The Hemp Connection:
DHA

If you've been following the blog over the last week, I've been reporting about interesting products and things I learned at the 2011 Natural Products West Expo. It's a huge exposition where food companies hoping to connect with buyers for health food stores have a chance to showcase their products. There were about 2,000 exhibitors there, and in 3 days I didn't get a chance to see and talk to everyone I wanted to. You can imagine, on the exhibitor end, the pressure there is to create a product, packaging concept, and booth display that catches the eye of the people you came to meet!

Unfortunately, not all concepts were on target. I'm sharing one that is a common example of how omega-3 marketing is not always accurate. It's still not regulated well, so there are lots of variations in how facts are presented that can be confusing to the person who knows they want to eat well but doesn't understand all the facts.

Yesterday I pulled a fish oil bottle out of my sample bag and noticed on the label that it was"extra-virgin" fish oil. This is a concept that I'm familiar with when it refers to olive oil, and it means that it is the olive oil from the first press of olives. It's a stronger oil, with a lower smoke point, and more appropriate for recipes where the oil is not heated. But it's not really a concept that has any relevance to fish. (I joked with my Facebook friends about whether or not it really mattered what the fish were doing before we caught them!) This particular product's label was also busy with breakdowns of omega-3's, 5's, 6's, 7's, and 9's, promoting a"perfect complement of 16 omega's". It all sounded very official, but to the average consumer who is still confused about 3's, 6's, and 9's, it only serves to make shopping for fish oil tedious and painful.

One of the reasons for all of this confusion is that fish oil is Mother Nature's patent. Consumers want their foods and supplements to be as unrefined as possible, but the only way to patent and protect a manufactured product, is to alter it. So it is very difficult for fish oil companies to create products that distinguish themselves from other competing products while keeping their customers happy. What is left to distinguish a product is where the fish is caught, what species the fish is, and the total amounts of omega-3 fatty acids. And lots of pretty, irrelevant marketing words.

Even with all my knowledge and training, I can spend hours in the health food store looking at labels on fish oil supplements and keeping up with new and different products. From my perspective, it's the total amount of omega-3's that matters. If you have a hard time with the flavor or the burps, there are several flavored options and packaged forms that can get you around that problem.

Here is my advice to you.

1. First of all, before you spend a lot of money and time, try taking fish oil to see if it works for the problem you're trying to solve. Be sure you take enough of it. For the degree of inflammation seen with PCOS, you're going to need to take the equivalent of 1000 mg DHA. That can be 2 to 3 times the recommended dose on the bottle. Be sure you do your math. It can even be the Costco brand. That is actually my first recommendation to clients. I'm more interested in whether or not adding DHA to the diet is helpful, not where the fish was caught, what the flavor of the fish oil is, yadayadayada. I just want to establish if there is a DHA deficiency.

2. Make a list of the problems that you have that you're looking for relief with that you know are related to omega-3 imbalance: memory, concentration, mood swings, carbohydrate cravings, skin problems, menstrual irregularity. Keep this list in a handy place.

3. If memory problems are on your list, be sure you have a mechanism for remembering to take the fish oil! I swear, this is one of the biggest barriers to PCOS, memory and forgetfulness keeping you from remembering what it is you need to do! If you need to engage your significant other, or set up an alarm on your phone, or a Google calendar reminder…do whatever it takes to be consistent. If you didn't take it, and it didn't work, it didn't work because you didn't take it, not because it's not the issue.

4. Be diligent about reducing your omega-6 intake: soy, safflower, sunflower, sesame, corn, cottonseed. The less of these oils you have in your diet, the better chance omega-3's have of doing the job.

5. Be sure you're reading the dose right on the label. One of my biggest issues I have with one of the most popular brands of fish oil is that their dose is two capsules, not one. Most people never read the fine print, assume a dose is one pill, and end up taking half of what they were thinking they were taking.

6. At the end of your trial period, look at your list and see what improved. Did it work? NOW, and only NOW that you've established whether or not you were DHA deficient, consider if the type of fish oil you take. Would you prefer a flavored, a gel, a capsule, a liquid? All of them are going to give you what you want, you're just deciding which one fits best with your personal taste and texture preference.

Pretty packaging and fancy words are not what are going to help you to feel better. It's what's inside the package, and in what concentration, that you need to focus on!

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.

This is to address some great questions about fish oil that Katie sent in.

Katie asked:
after reading about fish oil and its obvious benefits, I finally bought some Carlson Super Omega-3 Fish Oil Concentrate soft gels yesterday at Whole Foods.

I have several questions I have tried to get answered via this site and the Internet, but can't seem to find clear answers, so I am throwing them out here, in hopes you can help.

