In acknowledgement of PCOS Awareness Month, Dr Gretchen Kubacky speaks to the mental health impacts of PCOS. Dr Gretchen is a health psychologist in private practice in Southern California and author of The PCOS Mood Cure and Moving Through Grief. She is a Certified PCOS Educator, a frequent lecturer on women’s health, and the founder of the popular website, PCOSwellness.com. She is dedicated to education, advocacy, and empowerment for women and girls with PCOS.
Georgie Kovacs 02:03
So tell us your background and what brought you into specializing in mental health and PCOS.
Gretchen Kubacky 02:12
I grew up reading Psychology Today, my mother was a psychology major. And I read everything in the house. And I was always intrigued by it wasn't until I was in my mid 30s though, that I came to realize the lasting effects of suicide in my family. And then at that point, I was also dealing with some health concerns. And I realized that PCOS was a really big deal. It was not the minimal sort of thing that had been described to me by my doctor when I was 20, or whatever. And so I went back to grad school and got a doctorate in psychology and over time evolved from treating infertility and PCOS, specifically, because it's the underlying cause.
Georgie Kovacs 02:56
What I'm excited to talk to you today about is the mental health aspects of PCOS. Because so much of what I've read and seen online is the solution being around diet. Now people do talk about the mental health repercussions of PCOS. But from the solution oriented perspective, it seems very much related to food and taking certain medications. So I'm really excited to have you share this other perspective. So I guess tell us about the mental health repercussions of PCOS. And is it the chicken or the egg, right? Is it the PCOS that causes mental health concerns? Is it mental health concerns and exacerbates it? Or how does all that work?
Gretchen Kubacky 03:41
PCOS is the cause of many mental health concerns, or one of the underlying causes. There are many causes. Mental health issues can be caused by a history of trauma, they can be caused by some genetic issues. So for example, bipolar disorder, or schizophrenia have heavy heavily loaded genetic components to them. It's been inaccurately attributed to PCOS that there's depression because women are fat and can't get pregnant. And so that's an inherently misogynistic statement. But more importantly, it's not really accurate. The hormonal imbalance in PCOS is what contributes heavily to increased rates of depression, anxiety, obsessive compulsive disorder, bipolar disorder, and suicide, as well as eating disorders and sleep disorders. So it's really the gamut of mental health issues that can be associated with PCOS or exacerbated by PCOS.
Georgie Kovacs 04:40
Would you say if someone gets their hormone levels under control - and it's really mostly due to PCOS - that their mental health concerns are gone? Minimized?
Gretchen Kubacky 05:10
They're not gone, but they can be. They can recover from depression. So once you have depression, for example, it's not necessarily a lifetime sentence. You can go into remission from it.
Same thing with anxiety. You can go through periods of greater or lesser anxiety, you can be in recovery from an eating disorder. But those are always vulnerabilities.
So if you have had a history of it with depression, for example, once you've had a single episode of major depressive disorder, you have a 50% likelihood of a second episode, two episodes 70% likelihood of a third episode, or episodes 90% likelihood of a fourth episode. So it's something really to keep in mind, healing your body from PCOS, you also don't get rid of the PCOS it is something that can be so dramatically in remission, that tests don't show that you have any indicators of it. And that will almost always improve the mental health symptoms.
The problem, though, is that mental health issues have a lot of different factors. So for example, right now, we are going through a period of tremendous stress in terms of the employment situation, recession, fears around illness, all of that kind of thing. Many, many more people than typically would be depressed are depressed right now. Many more people are anxious. Many people are quarantined at home, and developing eating disorder behavior, or sleep disorders and dysregulation. So all of those things play in everything is multifactorial, and I think the idea that fixing it, you know, getting your hormones in line with pills is also inaccurate.
Even for mental health disorders, antidepressants are maybe 50% effective. Talk therapy is equally, if not more, effective. Sometimes you have severe symptoms, you absolutely need medication to support your well being. But that is never my first line of defense with a mental health disorder.
Georgie Kovacs 06:57
And I know that when we had our introductory call, we definitely hit it off and had so much alignment around the quick fixes. And I think one of the two quotes you said is, There isn't too fast a fix, it simply leads to longer term problems.” And to your point about wanting to have a pill, I often see people saying, “Tell me the diet that worked for you.” And it's, it's so complicated. And again, people talk about the mental health aspects. But you know, it's not always brought up from a solution. So maybe we could jump to how you help these women and the role they play. Because PCOS is so multifactorial, you kind of need a team of different experts.
Gretchen Kubacky 07:44
You definitely need a team, my recommendation is always that you have a primary care provider or general practitioner internist, sometimes a pediatrician, who is kind of the ringleader who's educated, you've got an endocrinologist and a gynecologist, probably a dermatologist, definitely a psychologist or other kind of therapist, then you may also need a reproductive endocrinologist and other doctors along the way.
