Fatty liver is a common problem in women with PCOS. In this study, EPA, an omega-3 fatty acid and a fish oil, was shown to improve the symptoms of nonalcoholic steatohepatitis (fatty liver). EPA is the fish oil that you cannot get when you rely on vegan sources of omega-3's--it's not in flax, and it's not in marine algae. Some research shows that when you've eaten enough marine algae to completely saturate your tissues, what's left can be used to make EPA, but it's not the way of getting it that the body prefers.
This is important to understand, because the vast majority of foods that are labeled as supplemented with omega-3 fatty acids either contain ALA (primarily in the form of flax) or DHA (primarily from marine algae).
The other advantage to eating fish is, that if you've put a fillet on your plate, you've likely removed another (fattier) kind of protein. That's the positive double whammy you get in seafood choices.
In my training I was always encouraged to develop good negotiation skills. In other words, if a client didn't like a certain food, to have a few other options up my sleeve that would provide equivalent nutritional value. Only when I got into omega-3 chemistry, inflammation, and PCOS, did I realize that in this one crucial area, I would have to dig my heels in and advocate that this essential nutrient was simply non-negotiable: if you don't eat fish, you miss out on total health.
Over the weekend I had an animated discussion with another dietitian who was adamant that her clients (mainly with eating disorders) simply were not going to accept this. I told her they simply would not achieve total health…and possibly total recovery. I got some resistance, but hopefully at some point this colleague will come to understand that we're here to guide our clients where they have the potential to go. We're not here to tell them what they want to hear, with the hopes that somehow health will just magically appear.
Tanaka N, Sano K, Horiuchi A, Tanaka E, Kiyosawa K, Aoyama T. Highly Purified Eicosapentaenoic Acid Treatment Improves Nonalcoholic Steatohepatitis. J Clin Gastroenterol. 2008 Apr;42(4):413-418.
I can tell by looking at this blog's visitation statistics that a very high percentage of its visitors are looking for help with an immediate problem that has"hit them where it hurts", so to speak. You may have acne. Or want a child. Or be looking for a successful weight loss plan.
The fact is, however, that sitting in my seat, it is equally important to offer insight and solutions for those problems as it is to educate about the big picture.
The fact is, 10% of women with PCOS will be diabetic by age 40.
The fact is, PCOS increases your risk of heart disease and high blood pressure.
And…since diabetes is increasingly being associated with Alzheimer's disease, the fact is, you may end up being at risk for that as well if you're on this blog looking for help with your acne.
Fortunately, you don't have to do one thing for your fertility, another for your acne, and another to prevent Alzheimer's. All the suggestions you see here work to help all organ systems function better.
And the fact is, there is a whole lot you can do to decrease your risk of having any of the problems mentioned above.
The fact is, you can't decrease your risk if you don't take action. That part of the solution is totally in your control.
In this particular study, the alpha-linolenic acid (ALA)concentrations in fat tissue were evaluated in 1819 people. (ALA is a type of omega-3 fatty acid found in flaxseed, flaxseed oil, soybeans, canola oil, and nuts, to name a few.)
Individuals with higher levels of ALA had a lower risk of heart attack.
The fact is…if you cook more often with canola oil, eat more nuts, put some edamame on your next salad, and/or add some ground flaxseed to your next bowl of oatmeal, you just might experience the same benefits as the people in this study.
If it can't hurt and it might help, there doesn't seem to be a reason not to try at least one of those things!
Campos H, Baylin A, Willett WC. Alpha-linolenic acid and risk of nonfatal acute myocardial infarction. Circulation. 2008 Jul 22;118(4):339-45. Epub 2008 Jul 7.
Many of the women I work with are vegan vegetarians. Which means when it comes to increasing omega-3 intake, they tend to want to go heavy on flax, hoping it will make up for not eating fish. It simply doesn't work this way…in ways that are very important to PCOS.
When different groups of rats are given ALA (the primary omega-3 in flax), EPA and DHA (the primary omega-3's in fish oil), EPA and DHA lowered glucose and insulin levels about 35-38% greater than did ALA. Insulin sensitivy improved by 60% in the fish oil groups compared to the ALA groups.
Bottom line, if you really, really want to get better, and you're not currently eating fish, or using a fish or marine algae supplement, you may want to seriously consider adding one of those to what you're doing. It's pretty non-negotiable, we need DHA and EPA to properly function as human beings.