1. The bottle says"Each Carlson Super Omega — 3 soft gel contains 1000 mg (1 gram) of a special concentrate of fish body oils from deep, cold-water fish which are especially rich in the important Omega-3's EPA and DHA." However, the Supplemental Facts read EPA 300 mg DHA 200 mg Other Omega-3's 100mg. I believe that adds up to 600mg. Right? There is no mention of the other 400 mg. Where are they? I'm very confused about this. Can you explain this to me? There is also Natural Vitamin E — 10 IU…incase that means something.

2. How many pills/mg am I supposed to take? I read between 1000 mg and 3000 mg. Which makes me confused again because even though the bottle says 1000 mg in each pill I can only find 600 of them! I want to make sure that I am taking enough, but not taking too much! How much do you take? Also, do I work up to that or just dive in?

3. Last question…is there anything else I should be taking with the fish oil? I know that sometimes if you take something you need to supplement with something else. Is that the case here?

Thank you in advance for your advice and information!

My response:
Katie, these are really great questions and something that I am often asked by my clients. Here's the scoop:

1. The dosage on the ingredient list can indeed be very confusing and frankly I believe it is a way in which some supplement companies try to give the impression that you are getting a better product with higher potency, but it can be misleading. When the label states something like…"contains 1000 mg marine oil", you are not getting the complete information.

The critical ingredients and the amounts you need to know about are — how much EPA (eicosapentanoic acid) and DHA (docosahexaenoic acid) are contained in each capsule.

EPA and DHA have been shown to support healthy functioning of the cardiovascular, immune, gastrointestinal, and musculoskeletal systems. EPA is also an excellent anti-inflammatory and helpful in conditions such as insulin resistance, diabetes and auto-immune related inflammation.

DHA is an important factor for those with PCOS as it supports many aspects of health including pregnancy, fetal development, and healthy neurological function.

The other"marine lipids" are simply the total fat of the fish, where the EPA and DHA are the active portions of that fat. It is the"actives" that are providing the therapeutic value. The vitamin E in the capsules is for preservative purposes and helps prevent rancidity of the fat.

2. Regarding the dosage you should take, that is a harder question to answer because it will depend on what you are trying to target. Those with PCOS should be targeting anywhere from 500 — 1000 mg. DHA. So you need to know how much DHA is in each cap, for example if the capsule has only 200mg. of DHA, you'll need to take 3 of them to get approximately 500mg. You can then work up to a higher dose, always start with the lower dose and work your way up. Sometimes it is easier to get a liquid version that is high potency versus taking handfuls of pills to achieve the same dose.

I do not recommend that you take a liquid fish oil that is derived from Cod Liver Oil as the source as it usually has a high amount of Vitamin A and it is possible to get toxic doses of vitamin A. Another thing to note is that in a combination EPA/DHA cap, the dosage EPA will usually be higher than the amount of DHA, that is no problem. The EPA will only be of additional benefit.

Don't hesitate consulting with a registered dietitian knowledgeable both in PCOS and supplements in order to have your supplementation tailored to your specific health needs — remember we are all different, with unique physiology, medical history and requirements.

3. Fish Oil does not have to be taken with anything else to enhance its function. It can be taken all at once, with meals, between meals — it is very flexible this way.

Here are a couple of additional tips:

- if you tend to"burp" back fish oil, make sure to buy a brand that comes in an"enterically coated capsule", they might cost a few cents more, but it's worth it.
- refrigerate your fish oil to protect it and this also can help reduce"burp back".
- contributes to creating beautiful, healthy skin.

One last fun fact about fish oil. Most of it actually comes from the southern hemisphere not as you might think from the deep waters off Norway!

Here's to fish oil!

Carmina McGee, MS, RD, LE
Ventura, California
805.816.2629
info@carminamcgee.com

While I was at Walmart today looking for vinegar, I ran across a new product that is perfect for PCOS! Crisco's Puritan brand has released a canola oil with algal DHA. What that is, is regular canola oil blended with marine algae omega-3's.

If you regularly read this blog, you know the"S" and"C" rule about oils; avoid, as much as possible, (with the exception of canola), oils beginning with the letters"S" and"C". For most women, that translates into cooking primarily with olive and canola oils. This new canola also has those hard-to-find marine oils, in the form of marine algae oil.

One tablespoon of this oil contains 32 mg of DHA. Fat is still fat, and you should still moderae fat intake…so this is really not a practical way to get all of your omega-3's. But, if you make simple switches and add a little DHA where before there was none, you can effect big changes. This oil could be used in waffles, muffins, salad dressings…wherever you were using any other kind of vegetable oil.

