Carolinas HealthCare System
Volume 8, Issue 4
April, 2016
Polycystic Ovarian
Syndrome (PCOS)
Polycystic ovarian syndrome ( PCOS)
is the most common endocrine system
disorder in reproductive aged women.
The prevalence of PCOS is high ranging
up to 18%. The cause of PCOS is not
completely understood. However, it is
believed that genetics and environmental factors play a role. This is important
as PCOS is the primary cause of female
infertility and can increase pregnancy
complications, can lead to cancer of the
uterine lining (endometrial cancer) and
is associated with developing gestational diabetes. Untreated PCOS also increases the risk for developing diabetes,
hypertension, metabolic syndrome, high
cholesterol, sleep apnea, fatty liver and
depression. PCOS can lead to weight
gain which only makes the condition
worse. In some cases, PCOS will develop with substantial weight gain. Many
women with PCOS are overweight or
obese. With early diagnosis of
PCOS, the appropriate treatment
can be started depending on the
woman’s age, reproductive status
and her own concerns.
In order to be diagnosed with the
condition, you must have at least
2 of the 3 following criteria: irregular menstrual periods, elevated
levels of male hormones
(androgens) with either physical
or biochemical signs, and polycystic ovaries. It is called a syndrome because it is not diagnosed
with just one test. You must have
at least 2 of the criteria and symptoms can vary from female to female.
Irregular menstrual periods are
very common. An example of irregular periods are menstrual period intervals greater than 35 days
In This Issue
Polycystic Ovarian Syndrome (PCOS) ...........................page 1
Exercise and the Environment .......................................page 2
Sabotaging Thoughts .....................................................page 3
Fermented Foods and Weight Control ...........................page 4
Sabotaging Thoughts (Continued) ..................................page 5
PCOS (Continued), Keto Korner ...................................page 6
April Calendar...............................................................page 7
Dr. Lisa Bellanfonte, MD
(normal is 28), fewer than 8 menstrual
periods per year or failure to menstruate
for 4 consecutive months or longer.
Elevated levels of androgens (male
hormones) may result in physical signs.
Although we call androgens male hormones, women also produce androgens. Hirsutism, male pattern baldness,
and acne can indicate excess androgens
in adult women. Hirsutism is defined in
females as excessive male pattern hair
growth. Hair growth may be seen on
the upper lip, chin, neck, sideburns,
chest, upper or lower abdomen, upper
arm and inner thigh, in places where
only men typically grow hair. Dark and
Continued on page 6
Edited by:
Stephanie Kinner
& Connie Simms
1
2
Exercise and the
Environment
Humans have always had the challenge
of overcoming the environment that they
live in. Snow, rain, wind, & heat all effect how the body physiologically responds to exercise. Charlotte, NC is a
beautiful place and we are lucky to have
an environment where we scarcely have
to worry about extreme cold. With
spring and summer right around the corner, this article will focus on how the
body responds to heat during a physiological stimulus such as exercise.
When we begin exercise our body uses
energy. At the molecular level this energy is call Adenosine Triphosphate (ATP).
When we move, our body sets in motion
a physiological cycle that begins breaking
apart this energy source, ATP. This
breakdown of the molecule, creates heat
inside of us and that is why we begin to
feel hot. The body will in turn increase
heart rate, breathing rates, and thermoregulation (sweating). This is the
body’s way of trying to maintain a stable
environment (homeostasis). So if you
tend to sweat a lot during exercise it is in
reality, very normal and helpful physiologically for the thermoregulatory process & evaporation.
If our bodies become hot during exercise and the environment is also hot and
humid this is where some issues can
arise. For the cooling of our bodies to
occur, we need a process of evaporation
to happen. This is when the sweat on
our skin is accepted into the environment
or the air. If the air is already saturated
with moisture (humidity) then it is less
willing/able to take the moisture (sweat)
from our body’s skin. The best thing that
we can do to solve this problem, is to
wear proper clothing during exercise and
increase the surface area for this process to occur. Choosing clothes
such as cotton that will “wick”
sweat to the surface for evaporation
is essential. Exposing as much skin
to the environment that is possible
and appropriate will decrease the
risk of heat injury. Avoiding any
materials that are impermeable to
water as this material will increase
the risk of heat injury.