Andersen G, Harnack K, Erbersdobler HF, Somoza V. Dietary eicosapentaenoic acid and docosahexaenoic acid are more effective than alpha-linolenic acid in improving insulin sensitivity in rats. Ann Nutr Metab. 2008;52(3):250-6. Epub 2008 Jun 19.
I just received an email from a client who noticed that every time she added flaxseed oil to her diet, she started to wheeze. We checked online, and sure enough, some people can be allergic to flaxseed. Here are some of the common symptoms of flaxseed allergy.
For anyone who is trying to increase their omega-3's, this can pose a challenge, since the vast majority of foods in the grocery store labeled as omega-3 supplemented contain flaxseed as the omega-3 source. If it turns out you are a flax-allergic person, be extra sure you read those labels!
ALA, the primary omega-3 in flaxseed oil, is not a substitute for fish oil; it has completely different and essential functions. A good way to think of it is that EPA and DHA from fish oil provide the"meat" of the structure of your brain and nerve cells, while ALA acts kind of like"rustproofing", keeping all that DHA and EPA in place that you worked so hard to get in the diet. They both need each other present in order for maximum effectiveness.
Here are some ideas for getting more omega-3's in the diet.
1. Other foods containing ALA include
Broccoli Brussels sprouts Cabbage Canola oil Edamame Kale Parsley Pecans Pumpkin seeds Spinach Spring greens Tempeh Tofu
One reason I have not included walnuts, which are typically the first vegetarian food recommended to increase omega-3 intake, is that the omega-6 content is so high that it is mathematically impossible to improve an omega-6 to omega-3 ratio when using them. I love walnuts and think they have some great nutritional benefits for PCOS, but in the rare and special case of a flaxseed allergy, it may not be a food that you would want to eat in large quantities. (I'm working on a pro-walnut post for a later date for you curious types!) Here are some practical ways to incorporate the foods above into your diet.
1. Know your nuts! The nuts with (a) the best omega-3 levels and (2) the best overall ratios of healthy to unhealthy fats include: macadamia, hazelnut, pecan, pine, and pistachio. Those are the nuts you should be using with the most frequency in your snacking and cooking. If you like nut-encrusted fish and pesto sauce…you're in luck! You can also throw nuts in your coffee grinder to make nut powders, which can be added to waffles, pancakes, baked goods, smoothies, and salad dressings. They'll give your creations a little bit of a gourmet twist!
2. Use shredded cabbage in your tacos instead of shredded lettuce. That's how they do it in Mexico…and it's the perfect topping for a fish taco!
3. Get in the habit of throwing a handful of dark greens--kale, spinach, parsley--into your smoothies. You won't even taste them.
4. Pumpkin seeds, like nuts, are easily added to trail mix, thrown on salads, soups, and hot cereals, and ground to include in your encrustings.
5. Cook with canola oil.
6. I've included the three types of soybean that are not tough on thyroid--edamame, tofu, and tempeh. Edamame is a fun snack when popped out of the shell, tofu and tempeh can be the basis for a meatless meal.
7. If you like pesto, you may want to try chimichurri, another parsley-based sauce that I call"South American pesto". It is wonderful on grilled meats and easy to make! I've seen ready made varieties in the grocery store.
8. Be extra careful about omega-6 fatty acids. The less of those in your diet, the less omega-3 you will need to counter their inflammatory influence. For review, except for canola, which is ok, minimize your use of oils beginning with the letters"s" and"c"…safflower, sunflower, soybean, corn, cottonseed. (The reason soy as a food is ok while soybean oil is not, is because the ratio of omega-6 jumps up when you extract and use only the fat and do not buffer it with the meat of the soybean.)
Here are a couple of recipes for you, one for chimicurri sauce, and one for a tasty squash/kale/whole wheat lasagna I tested out this week.
It just takes a little creative thinking to find ways around a flaxseed allergy. Hopefully some of the suggesstions I'm providing turn out to be favorites in your home!
Spinach Kale Whole Wheat Lasagna (from Sunset Magazine, February 2008)
Note: I couldn't find whole wheat lasagna noodles in my store so I bought whole wheat egg noodles and layered them with the other ingredients to make a casserole. It was great! Prep and Cook Time: about 2 hours. Notes: You can assemble and chill the lasagna a day ahead, but add 10 to 15 minutes to the baking time. You can also freeze the lasagna, wrapped well in plastic wrap, for up to 1 month and bake it frozen (add 1 1/4 hours to the oven time).