I especially love that I found this product at Walmart…meaning you don't have to have a lot of money to buy health-promoting foods or take care of yourself.

In the spirit of Mardi Gras week, I thought I'd highlight a kissin' cousin of that Cajun crawfish…shrimp.

Shrimp are one of those foods people love…and they have learned to be afraid of. When I started out in this field, I was taught to teach patients to avoid shrimp because of their high cholesterol content.

Turns out, dietary cholesterol in foods such as eggs and shrimp do not influence our own cholesterol nearly as much as pro-inflammatory fats, saturated fats, and trans fats. Some researchers even suggest that shrimp consumption may IMPROVE cholesterol and triglyceride levels!

In addition shrimp, lucky for a shrimp lovin' woman like myself, is extremely low in fat! A 3.5 oz (deck of card-sized) serving of fish has about 1 gram of fat…whenever I'm questioned about shrimp I always remind the person with the question that shrimp is so low in fat, it almost squeaks from lack of lubrication against your teeth when you bite into it.

Shrimp is also a great source of protein, vitamin B12 (crucial for mental health), tryptophan (needed to make serotonin), and vitamin D (thought to be important in managing PCOS). In addition, shrimp helps omega-3 balance by contributing a moderate amount of DHA. And, when you're replacing red meat with seafood, you're exchanging pro-inflammatory omega-6 fats with healthier fats, which ensures that your omega-3's are not metabolically destroyed before they have a chance to benefit you.

So if you see shrimp cocktail, shrimp fajitas, grilled shrimp on the menu…go ahead! Enjoy! It's contributing to your health while providing a tasty adventure.

Way back when I first started studying omega-3 chemistry, I put together a list of DHA contents of a variety of seafoods. I was recently asked for a copy of that list, and since the list was not complete the first time I did it, I decided to update it.

I noticed when looking at the latest list that there were two significant changes: Over half of the seafood given the"green light" are farmed. Meaning we need to be more open to eating farmed fish and better manage our ocean farming habits. Secondly, as a consumer it is also important to know what fishing method was used. Some are sustainable, some are not.

The list below is based off of the Monterey Bay Aquarium Seafood Watch list, most recently updated January 11. As much as I advocate for all of you to eat more fish, I want to be sure that I do my part to encourage responsible use of the ocean's resources. So the only options included on this list are the"green light", or most sustainable options. If you don't see it there, it didn't get a green light. The (F) in front of an item denotes"farmed".

I'll update this from time to time so you all can keep current. I used the national list, but you can also find more specific regional lists at the same website. The downloadable wallet cards or iPhone application are great to keep with you so that you can always make better choices when you're grocery shopping or eating out.

Bottom line, any seafood has omega-3's. Even if they're not as high as what is found in salmon, every time you eat fish, you're not eating a meat higher in saturated fat. There's a"double whammy" benefit over and above that simple DHA.

Hope this inspires you to think when buying or ordering your seafood!

Milligrams of EPA/DHA/total omega-3 per 100 gram (3.5 cooked ounces)

(F) artic char 600/500/1100
(F) US barramundi 900/600/1500
(F) US catfish 200/200/400
(F) clams 100/100/200
(F) US cobia 383/418/801
(F) Pacific cod, bottom longline fished 100/100/200
Dungeness/stone crab 100/200/300
Pacific US halibut 300/100/400
Pacific US spiny lobster 100/100/200
(F) mussels 300/200/500
(F) oysters 200/400/600
Alaska sablefish/black cod 100/100/200
Alaskan salmon 575/500/1075
(F) off-bottom scallops 100/100/200
Pink shrimp 100/200/300
(F) striped bass 600/200/800
*striped bass 200/600/800
(F) US tilapia 130/50/180
(F) US rainbow trout 400/100/500
US/British Columbia albacore tuna (canned white) 100/300/400
Skipjack tuna (canned light) 300/100/400

Source: Uploaded by user via Monika on Pinterest

I was asked by one of our readers (who happens to also be my dear cousin Susan), if there was anywhere on the Internet, a checklist for vegetarians to follow to be sure their diet is complete. Her pretty exhaustive research found nothing really practical for meal planning.

So in response to that, and knowing that a very high percentage of our own readers are vegetarian, I put something together. Please let us know if it needs refining or detail, so that we can make this as practical as it can possibly be.

There are five main things to attend to. All of them are important, but I ordered them in the way I look at them when planning a vegetarian meal for myself.

1. What is my protein source and how much of it do I need to truly give me enough protein?

Here are your goals based on the number of calories you eat. This will make 30% of your calories protein, which will help to fight insulin resistance.