Keeping in mind also that just because you have PCOS, doesn't mean you don't have other disorders. So it's something where you can focus exclusively on the PCOS, and that will probably improve most inflammatory conditions in the body. But to focus only on the PCOS is not enough.
I just want to back up for a minute, because you said people are really looking for the one pill solution, birth control pills have long been prescribed as the treatment for PCOS. What we have discovered now is, first of all, from a mental health perspective, imbalances and progesterone can often produce a suicidal level of depression in some women. And so one of the treatments is progesterone alone.
For the birth control pills, which are mixed, there's now an attribution of PCOS being caused by the birth control pill. I don't know how much I believe that one. I haven't seen enough science to support that. But the idea that, in fact, it's masking symptoms and not fixing anything, I think is important. So I am not opposed to birth control pills as a treatment method for many women for other reasons that are incredibly necessary. But it is something where there are many possibilities about how you treat.
In terms of what I expect from clients that I'm treating, I expect them to get really informed about the condition. I always say knowledge is power. And I also expect them to be proactive. They cannot just show up in my office, or lately on a Zoom, and expect me to fix them because I've imparted all the wisdom or you know, told them one easy thing to do.
It's always going to come back to a lot of self care.
Reducing dietary elements that are problematic for you
Doing exercise that's vigorous and to be helpful, but not so vigorous as to be an extra stress on the body
Adding in meditation
Doing other stress reduction - things like journaling, continuing with therapy, obviously.
So all of those things, and sometimes I do talk about supplements as a mental health issue, because I think they are relevant. There are a lot of nutritional deficiencies and people with PCOS.
And there are definitely some specific supplements that are helpful for mental health conditions in general, and also specific to PCOS. So we are almost always magnesium deficient. And magnesium and zinc are big players in mental health, we also tend to have a much higher level of IBS, irritable bowel syndrome, or other related stomach and digestive problems. So that inhibits getting all of the nutrients out of your foods. So you could actually be fat and be malnourished, you could be eating enough or eating too much. And to be malnourished, if you've got problems with absorption, all of that is relevant to the brain because the gut brain link is now strongly established about 85% or so of our serotonin, which is one of the feel good hormones or neurotransmitters is produced in our guts, not in our brains or some other part of our bodies. And so if you've got gut dysfunction, you're highly likely to have brain dysfunction.
If you're not getting enough protein, proteins are the building blocks of the neurotransmitters. So when you go on an extreme diet to try to regulate weight, you're probably missing out on a lot of good nutritional stuff. And a lot of protein potentially, also matters more as you age to get that adequate protein source.
Georgie Kovacs 11:50
One thing that I have to just acknowledge is when you were talking about the things that women need to do in the state of COVID, and all the varying dynamics that people feel from being overwhelmed with trying to do many jobs plus children to being bored to missing families. I mean, you name it, everyone's stressed for a different reason, let's just call it that. But what I loved is that when the list you gave about things someone can do and the action that you require of your clients to be successful. I love that you called it self care because it is so true. I think about the 10 years that I spent starting out with my fertility journey, and then just learning so much about health. And once you figure it out and make it like an experiment, it really is self care. Yeah, it's just a really neat journey. I'm sure you would agree that everyone's gonna have a different thing that works for them, like some will need the journaling, I don’t want people to hear, “Oh, my God, all these things I need to do!”
Gretchen Kubacky 13:02
Right. Those are the things all of us should be doing all of the time. But differences with PCOS bodies that have PCOS do not handle stress as well. And so a lot of times we're in a constant state of reactivity and intermittent elevated cortisol, a lot of people talk about cortisol as if it's the be all and end all, almost no one actually has clinically significant elevated cortisol. But we do have elevated cortisol because it is associated with fear, panic, anxiety, which we're all experiencing a lot of lately, and the stress hormones that are unremitting, you know, they were designed to be something that flared when you needed to escape danger and receded when you're out of danger.
The problem with our modern life is that we always have some sense of heightened danger. We are out of sync with our natural rhythms in terms of things like sunlight, and getting to bed and on time, it's become a badge of honor. “I get by on five hours of sleep at night.” No, you don't. Trust me.
And those things, you know, I might assign homework to someone to sleep an extra 15 out of 15 minutes per night, until I see you next week. Those are the sorts of things where it's not a big ask, right? You should probably want to sleep more. There are many other problems, of course, associated with why people are not sleeping, but if you're not sleeping, you are going to exacerbate or potentially cause depression or anxiety. You're also going to aggravate any overeating that's due to hormonal irregularity or imbalance or fatigue.
In general, when you're tired, you make poor choices. Bottom line, and so all of these things that we should all be doing are things like yoga, walking around outside during the day like getting enough sleep, turning off our devices by a couple of hours before bedtime - those are the things that really make a difference for everyone, but especially for PCOS.