Yield Makes 8 servings
Ingredients 4 tablespoons olive oil, divided 1 medium red onion, peeled and sliced 3 peeled garlic cloves (1 minced, 2 left whole) 2 cans (14 oz. each) crushed tomatoes 1 teaspoon dried oregano About 1 tsp. each salt and freshly ground black pepper, divided 6 cups (about 2 lbs.) butternut squash, peeled and cut into 1/2-in. cubes 1/2 tsp. dried thyme 1 pound Lacinato kale (often sold as dinosaur or Tuscan kale) 9 whole-wheat lasagna noodles (about 8 oz.) (Often, whole wheat pastas are made with flax…be sure to read your labels!)1 container (15 oz.) part-skim-milk ricotta cheese 1/8 teaspoon ground nutmeg 2 cups shredded mozzarella cheese, divided
Preparation 1. Preheat oven to 400°. Heat 2 tbsp. olive oil in a 2- to 3-qt. pot over medium heat. Add onion and minced garlic; cook, stirring occasionally, until onion is soft and translucent, 5 minutes. Add tomatoes, oregano, and 1/2 tsp. each salt and pepper. Reduce heat and simmer until thick and flavors are combined, about 30 minutes. Set aside.
2. While sauce is cooking, in a 12- by 15-in. baking pan, sprinkle squash with thyme, remaining olive oil, and salt and pepper to taste. Add garlic cloves and toss squash mixture to coat with oil. Bake until soft, 10 to 15 minutes. Meanwhile, bring 3 qts. salted water to a boil in a large pot.
3. Reduce oven temperature to 350°. Transfer squash and garlic to a food processor and purée until smooth.
4. Tear kale leaves from center ribs and discard ribs. Boil leaves until soft, 5 to 8 minutes. Drain; let cool. Squeeze out as much water as possible and chop finely.
5. In the same pot, bring another 3 qts. salted water to a boil. Add noodles and cook until tender to the bite, about 10 minutes. Drain; rinse with cold water.
6. In a bowl, mix ricotta, nutmeg, 1 cup mozzarella, and remaining 1/2 tsp. each salt and pepper.
7. Coat the bottom of a 9- by 13-in. pan with 1/3 of tomato sauce (about 1 1/2 cups). Lay 3 noodles in a single layer over sauce. Top noodles with squash, spreading evenly. Sprinkle 1/2 of kale evenly over squash. Arrange 3 more noodles on kale and top with ricotta, spreading evenly. Top with remaining kale and noodles. Cover noodles with remaining tomato sauce and sprinkle with remaining 1 cup mozzarella.
8. Bake lasagna until juices are bubbling and cheese is melted, about 30 minutes. Let stand 10 minutes before slicing.
Grilled Halibut with Chimichurri Sauce from Epicurious.com
1/3 cup extra-virgin olive oil 1/4 cup fresh lemon juice 1 tablespoon water 1 tablespoon minced garlic 1 tablespoon minced shallot 3/4 teaaspoon hot red-pepper flakes 3/4 cup chopped flat-leaf parsley 4 (6- to 8-ounce) halibut steaks (3/4 to 1 inch thick) 1 tablespoon vegetable oil print a shopping list for this recipe
Preparation
Whisk together olive oil, lemon juice, water, garlic, shallot, red-pepper flakes, and 1/2 tsp each of salt and pepper until salt has dissolved. Stir in parsley. Let chimichurri stand 20 minutes.
Meanwhile, prepare grill for direct-heat cooking over medium-hot charcoal (medium heat for gas).
Pat fish dry, then brush with vegetable oil and sprinkle with 1/2 tsp salt and 1/4 tsp pepper (total).
Oil grill rack, then grill fish, covered only if using a gas grill, turning once, until just cooked through, 8 to 10 minutes total.
Serve fish drizzled with some of chimichurri; serve remainder on the side.
Cooks' notes: ·Halibut can be cooked in a hot oiled large (2-burner) ridged grill pan over medium heat. ·Chimichurri can be made 1 hour ahead and kept, covered, at room temperature.
