The Hemp Connection:
cardio

Last week I had the opportunity to hear James May, the founder of Wisdom Natural Brands, based here in Phoenix, tell his story of how he became involved with developing the stevia industry. Below is a white paper he shared with us that is referenced and provides a lot of very interesting information. This is a business paper, not a scientific publication, but it does contain references that can get you started if you're looking for more information.

It's not just a sweetener, apparently it has some endocrine and appetite effects as well (may decrease your appetite for sugar), and a new study suggests it may help to improve memory.

Also, I'm providing a link to a brand new website, Stevia University, which is a resource for all things stevia. Be sure to bookmark it!

Stevia Rebaudiana Bertoni Prepared by James A. May and provided as an educational service by Wisdom Natural Brands
Stevia has been correctly framed as the promised sweetener that can help resolve many of the world's sweetener, obesity, and diabetes concerns. Stevia can also solve much of the poverty of the farmers in third world countries by giving them a cash crop to grow, even improving the productivity of their soil and the quality of their other crops.
Stevia can be the next generation of the world's most preferred steetener. Consumers are becoming even more excited as they learn that stevia extract was not originally a chemical invention targeted for a totally different purpose, such as a drug or insecticide, which, after it was tasted, became an artificial sweetener (1).
Stevia, in its various forms has always been a natural sweetener that also offers numerous health benefits. In its natural forms it has been in use in parts of South America for more than 1500 years and, as a high intensity sweetener, in Japan and Asia for over 35 years. (2) Millions of people have ingested stevia daily and there has never been a documented adverse reaction reported (3).
Modern consumers have joyful anticipation for increased use of this sweetener that does not cause fat storage, does not adversely affect blood sugar or blood pressure, reduces caries and gum disease, does no harm, is good for the human body and — can taste great — depending on the extraction methods utilized.
The Joint Expert Committee on Food Additives (JECFA) of the World Health Organization has studied and approved 9 of the numerous naturally occurring glycosides residing in stevia leaves to be safe for human consumption in high intensity sweeteners. They are: stevioside, rebaudioside A, rebaudioside B, rebaudioside C, rebaudioside D, rebaudioside F, dulcoside A, rubusoside, and steviolbioside. Any combination of these glycosides totaling a minimum of 95%, the balance being other components of the stevia leaf, meets the standard set.
HECFA refers to steviol glycosides rather than stevia glycosides in determining acceptable daily intake (ADI) amounts of 4 mg per kilogram of body weight. This provides a 100-fold safety factor, meaning the human body can handle 100 times this amount and still be within the safety limits. However, steviol is one of three metabolites (i.e. the breakdown aglycones being steviol, isosteviol, and a unit of glucose) of the stevia glycosides, therefore, this related to 12 mg of the naturally occurring stevia glycosides per kilogram of body weight. Stevia glycosides are broken down into the three metabolites by bacterial action in the intestinal tract. It is well documented that steviol and the other metabolites are entirely excreted from the body.
In a presentation of the recent science regarding stevia at the 2009 annual meeting of the Calorie Control Council, Claire C. Kruger, PhD, DABT, CEO of Spherix Incorporated, a biopharmaceutical company, reported that"Stevia glycosides have very low toxicity in animals and there is no evidence of risk in humans, including repeat dose systemic toxicity, carcinogenicity, developmental, or reproductive effects. The weight of evidence indicates that steviol glycosides are not genotoxic." She also reported that"Stevia extracts and steviol glycosides show no DNA damage in a broad array of in vitro and in vivo assay," and that the"safety of ingestion of steviol glycosides in hmans has been corroborated in clinical trials; measures of tolerance, body weight, clinical chemistry, hematology and urinalyis did not show any evidence of untoward effects." She reported that critical newly published studies (5) resolve questions about any untoward effects after long term repeated exposure to steviol glycosides.
The Proceedings of the 3rd Stevia Sumposium 2009, held in Belgium reported recent scientific studies that found that,"Stevioside (i.e. the combination of Stevia glyucosides- lowered glucose, insulin and cholesterol. It had no effect on triglycerides or glucose tolerance," and that it"inhibited atherosclerosis by reducing macrophage, oxidized LDL and lipids. Furthermore, stevioside treatment increased the smooth muscle area of the plaque. This increase, together with the reduction of macrophages resulted in an increase of the smooth muscle cell-to-macrophage ratio". The scientists concluded by stating that"this is the first report showing an association between stevioside treatment and increased adiponectin and insulin sensitivity, improved antioxidant defense and reduced atherosclerosis. The decrease of oxidized LDL by stevioside is particularly important in view of our recent observation that LDL is associated with metabolic syndrome components." (6) No allergic reactions to stevia have been reported (7).
A patent application submitted to the US Patent Office, dated February 17, 2011, makes several significant claims, as a result of their scientific research, pertaining to stevia and brain function."Thus to summarize, stevia extract enabled improved learning and memory performance, to a similar, or better, extent as a natural reference substance, ginkgo biloba, and a pharmaceutical positive control compound, rolipram. These data showed that stevia-treated mice not only learned better than other groups but also retained their memory for a longer time period." When the product was given to human subjects they reported that,"Cognitive function, alertness and the ability to focus on work are seen to improve." The product they used was make by cooking leaves in water and is basically the same product sold by SweetLeaf (R), as stevia concentrate, since 1982.
SweetLeaf Stevia Sweetener is the only commercially available stevia extract that is made with a revolutionary new technology that uses only cool purified water and a series of filters. All other brands, currently in the market, utilize old technology that incorporates various chemicals, solvents and alcohols, including ethanol and methanol. Because stevia extracts can be between 200 and 300 times sweeter than sugar, they must be blended with other ingredients utilized as a carrier to make them palatable as a table-top sweetener. While all other brands use a sugar product, SweetLeaf(R) uses inulin, extracted from chicory root, which is a natural soluble fiber and prebiotic, thus creating a sweetener that improve health and vitality. SweetLeaf (R) wass the first stevia brand in the United States to acienve the FDA GRAS (Generally Recognied As Safe) designation.
REFERENCES
1. Aspartame was developed in 1965 by GD Searle, a pharmaceutical company, to be a prescription only drug for peptic ulcers. After it was tasted the company began the process to obtain FDA acceptance as a sweetener,which was achieved in 1981. According to Discover Magazine, 20 Things You Don't Know About Sugar, Sucralose (Splenda) was originally developed to be an insecticide (Oct. 2009, 121).
2. May, James A, The Miracle of Stevia, Kensington Publishing Corp. New York City, NY, 2003, 7, 32-42.
3. Geuns, Jan MC. Review: The Safety of Stevioside Used as a Sweetener, Proceeding of the first symposium: The Safety of Steviiside, KULeuven, 2004, 112.
4. http://www.steviauniversity.com/. Health and Healing Benefits of Stevia.
5. Ferri et all 2006; Jeppesen et al 2006; Barriocanal et al 2008; Maki et al 2008.
6. Gerraert, Benjamine et a, Natural Sweetener Stevioside Inhibits Atherosclerosis by Increasing the Antioxidant Defense in Obese, Insulin Resistant Mice, Atherosclerosis and Metabolism Unit, Deptarmtne of Cardiovascular diseases and Leuven Food Science and Nutrition Research Center Laboratory of Functional Biology, Katholieke University, Leuven, Belgium.
7. Geuns, op cit p. 85.