Our bodies operate properly when
they are internally maintained at
98.6 degrees Fahrenheit. However,
death can occur if our body’s temperature reaches 113 degrees Fahrenheit. That is only a difference of
14.4 degrees! This is why it is crucial to be careful when exercising in
hot and humid conditions such as
North Carolina. Below are six suggestions to prevent heat injury when
exercising:



Exercise during the coolest part of
the day: this could be in the
morning before the sun has fully
risen, or the evening when the
sun has gone down.
Minimize both the intensity and
duration of exercise on hot/humid
days: intensity and duration of
exercise will increase core temperature. If we are exercising at
a higher intensity and a longer
duration then we will be more
susceptible to heat injury.
Expose maximal surface area of skin
for evaporation during exercise:
appropriate exercise clothing
should be worn at all times, for
all environments. A cotton shirt
& shorts that brings sweat to the
Joe Visker, MS,
ACSM-RCEP



surface is suitable in most conditions.
Provide frequent rest/cool down periods:
taking time for breaks is appropriate
when exercising in a hot/humid environment. 5-10 minutes is sufficient.
Whenever possible try to take breaks
in a cool or shaded area, avoiding
direct sunlight.
Avoid dehydration: workouts should
allow frequent time for water breaks.
Water intake is vital in the thermoregulatory process. Insufficient hydration reduces sweating rates. If exercising for longer than 60 minutes a
sports drink is appropriate to replace
electrolytes lost with sweat.
Increase Fitness Levels: a high level of
fitness is associated with a decreased
risk for heat injury. Those who are
physically more fit can tolerate more
exercise in a hot environment, acclimate faster to the heat, and also sweat
more (more efficient at evaporation).
In closing, exercise related heat injuries
can be prevented. The general symptoms
associated with heat injury include nausea, headache, dizziness, reduced sweat
rate, and confusion. If an extended exercise program is going to be outside in the
heat, it is important to gradually become
acclimated to the environment, dress appropriately, drink fluids before, during
and after exercise. Checking heart rate on
a regular basis is also essential in the prevention of heat injury.
3
Sabotaging Thoughts
Sabotage Diets!
We all know that weight loss and
maintenance is a long hard journey but how
hard does it have to be? When trying to
lose weight you need many tools in your
toolbox and lots of positive support from
yourself and the people around you. One
component of weight loss is definitely mental, often what we tell ourselves about a
situation dictates how we behave. Our
thoughts at times can be distorted and lead
to sabotaging our hard efforts to lose
weight.
Below is a list of common sabotaging
thoughts and how we can talk to these
thoughts and make weight loss a little less
stressful. Many of these sabotaging
thoughts were adapted from The Beck Diet
Solution by Judith Beck. If you need more
help combating these thoughts the book
would be an ideal place to start getting help.
Additionally, we encourage our patients to
set up an evaluation with a weight loss
counselor at Carolinas Weight Management.
Sabotaging thought: I don’t want to accept
the things I have to do. Dieting should be
easier. Helpful response: I have a choice: I
can struggle with what I have to do and feel
bad, or I can accept that this is the way it is.
It does not mean that I like it. There are
many things I do not like in my life. I do
not particularly like paying bills. I definitely
do not like getting up as early as I do for
work. I do not like straightening up the
house. But I accept them. I do not struggle
with these tasks, why should I let this cause
me so much discomfort?
Sabotaging thought: It does not feel that I
can eat normally. Helpful response: Actually, I probably was not eating "normally"
before, either. Before I started dieting, I
was probably eating too often and too much
and choosing too many unhealthy foods. I
am now eating normally for a person who
has a goal to lose weight.
Sabotaging thought: I should not have to
deal with this problem. Helpful response: I
have 3 choices:
1. I can give up and stay at this weight or
more likely continue to gain weight every
year.
2. I can diet on and off. Spend some
days/months/years eating whatever I
want, some days/months/years trying
to stick to a diet, and most of the time
weighing more than what I want to.
3. I can accept the fact that dieting
isn’t fair and move on, continuing to
do what I have to do to lose weight. I
am freely choosing this third option.