Georgie Kovacs 15:05
I'd love to get your thoughts on blue light glasses because I just bought a pair because I'm on a mission to make sure that I get some sleep. And so my routine and I'm sorry for everyone who's listening to the multiple podcasts, I'm gonna keep saying this, but I love the song from Marconi Union. It's called Weightless. And apparently, it's scientifically the most relaxing song. So I listened to that before bed. And when I remember, because some nights I am going to bed at midnight. So I'm sorry, I'm being naughty, but I'm really excited about them. So that's just what happens. But um, I added the blue light glasses, because I am working late. So tell us about them, please.
Gretchen Kubacky 15:37
Sure. So the deal with the blue light is that it is an awake light. It tells your body and your brain to be awake. And what happens then is melatonin gets suppressed, and your body doesn't have a cue that it's time to go to bed. So what's supposed to happen when things are functioning properly. In the morning, you get exposed to sunlight, vitamin D levels rise. Melatonin is suppressed, then as you go through the day, a couple hours before bedtime, your melatonin levels go up your vitamin D levels go down. And then your body knows, “Oh, it's time to go to sleep at say 10pm.
Ten to six is considered probably an optimized sleep schedule. I don't adhere to that one either. But I do try to do 11 to seven or 730. So that I'm really getting that solid seven and a half, eight hours of sleep. So the blue light glasses are definitely helpful. There are also blue light screens that you can get. And there are on Macs, I know there's a nighttime sort of feature that cuts out some of that light as well. I know iPhones also have settings you can do so that it reduces the background lighting, which again kind of contributes to your brain knowing that it's heading towards bedtime. So I recommend using those settings if you have them. And if not the blue light glasses, the blockers, some of them. Or the ones I have are amber. Or getting a screen. If you're on the screen a lot and the glasses are uncomfortable.
Georgie Kovacs 17:10
Thank you for explaining that. Because I wondered, “Are these really working? I'm not 100% sure, but it seems like it cuz some people post on, you know, social media. And they're like, I got my first perfect night's sleep. But there's so many factors.
Gretchen Kubacky 17:24
Sleep is so complicated, literally it is actually in my book, The PCOS Mood Cure, I have two chapters on sleep, because there's so much about sleep. And sleep is fundamental to everything. If there would be one prescription for everyone to get enough sleep. If you're not getting enough, do something to fix it. If your sleep is not quality, sleep, not refreshing and restorative, you've got to work on fixing that. And I can literally spend off 100 recommendations on how to do that. So it is really important, and it is fixable. But you it may take some work.
For some people, it's easy. It's like you stop drinking coffee after 3pm and turn off your device at 10pm. Great you sleep for other people that have really deeply entrenched patterns of poor sleep habits or other things contributing. And it could be anything from medication to supplements that are incorrectly timed. What you're drinking, what you're eating, what the temperature of your room is, how comfortable is your bed, a million things. But if you're having problems, definitely try and do a lot to calm down before bed, do a little yoga for sleep, a little meditation for sleep, something like that.
Georgie Kovacs 18:36
And I saw that on YouTube, you can get yoga routines specifically to aid in sleep. And they're different lengths. It's because the first ones that I was looking at, they're like 20 minutes and like, I'm tired. The last thing I want to do is feel like I'm adding 20 minutes to my going to bed time. So I found the seven minute ones. And that was that was my cup of tea.
Gretchen Kubacky 18:55
That's an important point. I'm a really big fan of brief interventions, because the reality is, there was a study that came out a few years ago that indicated that caring for diabetes takes about two and a half hours a day on average, if you are doing it the right way. So that's counting meal prep food shopping, actual eating of healthy items, testing blood sugars, doing the exercise, factoring in, you know, a 10th of a doctor's appointment. Whatever it is, who's got two and a half hours a day? Yeah, probably in and of itself explains why we have such a problem with diabetes management, which by the way, is a huge component of PCOS.
Most women with PCOS will either be pre-diabetic or go on to develop early onset type two diabetes before the age of 40. And that is something we're also trying to prevent. Poor sleep will contribute to speeding up that process.
It also is something that if you have diabetes, it's another factor in depression, right? So you can start to see how these things all make them also very common. For PCOS patients to be hypothyroid 40% of women over 40 in general are hypothyroid. If you're hypothyroid, it looks like depression. If you're high, or hyper thyroid, it looks like anxiety. All these things mixed up are all problems. So it's like standing on a wobble board and just always trying to get your balance. It does take real focus and consistency. But brief interventions are great.
I tell people who say, “I can't meditate, I can't meditate, I can sit still for 30 seconds.” Alright, fine. There are 30 second meditation recordings out there, find them and do them. I'll usually take them through about a seven to 10 minute meditation in my office and ask them how that was at the end of it and say, “Wow, I feel so relaxed.” I'll say, “You know, that was 10 minutes.” What? And then it's learning. Oh, I actually can sit still for 10 minutes. That was relaxing. I enjoyed it. I feel better. So some of these things. We have a lot of resistance to mentally and it just sounds overwhelming. You think you need all these special tools and trainings and a special cushion and music and incense? No, you can meditate sitting in your car parked on the side while you're waiting for carpool pickup.