This week we’ll talk about bargaining, from the perspective of how bargaining plays out in relationship to our PCOS, and the sadness and grief that are often parts of PCOS. Bargaining is part of the DABDA (denial, anger, bargaining, depression, and acceptance) model that is typically applied to chronic/terminal illness. In the dying process, bargaining looks quite similar to what it looks like in PCOS, although it tends towards making deals with god, or trying to manipulate doctors. In PCOS, it looks more like this:

• Making a deal with god to be more attentive to him/her, if only the PCOS will go away
• Trying to negotiate with doctors – “Okay, so I’ll take the metformin like you said, but I’m still going to keep eating fast food, and it should all balance out, right?”
• Negotiating with your dietician, personal trainer, etc. – “I’ll do the cardio, but then I don’t have to do weights today.” Or, “I’ll come in three times a week, but only if you cut your fee in half.” Or, “Look, I know that dark green leafy vegetables are really good for me, but they give me gas, so can’t I just have a (pre-sweetened, sugar-laden, actually junk food) yogurt instead?” (HUH?! As you can see, we get very creative with our attempts to avoid what we don’t want, and get what we do want instead.)
• Over-exercising in order to compensate for eating badly – we develop a strange, twisted, internal logic that allows us to, essentially, do whatever we want. We convince ourselves that there are no consequences.
• Eating badly but taking lots of medication or supplements – this is another favorite form of a secret internal balancing plan that absolutely has no scientific or logical merit. It doesn’t just apply to food.
• Figuring, I’m young, I can do what I want until ___ age, then I’ll behave – the damage is occurring now, the bad habits are just getting more cemented as daily behavior, etc.

