Tag Archives: research

PCOS and Eating Disorders

10 Aug

Aside from the fact that PCOS seems to predispose our bodies to hang onto calories, there is a connection between PCOS and disordered eating (binge eating disorder, bulimia, or compulsive overeating, for example). It’s not clear whether PCOS might cause the eating disorder or whether the eating disorder can change hormones enough to encourage PCOS to develop, as this article by Angela Grassi points out. The only thing that is clear is that the PCOS population has a higher rate of disordered eating than the rest of the female population.

But if you have PCOS and struggle with disordered eating, it doesn’t really matter which problem came first, does it? You just need to find the solution.

So what to do? Your first stop needs to be a counselor or health care professional. This treatment finder from the National Eating Disorder Association has some good resources. You could also go to your primary care doctor and ask for suggestions or a referral, or ask your counselor, psychiatrist, or other mental health care professional, if you have one.

Diagnosis

Your doctor or therapist can help you determine whether you have an eating disorder. In some cases, it’s very clear, and you already know that you have one, but some sufferers don’t realize that their eating is unusual or problematic. Each specific disorder has a separate set of diagnostic criteria, but in general, any of the following behaviors or experiences suggests that you should consult a professional. (I have focused on binge eating disorder and bulimia, as these seem to be the most closely linked to PCOS–anorexia may be the most publicized ED, but it is not the most common among PCOS ladies.)

Symptoms:

* You routinely eat when you are not hungry;

* You overeat large amounts of food, even to the point of making yourself feel ill or uncomfortable (and not just on Thanksgiving!);

* You feel as though your eating is out of control;

* You eat secretly and hide your eating habits from others;

* You feel ashamed or guilty over the things you eat;

* You purge after eating–for example, vomiting, abusing laxatives or diet pills, fasting, or exercising obsessively;

* You eat in response to non-physiological factors: stress, emotion, boredom, etc.

Keep in mind that some of these are behaviors that can be normal and fairly functional if they’re minor. After all, most of us would consider it reasonable for a woman who just broke up with her boyfriend to hunker down on the couch with a pint of Ben & Jerry’s, and most of us eat more than we need to in certain social situations. It’s a matter of degree. It’s a disorder if your eating habits interfere with your life (that is, if they’re harming your health, causing you anguish, interfering with your job or school, or compromising your family life). Ultimately, a trained professional is the person who will be able to help you figure out whether you have an eating disorder or just a few bad habits.

While you’re setting up treatment, check out this page from the PCOS Network–it has good suggestions for curbing binge eating, most of which apply to compulsive overeating or bulimia as well. Don’t assume that you can handle this problem on your own, however. Any eating disorder can wreak havoc on your health over time, and they are very difficult to manage.

Treatments

There are no shortcuts on this one: you have to do the hard work of figuring out why you eat the way you do and how to achieve healthier habits. Some of the things you might try, in the treatment process, include:

  • Cognitive-behavioral therapy (or other psychotherapy). In many cases, therapy can help. CBT is most often suggested, because it concentrates on revising your own self-talk–the things that you say to yourself inside your own head–and that can be very effective at changing behavior. But really, any kind of therapy that can help you be more conscious and mindful in your eating choices will help.
  • Group therapy. You can consider a group run by a mental health professional and/or something like Overeaters Anonymous.
  • Medication. Sometimes certain antidepressants can help. Your doctor can help you make decisions about this.
  • Nutritional counseling. While this is not really a problem that can be solved by a nutritionist–it’s a mental health issue, not a lack of education about nutrition–sometimes a good nutritionist can help you figure out what is reasonable, what kinds of things you will find satisfying that would also be good for you, and what you might do to avoid foods that trigger your binge behavior.
  • Treating your PCOS symptoms. This is only my opinion, and I haven’t seen it said anywhere, but if there is a link between the two problems, it would seem likely that treating the PCOS may also help.  Some researchers feel that the prevalence of binge eating disorder among PCOS patients may be due to the body’s response to insulin, and if so, treatments for insulin resistance–such as Metformin–could also help.
Summing Up
If you have an eating disorder, it will be very hard for you to treat your other health issues until it is under control. And it is very difficult indeed to manage it alone. While I think that self-care is often a good option for some problems (mild depression, for example), an eating disorder always requires treatment. If you need it, get it; if you can’t figure out where to find help or how to pay for it, ask your primary care doctor for suggestions.

a few thoughts about clinical trials

3 Aug

Research on PCOS (and any other disease, for that matter) is an essential part of developing treatments. One way that researchers study a new drug or a PCOS-related phenomenon is through a clinical trial, which ClinicalTrials.gov (a site run by the NIH) defines as “biomedical or health-related research studies in human beings that follow a pre-defined protocol.” You know what a trial is, of course; “clinical” just means that the treatment is being tested on real patients (not examined theoretically).

There is no substitute for the clinical trial; it is necessary to test new treatments on human subjects before they can be brought to market to help other patients. The better the study, the more useful it is, and–ultimately–the safer the patients are who might take the drugs or use a treatment if/when they are approved.

There are always risks in a clinical trial (some greater than others), but if you are interested in participating, check it out and read a lot about the study before you agree. If you do participate, you will be advancing research and helping patients (including yourself). It’s worth considering, especially if there’s a study nearby. Only some trials are medication-related; there are also studies that track lifestyle changes or habits.

One of the limitations on the reliability of clinical trials is that minority subjects are still underrepresented. This causes a number of problems: it might not reveal problems that certain minority populations have when they use the treatment, and it might not show differences in the ways that different populations respond to the treatment.