Georgie Kovacs 21:23
I will make Brene Brown proud of me for talking about vulnerability. Today's been a stressful day and my brain is racing. It probably didn't help that I was up till midnight. Honestly, no matter what time I go to bed. My son, no matter what time I go to bed, at 6 am he wakes up, it is the weirdest thing. I don't even need an alarm.
Gretchen Kubacky 21:44
Georgie Kovacs 21:46
It is a recent thing. And it's really annoying. But anyways, to your point….
Gretchen Kubacky 21:52
But you work with that right? You need to back it out. Like you've got that getting to sleep by 10. In order to get adequate sleep if you always wake up and say tonight it is 10 o'clock.
Georgie Kovacs 22:01
Okay, because I was stressed, which obviously I'm stressed because I'm not sleeping. And I lay down for seven minutes in the middle of the work day and put on my Marconi Union song and you are right, you don't need an hour.
I know a lot of celebrities are talking about transcendental meditation 20 minutes twice a day. Not happening for me. But in that seven minutes, I literally felt my body just calm down. It was just amazing.
Gretchen Kubacky 22:30
It is amazing the little bits, even five minutes of going outside, walking around the block or sitting on your balcony with a cup of tea makes a huge, huge difference. So it does not have to be that fully ritualized two and a half hours a day. I mean, in an ideal world true would be.
But even with TM (transcendental meditation), I was trained to that about 45 years ago. And people are only talking about it all over the place like now because now there are studies to back up what we've always known about meditation, they have validated it to the extent that they're using it at the VA, for example, with veterans who have Post Traumatic Stress Disorder from combat. And so when we're seeing that kind of success with something really extreme, why wouldn't you have success when you have milder issues than that. And I don't have 40 minutes a day to do meditation either actually meditate for about 27 and a half minutes a day. But when I don't have a lot of time, and I want to just log some in, I'll do a 10 minute meditation, which for me is short. Also take the TM and say, You know what, I've got my mantra, and I'm going to do it for five minutes. Still beneficial.
Georgie Kovacs 23:44
Is the mantra different every time or do you like a mantra and try to stick with it?
Gretchen Kubacky 23:50
Mantras are interesting in transcendental meditation. You are assigned a secret mantra, and it's your age and some other factors, I don't know. My brother was younger than I was when I was trained. And he got a walking mantra because he was hyperactive.
But when you're choosing a mantra for yourself, you can choose anything. What I would choose is something that feels like it's orienting you in the right direction. So you might meditate on peace or freedom or love or calm, doing breath exercises, it might be “breathe out stress, breathe in calm,” or “breathe out anxiety, breathe in peace.” So you can pick words that resonate for you that you pick words that resonate for you. And if you're stuck on them, do a search and you'll find a million recommendations for a mantra.
Georgie Kovacs 24:42
So a couple of things that you talked about in your blog. You have several wonderful blog posts and I think you said you have both written and video versions. So check those out on Dr Gretchen's website. We talked about circadian rhythm already. Spoon theory. I pride myself in knowing a lot about health, I have never heard of Spoon Theory.
Gretchen Kubacky 25:11
Because I cannot remember the name of the author of Spoon Theory.
Georgie Kovacs 25:15
We'll put it in the show notes.
Gretchen Kubacky 25:17
A woman with pretty serious chronic illness issues, not a very old woman, either someone young, which is most of the people I see, is relatively young people with chronic illness. She was trying to explain to a friend how it was that she had no energy to do anything. “What do you mean, you can't go to the drugstore and the grocery store?”
And she said, “You know, it's basically like, every day, I get 10 spoons worth of energy. Well, it takes one spend to get out of bed, one spoon to take a shower, one spoon to make breakfast, one spoon to get dressed. I'm not even out of the house yet. And I've already used up almost half of my spoons for the day.” And having that kind of visual is really powerful. And so it has become kind of an insider's nickname among people with chronic illness to call themselves spoonies. It's a good way of explaining to other people why it is that you look fine, but you are not able to function in the same way. But yeah, so spoonies if you look up like on Pinterest or Instagram, you'll find a bunch of #spoonies.
Georgie Kovacs 26:27
Ah, you know, I have seen it. And I think I went, I saw it and I'm like, okay, maybe I'm not sure how it relates to that. I would get distracted and forget to look it up. Thank you. That really is a perfect visualization.
We've talked a lot about sleep. You also mentioned sleep apnea in one of your blogs. So maybe you could just give some information about that as well.