Food item of the week-a perfect match for a meal idea Here is a perfect combination from once again our good old friend"Trader Joes"Trader Joes brand Valencia Peanut Butter with Roasted Flaxseeds-crunchy and salty, it contains 320 mg ALA Omega 3 Fatty Acids per serving (approx 2 tsps) and the ingredients are merely peanuts, roasted golden flaxseeds and saltplus…Trader Joe's Organic Superfruit Spread (a blend of morello cherrys, red grapes, blueberries and pomegranates) which is mostly from juices but only 8 grams of sugar per tsp and contains 60% DV of Vit C per servingThis combination is an anti-inflammatory, anti-oxidant and pro-nutrient dense match and might I add, on some whole grain full of seeds bread, it is a yummy sandwich!!!!!!!! you can enjoy as a meal or snack! Posted by Ellen Reiss-Goldfarb, R.D. at 5:34 PM 0 comments Labels: ala, anti-inflammatory, anti-oxidant, Ellen Goldfarb, Ellen Reiss-Goldfarb, Food Item of the Week, omega 3, PCOS Monday, June 29, 2009
Last night I settled in to watch the evening news, in time to see an ad for Country Crock's Omega 3 Plus brand margarine. With my reputation as somewhat of an"omega 3 queen," I figured I'd better pay attention. And by the time the ad was over, I knew I had today's post.
This label is a perfect example of why consumers are confused, and why they can have a hard time achieving the benefits of good nutritional choices.
First, the good news.
The margarine has no trans fats, because it contains no hydrogenated or partially hydrogenated oils. For fertility, this is a huge plus--with as little as 2% of your total calories per day coming from trans fats (about 2/3 tsp for the average woman), fertility can drop by as much as 73%.
Secondly, one serving provides 500 mg of omega-3's in the form of ALA.
Now for the confusing and potentially detrimental news.
When the professionals on this blog talk about what we're doing to enhance fertility and reduce inflammation, and we refer to omega-3's, we are primarily referring to EPA and DHA, the omega-3's that, except for omega-3 eggs and foods supplemented with algal DHA, contain either fish or fish oil. (Menhaden oil, which is what is found in Smart Balance Omega 3 Margarine, is a type of fish oil.)
Any other type of omega-3 is likely to be ALA. This type of omega-3 is found in canola oil, and flaxseed oil, among other things. In this margarine, the ALA source is canola oil.
But there is no fish oil or marine algae to provide a similar nutritional feature.
There are some things that flax and canola can do, and there are some that flax and canola simply cannot do.
Many people, nutritionists included, operate on the assumption that since the omega-3 found in canola and flax can be converted into EPA and DHA, that you can get enough of the latter two without having to eat fish. Most respected omega-3 chemists will tell you this is highly unlikely.
On a good day, when your diet is as perfect as it can possibly be (which, even in the case of the person writing this post is never), only about 2-3% of your flax and canola can be converted into the other omega-3's.
Bottom line, it's pretty non-negotiable, you are highly unlikely to get the amount of omega-3's your body needs, especially if you are trying to conceive, if you are assuming you can do it without fish.
Secondly, the primary oil in the margarine appears to be liquid soybean oil. Remember the rule about"S" and"C" oils? Soybean is one of those"S" oils with a tendency to be pro-inflammatory. It was impossible to tell from the label what the ratio of soybean to canola oil was, and I would suspect that it was higher than you're going to want if you're trying to choose fertility-friendly foods.
I immediately became suspicious about this Country Crock product when I went to the website and nowhere, I mean absolutely nowhere, could I find a plainly stated ingredient list. Sure, there's a label to look at, but it's strategically posted in a way that all the nutritional information is there except for the ingredients. Hmmmm…
…so I went to the FAQ section. Couldn't find it there either. I found a lot of long-winded explanations of trans-fat labeling, and that was my second red flag.
Since I had to go to the grocery store anyway, I stopped in and looked at the label. Here, for the benefit of the rest of the people on the Internet, is the list of ingredients from the side of the container of this product:
For more information on healthy fats, go to http://www.zingbars.com/science-of-zing.html, where my Zing Bar friends describe why they did--and didn't--include certain fats in their new product.
Any fat that is going to be solid at room temperature is going to have to have some saturated fat in its formula. Otherwise, it would melt. So even though the total saturated fat content is low, the type of fat being used to provide the solid quality is not one you want to get much of in your diet.
I'm not really a butter or margarine person so giving those up was not an issue for me. But I did start my career in the Chicago area, and I remember how people used to look at me like I was purple-polka-dotted if I even hinted that dairy intake might need to be adjusted. So I know it's an issue for some of you.
Bottom line--if you choose to use the product, do so only once in awhile and sparingly. I'd rather see people use olive oil-based dipping sauces for breads and cook with either canola or olive oil.
If you're interested in learning more, the authors of the study below also wrote a recently released book in plain English entitled, The Fertility Diet. I'd check it out.
Chavarro JE, Rich-Edwards JW, Rosner BA, Willett WC. Diet and lifestyle in the prevention of ovulatory disorder infertility. Obstet Gynecol. 2007 Nov;110(5):1050-8.