1200 calories 90 grams
1300 calories 93 grams
1400 calories 95 grams
1500 calories 98 grams
1600 calories 100 grams
1700 calories 103 grams
1800 calories 105 grams
1900 calories 108 grams
2000 calories 110 grams

2. Where is my vitamin D coming from, and have I had enough? You will have to make a very conscious effort to get enough of this vitamin. With regard to whole foods, mushrooms are pretty much the only vitamin D-containing food. With regard to vegan milk alternatives, beware. Most are so low in protein, they are more accurately thought of as juices rather than milks. If you choose to drink them you will need to find other ways to meet criteria nu,ber one above. I blogged about
this in detail not too long ago.

3. Are my fats healthy? If your definition of vegan is primarily not eating meat, and you are eating a lot of packaged, processed, prepared, or baked food…be extra sure you are not inadvertently letting the pro-inflammatory fats sneak in. Remember, they tend to begin with the letters"s" and" c" — soybean, safflower, sunflower, sesame, corn, cottonseed. (Canola is the exception.). Vegans are often blindsided here with salad dressings, baked goods, cookies, and chops. Read your labels--as much as I love Whole Foods, their entire snack food aisle only has a handful of choices you can bring home if you follow this rule! Good fats include olive and organic canola.

4. Am I getting DHA and EPA (marine omega-3)? Yes, flax, green veggies, and other foods contain omega-3, but the conversion rate is not high. You will need to find a marine algae supplement to be sure your intake of these two essential fatty acids is adequate. InCYSTer Chris Marquette found one that is not genetically modified; look for it next time you shop.

5. Am I getting enough fruits and vegetables? Ideally, these should be the vast majority of what you eat. I am surprised at how many vegans I know who do not like vegetables! You should be aiming for 2-3 1/2 cup servings PER MEAL. Beware of juicing; it is a great way to get in large volumes of fruits and vegetables…BUT…the carbohydrate to protein ratio is not going to help reduce insulin resistance. Make a smoothie out of your juice with your favorite protein powder.

Of course, you can take supplements to make up many of these deficiencies…but if your solution in more than one of these categories is a supplement, I challenge you to consider why you do what you do. The true definition of a vegan is someone WHO MEETS THEIR DAILY NUTRITIONAL NEEDS without using animal-based food to make it happen. If all you have done is remove animals from your diet, you are simply a picky or misinformed eater.

I recently read a blog entry about omega-3 fatty acids, in which it suggested that adequate DHA could be obtained from spirulina and chlorella, two supplements

found in most health food stores. I was surprised to read this, as I'd never run across any information in all the DHA research I've read to suggest that these were appropriate sources.

Total DHA content of pure algae, by percentage total fat, is as follows:

Life’s DHA™ from Schizochytrium – 37%
Life’s DHA™ from Cryptocodidium cohnii — 40.0%
Isochrisis galbana 17.16%
Chlorella vulgaris 13.32%
Spirulina platensis 7.53%

As far as total DHA content, it is clear that the Schizochytrium and Cryptocodidium cohnii provide more bang for the buck; the total volume needed of the former is far less than isochrisis, chlorella, and spirulina. Whichever supplement used, the total amount of DHA consumed is important.

Another benefit to using schizochytrium and cryptocodinium is that Martek has FDA approval to sell their DHA to companies who then incorporate it into foods.

By making a few simple changes in your grocery list, you can increase your DHA intake without having to use a supplement. If you want a supplement, those are available as well. A list of available foods and supplements can be found at this link.

Thanks to colleague Connye Kuratko, Ph.D., R.D. of Martek Biosciences, for being able to find a study (referenced below) that helped clarify this issue. Martek's Life's DHA marine algae supplement, found both in capsules and in foods, contains Schizochytrium or Cryptocodinium cohnii.

Ö. TOKUS¸OGLU AND M.K. ÜNAL Biomass Nutrient Profiles of Three Microalgae: Spirulina platensis, Chlorella vulgaris, and Isochrisis galbana. Journal of Food Science 68:4, 2003, 1144-1148.

Senanayake SPJN and Fichtali J. Single Cell Oils as Sources of Nutraceutical Specialty Lipids: Processing Technologies and Applications. in Shahidi F Nutraceutical and Specialty Lipids and Their Co-products. CRC Press, Taylor and Francis Group, Boca Raton, FL, page 268.

Women with PCOS tend to have higher risk pregancies. A risk that is pretty well acknowledged is gestational diabetes. However, the rate of pre-eclampsia is also higher in cysters. Did you know diet can help you reduce your risk?