Gretchen Kubacky 26:54
I'm fond of the big scary statistic. So 50% of people over the age of 50 have sleep apnea, OSA, obstructive sleep apnea. What is it? It is where you stop breathing many, many times during the night, it leads most often to that kind of louds knuffle off a ghost train roaring through a kind of snoring. The deal with sleep apnea is that it is again, way more common in PCOS patients. The causes of it are varied. Mostly it's through relaxation of the throat muscles with aging. It might be something though, where it happens only when you have had too much to drink. Or if you have a lot of extra weight, or whatever, right there's again, many many causes for it. But know that if you have PCOS, you are at higher risk for it. And it is something that you can get tested for. There's a take home test that's easy enough to get approved by insurance. There are sleep labs where you can go and get tested. If you need some more detail. It's important to get it fixed if you have the problem because it is potentially fatal.
Georgie Kovacs 27:58
The other topic that you talked about in one of your blogs, and maybe I didn't get a chance to read all of these. I saw the headlines and read a little bit. But actually your other book sounds really interesting. I think I mentioned to you the other book that you wrote around grief.
Gretchen Kubacky 28:30
And that one's a short, very action oriented book, if you're overwhelmed by the quantity of information in the PCOS book
Georgie Kovacs 28:36
So there was “How Not to Freak Out” and “Self Forgiveness.” I have a feeling they're somewhat related. But when I saw those, I really thought that would resonate with not only PCOS patients, but everyone dealing with COVID right now, so talk about that, please.
Gretchen Kubacky 28:54
So let's take how not to freak out. A lot of times with chronic illness issues, there is this sense of urgency imposed by the medical community, you must go. Now, with this other caveat, if your doctor says, “Leave here now and proceed to the emergency room,” you should absolutely always do that. However, everything else, even a cancer diagnosis, you don't have to start treatment tomorrow. You have a little bit of time to figure out what is going on. So any diagnosis you would get whether it's PCOS, infertility, diabetes, high cholesterol, even cancer, all of those things are things that you can take a little bit of time to research, get a second opinion or even a third opinion and get the information context within your life.
So for example, I had a doctor freak out on me because he discovered I was allergic to English walnuts. He said, “You must have an Epipen. This is an emergency. This is a crisis.” I was like it's actually really easy for me to avoid eating walnuts, right? I'm not paying $800 for an Epipen, so why don't we, you know, sit and wait 20-30 days while this processes through my insurance and I just won't eat walnuts between now and that, right? But the doctor was like, “Oh my god, it's a life threatening emergency.” Okay, maybe not really. Other things.
There's a lot of pressure to get started now, right? Especially dealing with infertility, you're 35 and a quarter, you better get on it right? You need to hire that reproductive endocrinologist and start doing IVF and do all this. And it's like, well, wait a minute, why don't you take a minute to think about it a few weeks or a month here and there is not going to make a huge difference. Now, if you decide to wait five years and fertility, that's going to make a difference, right? But know the actual risks, right? If you have a bleeding ulcer, that's a bigger emergency than a mole, that looks a little strange. And so asking other people in your life who are very calm or very logical, if you tend to be emotional is a good way to bring yourself back to center.
As it relates to the period of COVID. We have received a phenomenal amount of misinformation from the medical community as well as the political community on this topic. And it is unfortunate that a medical issue is politicized. But going back to day one, the first thing we were told is 96% of people are going to get this, and I forgot what the percentage was, are going to die from it. Everyone was distressed and decided to retreat home, and or someone's got locked down orders and so on. But the reality now as it's playing out, is significantly different. Most of the deaths are occurring in people over the age of 75. Do we all have to be careful? Absolutely. Is it something worth panicking about? No. Did I also fall victim to some panic about it? Yes, I'm high risk because of age, weight, asthma, right?
All of those things, taking into consideration what your unique situation is. And using all the tools making sure you're getting enough sleep, you don't decide to self soothe with alcohol or drugs. And you're eating reasonably healthy, yes, eat the cookies, but also eat the salad, really doing what you can to bring yourself back into a state of a reasonable mind. The part of you that actually does know a lot and has the ability to access a lot of information also, knowing also that different medical providers have their own biases about things and looking at medical providers as very good consultants, highly educated consultants. But do you absolutely have to do everything? They say? No, you don't. You don't. And you can take a little time.
Georgie Kovacs 32:46
Yeah, and I love that you're giving that permission. I mean, I tell a lot of people that when my fertility journey started, I had gone to my OB GYN for just an annual exam right after my honeymoon, as she asked a bunch of questions. I was, I think just turned 35, maybe 36. I don't remember. And she called me a couple days later to go to a fertility doctor. So I went because I'm obedient. You know, some who work with me may disagree. On certain things. I'm obedient. Certain things I'm not so I'll just leave it at that. I just kind of was like, Okay, and then the train left the building. And it was four years of hell. And I love that you're giving them permission,
Gretchen Kubacky 33:23
It can be a dramatic sense of urgency in infertility treatment.