The Hormone Foundation has compiled a handout for minority patients who might consider participating in a trial. There’s a more general list of questions at ClinicalTrial.gov, with information for any patient who might be interested.

The Meat Eater’s Guide to Climate Change and Health

20 Jul

The Environmental Working Group has put out the 2011 “Meat Eater’s Guide to Climate Change and Health.” This is an interesting document; it describes the environmental impact of the different foods we eat and suggests the best choices. If you are concerned about your health, you can find info about that, too, because their chart describes the things that you can look for when you buy your food–for example, looking for peanut butter that’s free of hydrogenated oils (very easy these days; any supermarket carries PB that’s made from just peanuts, or peanuts and salt).

If you are interested in this school of thought, check out Mark Bittman’s book, Food Matters. I covet the Food Matters cookbook and will certainly review it for this blog when I finally get it.

Gestational Diabetes: New(ish) research

2 May

I just read some interesting research about gestational diabetes–the 2009 Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study has provided compelling evidence that we should be using a lower cutoff point for diagnosing GDM (gestational diabetes mellitus). If you’ve ever had a baby and had standard prenatal care, you probably took the test for gestational diabetes (gross sugary drink, then a blood draw to see how your body processed it).

The study found that even women with “intermediate” results on the test (those whose results were not “positive” for GDM but were higher than average) had more adverse outcomes in pregnancy, including higher risk of c-section. This suggests that dietary changes or other treatments might be helpful for women whose results fall into that category.

For a good synopsis of this, see Jennie Brand-Muller’s blog post on the subject. (Brand-Muller is the author of The Low-GI Diet Revolution.)

new study: Metformin safer than other diabetes drugs

16 Apr

A new study in the European Heart Journal, by Tina Ken Schramm et al, found that metformin had the best outcomes out of a group of diabetes drugs: metformin, tolbutamide (Orinase), glipizide (Glucatrol), glibenclamide (Diabeta, Micronase, or Glynase), and glimepiride (Amaryl or GLIMY). The other drugs are known as sulfonylureas, whereas metformin is a biguanide.

The study, which compared metformin against available insulin secretogogues (ISs) found that the risks of “monotherapy with the most used ISs, including glimepiride, glibenclamide, glipizide, and tolbutamide, seems to be associated with increased mortality and cardiovascular risk compared with metformin. Gliclazide and repaglinide appear to be associated with a lower risk than other ISs.”

In other words, Met is safer. The American Diabetes Association recommends that sulfonylureas be used as a second-step treatment.

research: Metformin useful even for non-obese PCOS patients

14 Apr

A recent meta-analysis (which, for those of you who don’t read a lot of academic jargon, means that it’s a piece that examines a bunch of clinical studies and draws conclusions) has concluded that Metformin is a good first-line treatment for women with PCOS, regardless of whether or not they are obese. The studies–which looked for successful pregnancy and live births–found that both Met and clomiphene (Clomid) were good treatments for anovulation.

This is interesting because Metformin is usually used for women in the “obese” category on the BMI chart. In my view, this is further evidence that PCOS is associated with insulin problems, regardless of how heavy the patient is.

This could affect you if you are a relatively thin PCOS patient and you’re trying to induce ovulation: Metformin is worth a try!

omega-3 oils: new research

8 Feb

So, studies have shown that most supplements are…well…pointless. But the research I’ve been seeing about omega-3 supplements has been very promising. Some of the recent studies on this supplement have demonstrated that it is very effective as a treatment for depression. This recent article argues that major depressive disorder is linked to a low omega-3 index (that is, having too few omega-3s in the body).

PCOS patients may also find this recent study of interest. It showed a drop in bioavailable, or “free,” testosterone in women who took an omega-3 supplement. Since testosterone–especially the “free” testosterone–causes hirsutism, acne, and hair loss, this is an important discovery for PCOS sufferers.

Omega-3 fatty acids, which are a big deal in recent nutritional and medical research, are found in fish and other marine life. (They’re also found in flaxseed, but as I understand it, it’s harder for your body to use them in the form found in flaxseed, so that is less preferred.) You can certainly increase your intake by eating more fish, but especially considering the concern about getting too much mercury, you may want to consider a supplement. (It’s also really difficult to get the higher dose that is recommended from food alone.)

Here’s how it works: you need both omega-3 and omega-6 oils. The standard American diet, however, contains FAR more omega-6 than you need, and much less omega-3. The ratio of the two in Western diets is often 10-1 in favor of omega-6; in fact, sometimes it is as high as 30-1. The optimal ratio, scientists think, is somewhere closer to 4-1. That means you need MORE omega-3, but less omega-6. In part, this disrupted ratio is due to the predominance of soybean, sunflower, corn, and canola oils in our diets–all of these oils are high in omega-6.

On an episode of the Kojo Nnamdi show on NPR, an expert recommended a fairly high dose of omega-3s per day. (The show, by the way, is worth a listen if you are interested in the effects of omega-3s on depression.) The consensus seems to be that you should get at least a gram–possible 2 or 3 grams–of omega-3 per day. Don’t be confused by the dosage of “fish oil” on the bottle; it should also list the dosage of “omega-3.” This will probably be divided into DHA and EPA.

It’s also important to get a high-quality supplement, to avoid possible mercury contamination. The bottle should say “molecularly distilled.” You don’t have to pay a fortune to get that, though. I get mine at Costco. If you try omega-3s and see a difference in your mood or PCOS symptoms, please report back! I’d love to hear your results.