Researchers analyzed the diets of women with pre-eclampsia and gestational hypertension to see if any specific nutrients were correlated with these problems. The specific nutrients they looked at were: calcium, omega-3 and omega-6-6 fatty acids, trans fatty acids, magnesium, folate, and vitamins C, D, and E. There was a slight reduction in risk of pre-eclampsia in women with a higher intake of omega-3 fatty acids.

Omega-3 fatty acids, especially DHA and EPA, are two essential items you should include in your"Healthy Pre-pregnancy, Pregnancy, and Nursing Toolbox".

Boomsma CM, Eijkemans MJ, Hughes EG, Visser GH, Fauser BC, Macklon NS. A meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome. Hum Reprod Update. 2006 Nov-Dec;12(6):673-83.

Oken E, Ning Y, Rifas Shiman SL, Rich Edwards JW, Olsen SF, Gillman MW. Diet during pregnancy and risk of preeclampsia or gestational hypertension. Ann Epidemiol 2007 Sep;17(9):663-8.

Yesterday I was a home remodeling whirlwind. I spent much of my morning at IKEA, Lowe's, Home Depot, the paint store, you name it, spending all my money, and I spent most of the afternoon repairing, painting, installing…and before I knew it, the sun had set and I was starved!

I ran out to Trader Joe's to get a sushi dinner. I grabbed the California rolls with artificial crabmeat that said"brown rice", without reading any further. It was only when I got home and was enjoying the meal that I realized I was eating vegetarian sushi that was omega-3 supplemented with Life's DHA. This is omega-3 from marine algae that is being used as an omega-3 supplement in many foods, which you can read about elsewhere in this blog.

As much as I work to reassure pregnant women that eating most seafood during pregnancy can be safe, I know some of you will still opt not to eat it. This product, which tasted just like fish (even my cat couldn't tell, he loved it too!) and can provide the omega-3's that are essential for both mother and baby that can be challenging to get if you aren't eating seafood.

The label said that a serving contained 32 mg of DHA, but I ate the whole 280 calorie box which gave me 64 mg.

For more information about this product, and its nutritional content, visit the Fujisan Foods website.

If you're a regular reader of this blog, you know how big I am on omega-3's from seafood. For those of you who are vegan, I've been recommending a product called Life's DHA, which can be found in supplements as well as foods. Many of these foods are labelled as organic, which is supposed to mean they are free of anything genetically modified.

Many thanks to our network member Michal Hogan who forwarded a news release with a detailed report about this product. It is GMO, and it is being incorporated into many foods that are sold as organic. I used to point several of them out when I did grocery store tours at Whole Foods.

This creates a dilemma for vegans, as the truth seems to be, if you're omega-3 deficient, and wish to supplement, you may have to use a fish-based product. There is always nori (sushi wrappers) and you can add sea vegetables…but the reality is, the average American is unlikely to be able to eat enough of these to be able to use them as a way to replete low DHA stores.

If you're vegan, it's going to be especially important to cut the omega-6 out of your diet to be sure it's not overwhelming the omega-3 that is actually there.

One thing I can recommend, and now that I read this report, strongly recommend…is that you have your blood omega-3 analysis performed with the home fingerprick test we offer. We do offer it at a discounted price. It will tell you exactly where you stand, how much this situation personally affects you, and gives anyone trying to help you pick the right foods, a better idea of what to advise you to do to improve your omega-3 status.

If you're simply relying on generalized Internet information you're playing a huge game of hit and miss. Why not get right to the point and figure out what YOU need to do personally?

I am not just sorry about having to backpedal. I am very, very sad. Such a high percentage of our readers and fans are vegans, and this was one of the ways out of the dilemma. Back to the drawing board.: (

Here is the article if you're interested.

http://www.naturalnews.com/034364_infant_formula_DHA_genetically_modified.html

Here is a list of foods from the Martek website that contain this ingredient.

http://www.lifesdha.com/Products-Containing-lifesDHA-/Partner-Products/tabid/683/Default.aspx

I nagged you about fish oil a couple of days ago. Here's why.

One of the places where inflammation, the underlying cause for PCOS, does its worst damage, is the brain. It destroys neurons. Wondering where your motivation, your memory, your focus and concentration went? Out the door with inflammation.

Think about a piece of rusted out metal. That's the result of oxidation. Inflammation is the process that is trying to repair oxidation. But if you're burning through brain cells faster than you can repair them, you create holes. They've even shown it on brain scans. Where depression exists, (and depression is the result of so many brain cells being scavenged that the brain is literally moving in slow motion), there is inflammation.

There is one, and only one chemical known to man that can repair those holes. That chemical is docosahexaenoic acid (DHA), or one of the two things you get when you take fish oil. If you're vegan, you can get it in marine algae. If you've ever been vegan at any time in your life, or you hate or are allergic to fish, chances are it's a major factor in your PCOS. You can't repair your brain holes, and if you have holes in your brain, your brain can't regulate your hormones.