Georgie Kovacs 33:31
Absolutely. And I agree with exactly what you said with that - and would relate to any illness that you're struggling with, as long as it's not an actual emergency and it needs to go to the ER department - where a couple months, a couple weeks, a couple days doesn't make a difference. And I like your advice of going to people who are calm and very logical in your life, and just getting different types of perspectives. And for all you out there who are relying on social media, I mean, that's also swayed. And it's also like, you can get on a social media high with all the conversations, I think it's a great resource, because you do get a wide variety. But I do.. I just love the advice and just given what I went through, and I wish that I happened to meet you in October 2010.
Gretchen Kubacky 34:15
Yeah, it's it is really difficult with certain things, and I would say infertility issues are one of the most pressuresome, you know. There's these deadlines, you know, you're 35 and that's that well, let's be real, your egg does not know that it is 34 and 364 days old, versus two days older than that where you've crossed the line, right? I think that in general, there is a lot of extreme fix it attitude built into allopathic medicine, Western medicine. And so the mix of drawing from alternative medicine or traditional Chinese medicine, Ayurvedic medicine, Native American plant spirit, healing all of those things. They look at a more patient process kind of a lifetime process of constantly tweaking and restoring to equilibrium in the body. Homeopathy, obviously. But those things are, are very much contrary to the kind of Western medical system that we're living in. And so I think that, like most things, neither extreme is right. Probably correct somewhere in the middle, you know, and be sensible.
I broke my foot a few months ago. Did I get it x-rayed? Yeah. Did I not do yoga and not go on long walks with a broken foot? Yeah. Right. I followed medical advice because it made sense. You had a second question, a second blog that you were asking about.
Georgie Kovacs 35:47
It was self forgiveness, self forgiveness.
Gretchen Kubacky 35:51
So that's a good one for you. All right. Self forgiveness about having been obedient. Following the doctor's order to get yourself to a reproductive endocrinologist. A lot of us have been through a lot of experiences in our lives, especially with PCOS. The eating disorder percentage is astonishingly high. We have done a great deal of damage to our bodies, in some cases, really permanently lowering our metabolisms by up to about 500 calories a day, because of repeated dieting, yo yo dieting, some of us have damage from more severe forms of eating disorders, we may have done things like over shopped or become sexually promiscuous, or, you know, engaged in repeated relationships that are not healthy for us because of the trauma that came before or our self hatred and loathing for our bodies.
All of those things are the past. All those things. If you can remind yourself that you were at that time with the tools that you had the knowledge that you had, doing the absolute best that you could for yourself, forgive yourself, right, you get to know better, do better, and make different and better choices for yourself now. And that is precisely what you should do. Now, if you have all of this knowledge, and you continue to make poor choices in your life, it's time to go to therapy and look at why you keep making poor choices in your life that lead you being really unhappy or really unhealthy.
Georgie Kovacs 37:20
It's always a good reminder. And you know, I think, you know, if we don't learn the lesson early, we're gonna keep getting whacked until we learn it right?
Gretchen Kubacky 37:29
At repeated opportunities to learn that lesson, fluidly.
Georgie Kovacs 37:33
One thing I wanted to come back to is around the more naturopathic and versus allopathic. So earlier, when we were talking, you were listing out the team that people would need for PCOS. It’s not been done by design, but just the people that I've happened to interview and just the things that come up, it does seem like there's different ways of thinking with the allopathic versus naturopathic and some of the specialties in allopathic medicine, you were listing, my mind was saying, “Well, couldn't I go to a naturopath? Who would do that, and then if I need a next step, go to some of those sub specialists.”
As I was listening to that list of doctors, you know, some might say, “I don't have insurance, I can't afford it, or I live in a town where we don't have that.” Granted, with telehealth and COVID, things are changing. But I guess just given, since you work with women and have very deep conversations, and you understand the experience with PCOS, personally as well, it would be great to just get that perspective on how to be reasonable with that team, because I can imagine trying to find it and manage them all is stressful, too.
Gretchen Kubacky 38:43
Which is a really good point. I'm very conscious of the fact that there is a wide disparity in the level of health care that we have access to in States in the United States where there is literally under one psychiatrist for the entire population.
I'm serious, mind boggling as that may be.
And what that means then is, if you need a psychiatrist because your mental health condition is complicated, you're going to have a really hard time getting a hold of a psychiatrist. And, you know, that's very different if you live in New York. I live in Los Angeles, we've got more psychiatrists than we know what to do with, right, we're psychologists, blah, blah, blah. A lot of people don't.
People may live in towns or cities that have one doctor when one general physician, so looking at all of that stuff broadly, I've come to the perspective that we do the best we can, again with what we have access to. In an ideal world, you would have a functional medicine doctor, somebody who's an integrative physician who has both western and eastern training, and that person could be your guide for everything.
