they all cried and Deb (my nurse) said he's taken a special interest in me knowing my full history. I swear I'm going to name my kid after this man. Anyways...I told them I just needed some time to think and hung up.
I talked to Mark and then it hit us, "What if we're pregnant now..." I failed to mention to them that I've been throwing up and I've been reading up on this and morning sickness CAN happen as early as 3 weeks but for most women its weeks 6-12. Considering I'm a medical mystery, this sent us into a panic and I called Dr. P back and explained the cramping I had earlier in the week and the fact that I was home sick (throwing up) and just feeling like crap for no known reason. They immediately faxed in a blood order for several tests including pregnancy and progestrone level.
See the thing that needs to be understood is some women with low progestrone get pregnant and the body self corrects with no issue. However, for pcos women, this isn't always the case as our ovaries tend to misbehave (for lack of a better word). The low progestrone + pcos + bad thyroid level = potential recipe for disaster.
So ideally, what we are hoping for is for the pregnancy test to come back NEGATIVE (yea, first time wanting that).
IF we get a positive we really don't know what will happen to us or the baby at this point. A lot of testing was done today and to be honest, I need to stop typing as I've cried enough today. We won't know how to deal with it until we know what the HCG and progestrone say.
The fact of the matter is we're a bit scared right now. We don't know why this is happening but what we do know is I got a two level bump on my thyroid meds which should prevent this from happening again.
I've got a lot of faith in my doctor. I'm completely trusting in him and God that we'll be okay, but even though I trust - it doesn't mean that Mark and I both aren't terrified right now.
So now... we wait.
On January 26th, I went in to the doctors to have my bloodwork done to determine if I am indeed ovulating. For the past week or two, my feet have been REALLY cold and my weight loss has been at a standstill/plateau so I added on a thyroid check. Thank God I did that.
Thursday, the 27th, I began having some intense pain in the ovary area. It was to the point where standing up was the most comfort for me. I figured something good must be happening in there because I've never felt that before.
Flash forward to 3am today (1-31-11) when I woke up choking on my vomit. Lovely. I threw up quite a bit this morning (I'll spare you the details) and just wasn't feeling well. I called off work considering the nausea lasted for a while and I just wasn't feeling 100%.
The doctors office called with my test results from the 26th. I was glad to be home for the call because I just CRIED over them. I'm so upset about this because really no one is going to understand this best unless you are a fellow PCOS-er (no offense).
My results came back that I did ovulate, however, my progestrone was at level 6 and it needs to be 10 or higher for a SUCCESSFUL and viable pregnancy. In addition to the 6, my thyroid came back BAD. Dr. P is completely puzzled as to WHY my thyroid went from awesome to BAD during this cycle. My thyroid was at 3.35 which explains the plateau and the cold feet. I know my body well and I know if my weight isn't moving and if my feet are cold (even though it is winter), that my thyroid is off. A healthy thyroid range is 0.2-5 HOWEVER, a woman trying to have a baby needs a number less than 2. With the combination of the 6 and the 3.35 this means that if I am in fact pregnant right now, the possibility of chemical pregnancy and/or miscarriage is HIGH.
The nurse asked me when I was due for my period and I told her it has been coming religiously on the 4th of the month. She talked to me about my options for a bit. I could have a month off of TTC and get my thyroid under control OR I could get my thyroid under control and then opt for chlomid or femara for a stronger ovulation. Dr. P indicated that he will be taking over my charts from here on out for my thyroid now as well as for my pcos and infertility. This is the good news. He absolutely refuses to put me through a miscarriage on his watch if he can help it. The nurses all read the letter I wrote him before Christmas and they all cried and Deb (my nurse) said he's taken a special interest in me knowing my full history. I swear I'm going to name my kid after this man. Anyways...I told them I just needed some time to think and hung up.
I talked to Mark and then it hit us, "What if we're pregnant now..." I failed to mention to them that I've been throwing up and I've been reading up on this and morning sickness CAN happen as early as 3 weeks but for most women its weeks 6-12. Considering I'm a medical mystery, this sent us into a panic and I called Dr. P back and explained the cramping I had earlier in the week and the fact that I was home sick (throwing up) and just feeling like crap for no known reason. They immediately faxed in a blood order for several tests including pregnancy and progestrone level.
See the thing that needs to be understood is some women with low progestrone get pregnant and the body self corrects with no issue. However, for pcos women, this isn't always the case as our ovaries tend to misbehave (for lack of a better word). The low progestrone + pcos + bad thyroid level = potential recipe for disaster.
So ideally, what we are hoping for is for the pregnancy test to come back NEGATIVE (yea, first time wanting that).
IF we get a positive we really don't know what will happen to us or the baby at this point. A lot of testing was done today and to be honest, I need to stop typing as I've cried enough today. We won't know how to deal with it until we know what the HCG and progestrone say.
The fact of the matter is we're a bit scared right now. We don't know why this is happening but what we do know is I got a two level bump on my thyroid meds which should prevent this from happening again.
I've got a lot of faith in my doctor. I'm completely trusting in him and God that we'll be okay, but even though I trust - it doesn't mean that Mark and I both aren't terrified right now.
So now... we wait.
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