Sabotaging thought: I feel overwhelmed. This program is way too
involved. I can’t do it. Helpful response: Starting with small changes
will help me. I do not have to learn
everything in one day. I can get a diet
coach to help me.
Sabotaging thought: The steps are too
hard. I do not want to keep on doing
these things. Helpful response: I am
just feeling overwhelmed at this moment. It does not always seem this
hard. Later on today or tomorrow, it
will probably feel easier again.
Sabotaging thought: I am not thinking
about anything specific when I stray
from my diet. It just happens. Helpful
response: Eating is not automatic. I
just try to ignore my thoughts so I can
eat. The next time I am tempted to
stray, I am going to look for some sabotaging thoughts that gave me permission, such as, it is okay to eat this because…
Sabotaging thought: I want to try this
diet I heard about. It promises I can
lose a lot of weight very quickly, very
easily and without effort. So what if it
is not nutritionally balanced? I won’t
be on it for long anyway. Helpful response: A fad diet is not healthy and I
will need to be on a diet or a variation
of a diet for a long time. Promises that
sounds too good to be true invariably
are too good to be true.
Sabotaging thought: I can learn to eat
sensibly after I’ve finished dieting.
Helpful response: If I do not learn
how to eat sensibly now, what evidence do I have that I will be able to
learn later? I need to start now.
Nicole Marino, LCSW
Sabotaging thought: I can lose weight
only if I find exactly the right diet.
Helpful response: There is no one right
diet. There is nothing magical about any
diet. The only formula for losing weight is
taking in fewer calories than your body
expends.
Sabotaging thought: I do not deserve
credit until I have lost all the weight that I
want to lose. Helpful response: It is counterproductive to wait. I need to strengthen
the part of my mind that believes I can
follow the program. I am only human if I
stray from my plan from time to time.
When this happens, a sense of helplessness might kick in. Continually building
my confidence by giving myself credit can
protect me from feeling helpless and hopeless and from throwing in the towel.
Sabotaging thought: I truly do not have
time to eat slowly. Helpful response: I
need to rearrange my schedule to make
that time. If I needed to take time for a
lifesaving medical procedure 3 times a
day, somehow I might find time. I am not
giving eating properly high enough priority.
Sabotaging thought: I should be able to
do this by myself. Helpful response: If I
could do this by myself, I would have already lost weight and kept it off. I need to
face the fact that I need help, just as many
other people do.
Sabotaging thought: I shouldn’t put my
needs above the needs of my family.
Helpful response: I am entitled to work
towards a goal that’s important to me. It
is time for me to practice meeting my
needs. Besides, my family does not need
junk food. They would be better off if they
did not eat it either.
Sabotaging thought: I do not want to
waste food by throwing it out. Helpful
response: If I don't throw it out, I'll be at
risk for "wasting" it in my body, where
it’ll turn into fat. Which is a better way to
waste it?
Continued on page 5
4
Fermented Foods and
Weight Control
Research has been ever increasing on
gut bacteria and it’s relation to our
weight. In fact, research is concluding
that certain types of gut bacteria may
even influence someone’s ability to gain
or lose weight. Studies have found that
if you look into a lean persons gut bacteria, you will find that it looks quite a
bit different from an obese persons. The
lean individual is often flooded with
healthy bacteria, whereas obese populations tend to have more of the unhealthy variety. This bacteria can also
affect insulin resistance, digestive issues, and a variety of other health related concerns.
What causes this unhealthy bacteria
to populate in our gut?! Science is concluding that processed foods, high saturated fats, and high sugar may be of a
concern- which encompasses our typical “Western” diet. Also, taking antibiotics often strips the good bacteria from
our gut, allowing it to be flooded with
unhealthy versions of the bacteria we
need. The positive news is that our diet
can help make the change.
Many of us are aware that taking probiotics can replenish this healthy bacteria we need for a normal functioning
gut, but what foods can we eat to restore this without taking a pill?! Fermented food items can be the answer.
Fermented foods are foods that have
been exposed to healthy bacteria either
naturally or on purpose. Example: sauerkraut is fermented cabbage. The cabbage naturally has healthy bacteria, it
just needs 4-6 weeks in an anaerobic environment to flourish.