What I find with PCOS is that it ends up being much more patchwork and even the list that I gave you as overwhelming as it sounds is the shortlist In ideal world, I would also want you to have a personal trainer, a physical therapist, a craniosacral, therapist, some sort of dietitian, advisor and an acupuncturist, right, so just double the number of providers. That's not reasonable for most people. And so finding a person who gets you who gets your state of disease or wellness and can give you guidance that you trust and seems to be moving you in the right direction is important. I do find overall, but it is almost impossible with PCOS. To get everything you need from a purely Western practitioner, I think you are going to have to venture out into a little bit more education around alternatives and dietetics.
And, you know, learning things about exercise physiology. It's really easy to over exercise with PCOS - it creates too many stress hormones. You need gentler exercises, which totally flies in the face of what we're told, because what we get told from day one is eat less, move more, move harder. Oh, that's not working. Even less move harder. I'm a typical, okay, so when I was a teenager, I ended up eating 800 calories a day and exercising five hours a day, I was still fat. Why PCOS? Well, nobody knew. But I had a legitimate eating disorder at that point. And that's a not at all uncommon story from patients that I see is that they eat squeaky clean. It's all perfect. It's paleo or vegan or whatever. They're exercising, doing all the cardio, all the weightlifting. And they're still struggling because they weigh 200 pounds.
And so the reality is that there's no magic way to fix all of this. Everybody's solution does have to be customized. And I think that's a really unappealing option. People want to be handed the one pill, here's the diet - “Here's the exercise plan. That's all you have to do. It'll fix everything.” It rarely works that way in PCOS.
Georgie Kovacs 42:02
I mean, I see it with people posting, I mean, so many times it's, “I tried this, it didn't work. What did everyone else try?” I see such a theme. So I appreciate that. You're acknowledging it. And again, I hope when people hear this, it's, it comes from a place of “Wow, now I get to learn how to care for myself,” rather than “Oh, goodness, here's this list,” because it really is about self care. And it's hard with so much of the marketing being around some of these quick fixes, and the social media posts that kind of make things seem nicer.
Gretchen Kubacky 42:37
They make it seem like if you take these six supplements and drink this, you know protein powder every day, you're going to be cured. You're not, sorry, end of story. Anybody that's offering the magic pill, run as fast and as hard as you can. The truth is, it is all hard work. And I know it's discouraging.
And just to wrap back in around the expense issue, all of the things that I suggest, as a starting point, are things you can do for yourself, work on your sleep habits, refocus your diet, start doing a little exercise and meditation. Those things cost nothing, essentially, you know, you start buying less processed food or fast food, all of a sudden vegetables are not that expensive. So it is something where I think that being mindful that just because you don't have all the tools, something where I hear this from from clients sometimes as well, I don't have money to get a massage every week and join the fancy gym that has all of the amenities and you know, get a meal delivery service. So I'm never going to.
What happened to cooking your own food? What happened to taking a walk around the block in any tennis shoes that are comfortable? What happened to downloading the insight timer app, which is thousands or 10s of thousands of meditations every.
Georgie Kovacs 44:02
Now I think we've evolved to making things unnecessarily complicated and I think COVID is teaching simplicity. So you know the women who are coming to us struggling with PCOS tell us what working with someone with your expertise would be able to do to offer support and maybe examples of things that you can specifically help with and ways of working with them.
Gretchen Kubacky 44:25
So when I work with people, which in California is usually through psychotherapy and other places around the world, I do coaching and consultation. A lot of people with PCOS will call me up and they will want an hour or two of “pick my brain” session. They'll have a million questions, and I will answer all the questions and listen to what's going on individually and offer some specifically tailored advice.
Therapy is less about advice. So what we typically would do is prioritize what needs to be addressed as a problem and start working on that. I will offer some solutions, some advice, some homework and have them try it, try it out and see what happens. So good example, again is sleep, where I discovered that someone is having six Red Bulls every day. True story, and then they're dealing with an anxiety problem and they can't sleep at all. So they didn't realize that that was actually a huge problem. We started cutting back one every few days, right? Because when you're dependent on that much caffeine and sugar and whatever else, it's not gonna feel good to cut it out. And we do that and we look at what are the things that are interfering with cutting out that terrible-for-you substance.
And by the way, there is no bad food, no bad beverage, anything is possible to be okay. Unless you are actually allergic to it, like I am walnuts are never going to be a good idea for me, right? Because anaphylaxis death is not a good side effect. Not worth it. But a little bit of anything if you just love, love, love, like, you know, whatever your favorites, garbage snack food is making a little space for it. But I don't mean eat the family size bag, I mean buy the little tiny snack bag out of a vending machine once a month, and enjoy it thoroughly.