It is that simple. Really.

I had a client once who said to me,"This fish oil stuff works wonders. That is, when I remember to take it."

I don't care what you have to do — program your smart phone, post it note your computer monitor, ask your spouse to nag you — take fish oil.

The dose you're going to need is higher than what's recommended on the bottle. You're going to need 1000 mg, or 1 gram, of DHA per day. Not 1000 mg of total fish oil, of DHA. It's about 4 times what you see on many bottles.

Oh, and just so you know. That repairs the damage, but it doesn't protect you from new damage. For that part, you're going to have to change your eating and lifestyle. It really isn't going to work to take a ton of fish oil with the belief that it's cancelling out the damage done by that donut, by not working out, or not getting to bed on time.

I have clients who keep a rusty can next to their computer. It's a reminder. For some reason, when they hear that this PCOS thing is totally messing with their BRAINS — it gets their attention. If that's what you need to do, go find a rusty can. Yup, that could be your brain if you don't start getting that fish oil.

It's the first, most crucial step in the road to balancing your hormones. It's simple. And if you go to Costco, it's not really all that expensive.

Just do it. You'll be amazed at how quickly you start to notice little signs that inflammation is peeling away.

A significant percentage of the women I counsel, whether their issues are officially related to PCOS or not, are vegetarian. They get in trouble with their vegan lifestyle because it eliminates the essential nutrients DHA and EPA.

Not any more!

Marine algae is an up and comer in the omega-3 world. It's been increasingly incorporated into foods, which I've written about before. Now, the people who developed this ingredient are reporting that this algal DHA is as effective as salmon in increasing the body's DHA levels.

You can either take it as a supplement, or you can find it in popular foods. The best place to go in order to get the list of foods you can use is the Martek website. I'm also including the"Life's DHA" logo here, because it's on the packaging for these products for easy identification.

No more excuses, all you vegans! You can make choices that help you to be healthier while honoring your culinary code of ethics.: )

Arterburn LM, Oken HA, Bailey Hall E, Hamersley J, Kuratko CN, Hoffman JP. Algal-oil capsules and cooked salmon: nutritionally equivalent sources of docosahexaenoic Acid. J Am Diet Assoc. 2008 Jul;108(7):1204-9.

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.

Since we talk so much about the importance of fish oil for women's health, we get forwarded articles and studies from colleagues who'd like to know what we think.

Late last night, Minh-Hai Tran forwarded me an article entitled,"Healthy and Pregnant: Forget the Fish Oil".

The hairs on the back of my neck immediately prickled on seeing this title…knowing the potential for confusion this could cause with readers like ours, who've heard us talk so much about an opposing viewpoint.

Here's a closer look at what the article says and how it fits into our treatment model.

I've always followed the guidelines established by the International Society for the Study of Fatty Acids and Lipids (ISSFAL) when evaluating studies and formulating recommendations. Here are their recommendations, right off of their website. I comment on the current study's accommodation of these recommendations in italics below each item.

1. Dietary fat intake during pregnancy and lactation, as a proportion of energy intake, should be the same as that recommended for the general population.

I was not able to find if there was any standardization of diet during this study. This is a common error in study design when evaluating the effectiveness of a supplement. Any added chemical in any study is going to respond differently, depending on the biochemistry of the environment into which it is introduced.

The pre-pregnancy weights of the women in the study were not mentioned, either. I would imagine that this would potentially affect the outcome of the study.

2. The n-3 LC-PUFA, DHA, must be deposited in adequate amounts in brain and other tissues during fetal and early postnatal life. Several studies have shown an association between maternal dietary intake of oily fish or oils providing n-3 LC-PUFA during pregnancy and/or lactation and visual and cognitive development as well as other functional outcomes of the infants.Pregnant and lactating women should aim to achieve a dietary intake of n-3 LC-PUFA that supplies a DHA intake of at least 200 mg/d. Intakes of up to 1 g/d DHA or 2·7 g/d n-3 LC-PUFA have been used in randomized trials without occurrence of significant adverse effects.

It appears from the comment of the lead researcher that a dose of 200 mg DHA per day is what was used in the study. Our experience at inCYST is that it can take significantly more DHA than that to see benefit. This is especially true if the diet in which the supplement is included is high in omega-6 fatty acids, which interfere with omega-3 activity. The study size is large--around 2,400 women, which would have given these researchers an opportunity to collect dietary intake data and evaluate if there were different results in women whose diets were high in omega-6 fatty acids vs. those which were higher in omega-9 fatty acids. Huge opportunity lost, and important advice for anyone currently putting together any kind of study regarding omega-3 fatty acids. The entire diet, not just the dosed supplement, is important to standardize and measure.