When beneficial bacteria is exposed, they beat out the “bad”
kind, and can also eat up some of
the carbohydrates of food. This
usually lends itself to different
types of smells, etc. If you have
ever smelled sauerkraut, you have
likely understood this theory.
cooked soybeans and grains, mixed
with salt and healthy fungus to ferment.
The end product can be used in soups
or vinaigrettes.
The encouraging news is that
there are many options out there of
healthy foods that can help your
gut bacteria.
Tempeh: Cultured and fermented soybeans that are often used as a vegan
protein substitute
*Kombucha Tea: Kombucha is a
type of healthy bacteria. When in
the presence of tea and sugar, it
ferments creating a drinkable form
of gut-friendly substances
Kefir: Often described as liquid
yogurt, made using Kefir “grains”
which is the living bacteria and
milk. Many brands are beginning
to sell kefir in a ready to drink
form.
Sauerkraut: Fermented cabbage,
often used on top of a meat for flavor.
Pickles: Pickled cucumbers,
chances are you have had a few of
these. You want to look for lactofermented pickles at the store, not
just ones in vinegar, for the most
health benefits.
Miso: Often used in Japanese
cooking- made from mashed
Megan Via,
MS, RD, LDN
Kimchi: A Korean take on fermented
cabbage, usually spiced up with chili
peppers and garlic.
Yogurt: Form of milk that have been
introduced to healthy bacteria. Coconut yogurt also provides beneficial bacteria, if you are lactose intolerant.
The positive news is that the food industry has begun to pick up on consumer want for fermented foods. Many are
more available than ever before, making
it easy to get healthful bacteria in your
diet. There are currently no specific nutrition guidelines on how often these
foods should be incorporated into your
diet. However, if you are looking for
another way to help in your weight loss
or overall health efforts, beginning to
add some fermented foods, therefore
increasing your healthy gut bacteria,
may be a great place to start!
*Kombucha Tea has caused some rare, but
serious negative side effects. Not recommended for immunocompromised or pregnant populations.
**Some of these fermented foods are sold as
dietary supplements, therefore not always
regulated by the FDA. Please talk with your
pharmacist to see if any may react negatively
with the medications you are taking.
Sabotaging Thoughts Sabotage Diets!
Continued from page 3
Sabotaging thought: I'm a spontaneous
person, I do not like to schedule my time.
Helpful response: To lose weight, I have to
give up some spontaneity. I wish I did not
have to, but that is the way it is at least for
now. Until I develop a routine, I can’t rely
on spontaneous shopping and spontaneous
food preparation. But that does not mean
that I cannot be spontaneous in other ways.
Sabotaging thought: I do not want to exercise. Helpful response: I should not go by
whether I want to exercise. If I want to lose
weight and keep it off, I need to exercise.
There are also lots of other benefits to exercising. I might be making this into a much
bigger deal than it really is. I can do this.
Sabotaging thought: I am too busy to exercise. Helpful response: I have to make exercise a priority. If I needed to exercise each
day to stay alive, I find that time. I might
have to get up earlier in the morning if
needed. But I should not fool myself into
thinking that exercise is optional.
Sabotaging thought: Losing only 1-2
pounds a week is much too slow. Helpful
response: How much will it matter a few
years from now how long it took? I need to
remind myself why it is important to lose
weight slowly. My long-term success depends on this.
Sabotaging thought: I do not want to write
anything down. Helpful response: Which is
stronger: Wanting to lose weight or not
wanting to be inconvenienced? Since I do
want to lose weight, I am going to start
writing. It will probably take only 5
minutes. I have a choice. I can listen to the
resistant part of my mind, or I can firmly
and decisively decide to do the writing,
even though I feel resistant. It’s great practice to ignore my resistant feelings because
they will come up again and again when I
do not like following my eating plan.
Sabotaging thought: I do not need to write
this down; I can remember what I ate.
Helpful response: Not writing things down
has not helped me in the past. I undoubtedly forget about some of the food that I eat. I
have to make myself conscious of what I
am eating.
Sabotaging thought: What if I end up feeling hungry before it’s time to eat again?
Helpful response: Hunger is not an emergency. I can tolerate the sensations of hunger and if I do not focus on it, the hunger
will dissipate.
Sabotaging thought: It is okay to eat
this because the amount of food is so
small. Helpful response: Just because
it does not have many calories does
not mean I should eat it. I should not.