So we start working on the small things, what's interfering with the behaviors? You know, is it money? Is it a lack of time? Is it because you're working three jobs? Or you have four kids under the age of six? Or is it because your husband is always getting in your way? Or because you're trying to go to school and go to work simultaneously? looking at all of that and figuring out, okay, despite all of these stressful things going on in your life, what can we do to keep moving you forward towards your goals? We focus on goals that are quality of life improvement, not cures?
Georgie Kovacs 46:56
What would you say surprises you. And maybe since you've been working with these patients for so long, maybe at this point, nothing surprises you, but from the value that you're able to bring, are there any interesting stories that you would like to share about some of the experiences and, and some of the great stories that you've come across because of the women that you've supported?
Gretchen Kubacky 47:19
I think anybody first of all can change. But you do have to make the choice about it. So one of my favorite patients, she was five feet tall, and probably about 300 pounds. When she came to see me, she was dealing with PCOS, diabetes, high cholesterol, and thyroid issues all at the same time. Absolutely. And major, major major depression. And when she first came in, she had not bathed in a week. She was wearing the same black clothes she wore every day, just covered head to toe and hated her body. Over time we worked together and got her to get some proper medical care and started taking medication to get a rapid fix on things while we worked on the other stuff.
And then worked on changing her eating behaviors and doing stress management things, getting enough exercise, by the way, cutting out the alcohol, that was also a problem, so on and so forth. Over time she started bathing every day, she started putting on pretty clothes with colors, she got a haircut, she was able to wean off of most of the antidepressants, you know, she had diabetes under control. And she was actually back in love with her husband.
And now she's a resource. So when other people have a problem, they'll come to her and say, “Well, you did something amazing. Can you tell me how to do this?” So that is something that is a good case. It's also something that took a long time there was very significant trauma, as well as all these other issues around the endocrine system functioning or dysfunctioning.
Other times it will be something that I think is really simple, but I've been in it so long. It's not simple. I will get someone to stop watching scary movies or the news, same thing, at night, and cut off the caffeine by noon. All of a sudden they slept fine when they thought they had this incurable insomnia problem.
And so those are the things that excite me there are other things that are not such rapid or easy fixes. But sometimes it really is just getting a very specific piece of knowledge tailored to you and given to you in a way that's palatable for you.
The part of being a psychologist is also what makes a person tick. Are they competitive? Are they fearful? Are they anxious? Are they you know, too depressed to do anything? So part of this is understanding what's happening that's making someone think or behave or feel the way they are and then working with them. As opposed to directly opposite to it, if I were to lay that prescription of you know, go and get these 10 doctors and take these 12 supplements and cut all these things out of your diet and add these things, the depressed person is going to do what?
Georgie Kovacs 50:15
Gretchen Kubacky 50:16
They quit therapy after one session. Yeah, and get nowhere. Exactly not helpful. So it really is, you know, when you work with a qualified therapist, and the category of therapists that I'm in, by the way, because if you're not in Los Angeles, is called a health psychologist, there's not a whole lot of people who really identify as health psychologists, but they may have expertise in oncology, diabetes, infertility, few other conditions. But people who have some training or expertise or just happen to mention that by the way, they do a lot of work with postpartum depression will probably be good people, as a starting point to try and find somebody who, who gets you because most therapists do not have any training or have incredibly minimal training in health issues.
Georgie Kovacs 51:04
Thank you for sharing that perspective. Because one of the things I'm also learning and doing this podcast is that there's all these sub specialties. I've been in the biopharmaceutical industry, my whole career, and some of these I never even knew existed. So thank you for sharing that. So the last question I always like to end on this high note is what is your greatest hope? And I usually save women's health. So today, I'm going to change it up and ask what is your greatest hope for these PCOS patients?
Gretchen Kubacky 51:31
My greatest hope is that we will continue to build upon the visibility that has started to happen in the last few years. There are a lot of people who have been working very long and very hard for over a decade now to get this into the public eye. Because PCOS has up to 21% of women affected by it. And it's very poorly funded. And prevention is really helpful here. Because if you don't know what you've got, you don't know how to treat it, you will not be able to stave off the side effects. So a person who knows they're pre diabetic, or that they have PCOS may start on a little bit of Metformin, which is an inexpensive generic drug, and stave off a diagnosis of type two diabetes by at least a decade, if not forever. It is much better to get type two when you are 70 than to get it when you are 30. So my hope is that the visibility will be increased, the awareness will be increased. People will have the internet, do symptom searches, start reading, getting educated, and start taking better care of themselves so that they have better quality of life.
Georgie Kovacs 52:38
What a way to end thank you so much for taking your own experiences while challenging and transitioning them into something positive and helping so many people just being here with you and the ease in which you speak. Makes me feel calm. So I feel so calm right now. Thank you. It's truly been a pleasure. And I know that we will definitely stay in touch and continue working together. And again, thanks for what you do.