I would have been interested to see various levels of DHA--200, 500, 750, 1000 mg, to see if the same results resulted. Using the lowest dose possible is going to be the treatment least likely to produce positive results.

3. Women of childbearing age can meet the recommended intake of DHA by consuming one to two portions of sea fish per week, including oily fish, which is a good source of n-3 LC-PUFA. This intake of oily fish rarely exceeds the tolerable intake of environmental contaminants. Dietary fish should be selected from a wide range of species without undue preference for large predatory fish, which are more likely to be contaminated with methylmercury.

I agree, that there may be more to this issue than DHA. For example, much information is coming out about the importance of adequate vitamin D for reproductive health. Is it the fish oil or the vitamin D in the salmon…or the interaction between the two that is important? Future studies need to separate out and explore these questions…in the presence of a controlled diet.

Intake of the precursor, a-linolenic acid, is far less effective with regard to DHA deposition in fetal brain than the intake of preformed DHA.

5. There is no evidence that women of childbearing age whose dietary intake of linoleic acid is adequate need an additional dietary intake of arachidonic acid.

This was not a concern with this study.

6. Some studies have shown that maternal intake of fish, fish oils or n-3 LC-PUFA results in a slightly longer duration of gestation, a somewhat higher birth weight and a reduced risk of early preterm delivery. The clinical importance of such effects with regard to infant health has not been fully elucidated.

This finding was confirmed in the new study. I look forward to future studies understanding why.

7. Screening for dietary inadequacies should be performed during pregnancy, preferably during the first trimester. If less than desirable dietary habits are detected, individual counselling should be offered during pregnancy as well as during lactation.

It does not appear that individual omega-3 fatty acid status was evaluated in the women in the new study. So if the women were deficient, a low DHA dosage likely would not have been enough to elucidate a treatment response. If the women had adequate DHA in their tissues before coming pregnant they likely would not have experienced a treatment response.

All due respect to the well-intended researchers, some important aspects of study design were not incorporated, limiting the conclusions that can be drawn from this study. I hope they include a dietitian in future studies.

All due respect to MSNBC, please consider the damage and suffering you potentially inflict on women who could drastically benefit from a simple dietary intervention, on behalf of titling an article purely with SEO (search engine optimization) in mind. Post partum depression is a serious disorder, hurting many others in addition to the woman whose biochemistry produces it.

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.

Secondary infertility is the inability to conceive or carry a pregnancy to term after successfully and naturally conceiving one or more children.

Secondary infertility also appears to often be a condition with a significant nutritional cause…and a fairly easy solution.

A developing fetus has no way of obtaining the important omega-3 fatty acids, EPA and DHA, that it needs for adequate brain and nervous system development, except from its mother.

And what do we do to pregnant moms? We tell them to not eat the main source of these fatty acids, fish.

Even though the FDA warning limits their advised restrictions to four fish (shark, tilefish, king mackerel, and swordfish), studies have shown that women tend to limit ALL fish consumption while pregnant.

So as their firstborn develops, mom's omega-3 stores gradually dwindle. It's highly likely, given the stressful demands of new motherhood and the continued concern that fish may not be safe while nursing, that omega-3 intake continues to be inadequate.

And since fertility is dependent on adequate omega-3's as well, it makes sense that what it required to conceive and carry the first baby to term, may be exactly what's keeping baby #2 from happening.

We've been pretty successful at inCYST with this type of infertility. It's about getting over the fear of eating fish when you're pregnant.

At this point, pretty much every reputable fish oil on the market is molecularly distilled, meaning it's clean. Random tests of bottles of fish oil pulled off of pharmacy shelves rarely find mercury. Believe me, if they did, with the popularity of fish oil, it would be all over the news.

You can't just take fish oil and expect your problems to be solved. It is important to combine this with a healthy diet free of trans fats, low in inflammatory fats (safflower, sunflower, soybean, corn, cottonseed), and rich in antioxidants.

When you DO dose the fish oil, you'll need to take more than the recommended dose on the bottle; about 1000 mg DHA. You will need to calculate the number of capsules your favorite brand provides.

This issue is actually one of the things that inspired me to create the inCYST Network. When I saw what the fish fear was potentially doing to mother, child, and unborn children, I decided it was time to step up and speak out.

I hope you find this information helpful!

Hello everyone,

It's great to be back with the new team of PCOS course graduates! I hope you enjoyed Susan Dopart's recipe and that other contributions will be educational and practically useful.