I need to use every opportunity I can
to break myself with the habit of eating things I have not planned to eat.
Sabotaging thought: It is okay to eat
this because everyone else is eating it.
Helpful response: I have to decide
whether I want to eat like everyone
else and remain overweight or control
my eating and lose weight.
Sabotaging thought: It is okay to eat
this because I want it and besides I do
not really care. Helpful response: I
might not care right at this moment
but I will care in a few minutes. I will
be very unhappy if I eat something I
shouldn’t have eaten, and I sure will
care when I find that I am not losing
weight.
Sabotaging thought: This is too hard.
I cannot do it. I will never be able to
stop myself from eating like this. I
may as well give up. Helpful response: So I made a mistake. That
was inevitable. It’s unreasonable to
expect myself to be perfect every single time. I am not a failure. I can
learn something from this experience
to help me the next time.
Sabotaging thought: I do not need to
weigh myself. I know how I’m doing
by how my clothes fit. Helpful response: This employment to learn the
art of using the number on the scale as
information to guide my eating and
exercise plans is important. I am fooling myself if I think I can regulate myself without this information.
Sabotaging thought: I do not want to
weigh myself. I think I've gained
weight.
Helpful response: I may or may not
have gained weight. If I have, it is not
the end of the world, but I do need to
know so I can figure out what to do. I
need to get over my fear of the scale.
It is very important that I not avoid
facing facts.
There are also what Judith Beck calls
“Thinking mistakes”. It’s important
to realize that thoughts are just ideas, not truths!
5
#1 – ALL OR NOTHING THINKING
You see things in only two categories and
ignore the fact that there is a middle
ground. SOUNDS LIKE: “I’m either successful at dieting” or “I’m a failure.”
#2 – OVERLY NEGATIVE FUTURE
PREDICTION
You predict the future in an overly pessimistic way without considering other possible outcomes. SOUNDS LIKE: “Since I
didn’t lose weight this week, I’ll never be able to
lose weight” or “Since I gave into that craving,
I’ll never be able to tolerate cravings.”
#3 – OVERLY POSITIVE FUTURE
PREDICTION
You predict the future in an overly optimistic way without considering other possible
outcomes. SOUNDS LIKE: “I’ll be able to
eat these cookies that I’m craving and then stop”
or “It’s ok if I just estimate the amount of food
I’m supposed to have instead of measure it. I’ll
still lose weight.”
#4 – EMOTIONAL REASONING
Drawing conclusions about the nature of
the world based on your emotional state.
SOUNDS LIKE: “I feel so angry about eating
that ice cream — I must really be a failure” or “I
feel like I just have to have something sweet right
now.”
#5 – MIND READING
You’re sure you know what others are
thinking, and you expect them to know
what you’re thinking. SOUNDS
LIKE: ”My co-worker will think I’m rude if I
don’t eat that cake she brought for her birthday”
or “People will think I’m strange if I don’t drink
alcohol at the party.”
#6 – SELF-DELUDING THINKING
You rationalize by telling yourself something that you really wouldn’t believe at
other times. SOUNDS LIKE: “If I eat this
cake on my birthday, then the calories don’t
count.”
#7 – RULES THAT DON’T HELP
Mandating actions without taking circumstances into consideration. SOUNDS
LIKE: “I can’t inconvenience my kids by removing all of the junk food in the house” or I can’t
waste food.”
#8 – JUSTIFICATION
You connect unrelated concepts to justify
your eating. SOUNDS LIKE: “I deserve to
eat this because I’m tired and stressed out” or
“It’s ok to eat this because its free.”
#9 – EXAGGERATED THINKING
You blow a situation out of proportion.
Sounds like…”I can’t stand this craving” or “I
have no willpower.”
6
Polycystic Ovarian Syndrome (PCOS)
Continued from page 1
coarse hairs are seen. PCOS is a common cause of hirsutism in 60 % of hirsute women. Biochemical signs of excess androgens can be diagnosed with
blood tests of androgen levels. With
male pattern baldness, you can experience hair loss from the top of your head
like men do.
Polycystic ovaries can be seen on pelvic ultrasound. A pelvic ultrasound uses
sound waves to make a picture of your
uterus and ovaries. In PCOS, the ovaries make many small follicles instead
of one big one.