Today I wanted to share some recent findings about the effects of elevated glucose on a developing baby. If you have PCOS and you are pregnant, you are at risk for gestational diabetes. I realized while reading this study that rarely is the effect of hyperglycemia on the fetus ever discussed. You might hear that it can effect your weight and the baby's weight, but can it do anything else? Some researchers think so.

A group of chick eggs were injected with glucose. Significant changes were found in the babies that developed from those eggs, including:
--their own hyperglycemia
--elevated oxidative (degenerative) activity in body and brain tissue
--lower body weight
--lower brain weight
There also seems to be lower levels of DHA in babies exposed to hyperglycemia. This may be due to the elevated oxidative activity destroying any DHA that might be there.

You're likely aware that taking folate is pretty much an across the board recommendation to pregnant women. In this study, hyperglycemia seemed to induce a level of oxidation/inflammation that was not significantly helped with a folate supplement.

Bottom line, it's important to eat well not just to avoid weight gain or to keep your blood sugar low to keep your doctor and dietitian happy, but because your baby's brain and body depend on you to do so.

I did not write this post to scare you, I did it to make you aware. However, if you're feeling as if you now don't know what's right to eat, or you're trying and having a hard time, please take a look at the right hand of this blog screen. There is a whole list of professionals ready and waiting to help you figure it out.

Most of my clients express surprise that healthy eating includes as many tasty foods as it does. So before you write off a visit to the dietitian because you're afraid of what you WON'T be able to eat, consider that it may be your ticket to freedom and guilt relief to work with someone who can introduce you to the many foods that will BENEFIT you and baby!

Cole NW, Weaver KR, Walcher BN, Adams ZF, Miller RR Jr. Hyperglycemia-induced membrane lipid peroxidation and elevated homocysteine levels are poorly attenuated by exogenous folate in embryonic chick brains. Comp Biochem Physiol B Biochem Mol Biol. 2008 Jul;150(3):338-43.

Thank you to Christine Marquette and Michael Keele for such an informative program this morning!

If you're interested in hearing our discussions about vegetarian eating, home design for better health, and farmer's markets, please visit our show archives. It is the second show on the list. (I'm still learning how to work the software and didn't properly title it.)

When working with women who desire very much to conceive, it can be challenging to help them understand the big picture. They want a baby…they want it NOW…and if that's not something you can promise…well, there are a gazillion other people out there who will gladly take their money if they say what these women want to hear.

We're establishing a pretty good track record when it comes to fertility help, but what I want to be sure everyone understands, who comes to this blog, is that we're equally concerned about your long term health, and preventing infertility in the babies you might have.

One of the patterns I'm seeing when evaluating clients, is that they were either formula fed, or breast fed for a short time before being switched to formula. Yes, what happened to you as a child can definitely affect your fertility. We can do a pretty good job of playing catch up, but if you only play catch up long enough to become pregnant, then go back to your former way of eating, you're setting up your babies to have similar problems in THEIR adulthood. Knowing what you've likely gone through yourselves…why would you wish that on anyone? Especially your own child?

So even though you may not really be thinking about the fertility prospects of the baby you may not even have yet, I'm encouraging you to think long-term and big picture. Here's an example of research that tells you why I'd do that.

Seventy-seven healthy babies born to term were compared to each other based on the following: (1) breast fed longer than 6 months, (2) breast fed between 3 and 5 months, and (3) exclusively formula fed.

Baby's DHA levels (that's the omega-3 found primarily in fish oil and marine algae) did not differ much at birth, but DHA significantly decreased between birth and the first year of age in babies who were not breast fed. The researchers concluded that breast feeding for at least months is what is required to prevent this decline.

Because every milligram of DHA a baby gets in breast milk comes from mama's personal supply, it is crucial that mama's diet be adequate in DHA throughout nursing. Fortunately, the very diet we've been encouraging you to consume to become pregnant and stay pregnant…is the diet that facilitates this process. It wasn't that you were healthy and just needed a little push to become pregnant. You were out of balance, and the way you chose to eat restored that balance. Once you get there, the goal is to maintain balance, not go back to being out of balance because you've achieved your important goal and want to get back to the easier way of doing things.

It's about your pregnancy, your baby's health, your brain and baby's brain. And it's not really that hard. Hopefully we're helping you to see that.

Sanjurjo Crespo P, Trebolazabala Quirante N, Aldámiz-Echevarría Azuara L, Castaño González L, Prieto Perera JA, Andrade Lodeiro F. [n-3 and n-6 fatty acids in plasma at birth and one year of age and relationship with feeding.] An Pediatr (Barc). 2008 Jun;68(6):570-5.