It is estimated that 50 to 80% of women with PCOS are insulin resistant. Insulin is a hormone that is produced by
specialized cells within the pancreas
that control blood glucose (sugar)
levels. When blood glucose levels
rise after eating, insulin is produced to help the body use glucose
for energy and lower blood glucose
(blood glucose homeostasis). With
insulin resistance, the glucose levels in the blood do not respond to
normal levels of insulin released
and the pancreas is required to
make more insulin to maintain
homeostasis. When increased
levels of insulin are needed to
maintain a normal blood glucose
level, a person is said to be insulin
resistant.
Obesity increases insulin resistance and can worsen the reproductive and metabolic abnormali-
ties seen in PCOS. Weight loss through
diet and exercise interventions are the
first step in treating overweight and
obese women with PCOS. Losing as
little as 5% of initial body weight improves ovulation and spontaneous conception.
Goals for treatment include decreasing symptoms of excess
androgen (like excess hair growth or
balding), managing metabolic abnormalities, reducing risk of endometrial
cancer and hyperplasia, contraception
for women not pursuing pregnancy and
ovulation induction for women who
desire pregnancy. Different medications are used depending on the specific
goal of treatment but weight loss is the
first line intervention for all overweight
or obese women with PCOS.
KETO KORNER
Cream Cheese Pancakes
Resource: recipe and pic www.ibreatheimhungry.com/2012/01/cream-cheese-pancakes.html
These delicious low carb pancakes taste
like skinny fried cheesecakes! They can
also be made without sweetener and
rolled to make delicious low carb
wraps!
Author: Mellissa Sevigny
Recipe type: Low Carb Breakfast Recipe
Cuisine: American
Serves: (4) 6" pancakes
INGREDIENTS
 2 oz cream cheese
 2 eggs
 1 tsp granulated sugar substitute
 ½ tsp cinnamon
INSTRUCTIONS
Put all ingredients in a blender
or magic bullet. Blend until
smooth. Let rest for 2 minutes
so the bubbles can settle.
Pour ¼ of the batter into a hot
pan greased with butter or
pam spray. Cook for 2
minutes until golden, flip and
cook 1 minute on the other
side. Repeat with the rest of
the batter.
Serve with sugar free syrup (or
any syrup of your choice) and
fresh berries.
NOTES
Approximate nutrition information per
batch of pancakes:
344 calories, 29g fat, 2.5g net carbs, 17g
protein
7
April 2016
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Charlotte Brain Tumor 5K Run/Walk –
Charlotte
Puppy Rescue 5K –
Concord
1
3
10
4
11
5
Medical Support
Group Meeting
6PM Carolinas
Weight Management
Lobby
Bariatric Surgery
Information Session
6:30PM
Gastonia Marriott
Courtyard
12
6
18
Tuck Fest 5K Trail
Race – Charlotte
24
19
Surgical Support
Group Meeting
6PM Mercy
Auditorium
25
26
8
Bariatric Surgery
Information Session
6:30PM
Mercy Auditorium
13
Bariatric Surgery
Information Session
6:30PM
Mercy Auditorium
17
7
20
14
Bariatric Surgery
Information Session
6:30PM
Rock Hill Hilton
Garden Inn
21
15
28
Belmont Rail Trail
5K
Charger Challenge
5K – Concord
Feeding Frenzy 5K –
Kannapolis
Harrisburg 5K
Race for a Reason 5K
– Huntersville
Run for U 5K–
Monroe
9
Color Vibe 5K –
Concord
Foam Glow 5K –
Concord
Governor’s Village
5K – Charlotte
Queen City Trail Run
5K – Charlotte
Pure Religion 5K –
Charlotte, NC
16
FreeMoreWest 5K on Bulldog 5K – Charthe Greenway – Char- lotte
lotte
Family Fun Puzzle
Run – Huntersville
Sunshine 5K – Matthews
22
Bariatric Surgery
Information Session
6:30PM
Mercy Auditorium
27
2
29
23
Charlotte Water for
People 5K – Charlotte
CPCC Skyline 5K –
Charlotte
Miles Against Melanoma 5K – Charlotte
The Color Run –
Concord
30