And here’s the thing about these games that we play with ourselves, our partners, and the professionals who try to help us – who’s it hurting? Really? You know the answer to this one. It’s only hurting you. I know reality is uncomfortable, but you’re spending so much energy on this bogus bargaining practice. What if you applied all of that energy to grounding yourself in reality, and taking small, manageable steps towards getting your self-care practices in line with what you know (or at least believe) to be true?

Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She has completed the inCYST training. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.

If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at AskDrHouseMD@gmail.com. You can also follow her on Twitter @askdrhousemd.

I don't know if it's because so many women with PCOS are struggling with weight, or if it's the attitude that health practitioners often have toward people working on weight issues (negative and judgmental), or what, but I meet and hear from many women who overlook activity possibilities that don't involve pushing yourself, in a very punitive way, to the point where exercise is painful and lacking in pleasure.

The Biggest Loser certainly doesn't help that mentality. If I have to see one more person pushed to the point of vomiting by a verbally abusive trainer who justifies that attitude by saying"This is what they come here for," I think I'll vomit myself.

But I digress.

Exercise should be challenging, and sometimes you'll feel sore, but it shouldn't feel like punishment.

One of the exercises I love to recommend is yoga. There are many reasons why yoga is helpful to PCOS.
1. It increases flexibility. If you haven't exercised much in awhile, your flexibility has likely diminished, and you're more prone to injury. The last thing you need, when you're just starting to take care of yourself, is to knock yourself out of commission with that!
2. Yoga can help to alleviate depression. And in turn, when you're less depressed, you are less likely to crave sugar, or to binge.
3. Yoga is good for improving circulation to your internal organs, including the reproductive ones.
4. It helps to release that pain-causing lactic acid I wrote about yesterday.
5. It helps to increase range of motion and fluidity in joints.
6. It helps you to improve your posture and stand taller, which can help you to have a longer, leaner look.
7. It reduces stress hormone levels.
8. It improves focus and concentration.
9. It can reduce cholesterol.
10. It can reduce symptoms of asthma, back pain, and arthritis, other inflammatory conditions often found in women with PCOS.

I'll be writing about various aspects of yoga throughout the week. But for now, just consider that even though cardiovascular exercise and strength training are important, you don't have to kill yourself with those, and exercises that don't emphasize those have benefit, too!

It never fails, I teach a PCOS class and walk away learning something new that challenges me to learn more about the syndrome.

This past week in Vermont, more than one woman in the class asked me why they experience so much physical pain after exercise.

I'd never heard that complaint before, but it made sense. With regards to a simple concept that can come into play for a couple of reasons.

The concept: When your body and diet's omega-6 content is high compared to its omega-3 content, one of the things that can happen is that your nervous system registers incoming stress at lower real levels of stress. And when it's there the way the nervous system registers that stress is more profound than it would be in a woman without PCOS. And…women with PCOS seem to already be programmed to have hypersensitive nervous systems.

Simply put, there's a double exercise whammy. Imagine you and your BFF, non-PCOS friend, are next to each other at the gym, both on elliptical trainers, set at the same intensity, same exercise duration, same data entered into the machine. You, with your PCOS, are likely to feel more stressed, more winded, and to experience a higher heart rate than your friend. Even if you've been training longer and are logically/theoretically in better shape than your friend.

What that means, is that you likely leave your aerobic/cardio intensity zone at a lower intensity of exercise than your friend, and enter the carb burning range, also meaning:
--you're not burning as much fat
--you're feeling more winded
--over time, you're bulking up more than you're burning fat.

When you burn a lot of carbohydrates with exercise, you create a lot of lactic acid, which can result in muscle soreness.

I proposed to the women in the class that for the rest of the week, they be sure to keep their exercise in the target heart rate zone. They did report that this level of exercise was lower than what they had been pursuing prior to our discussion, and that at this level of exercise they did not experience the soreness.

If we're on to something, there are some really important things to remember about exercise with PCOS.
1. Don't succumb to the"more is better" mentality! It may end up, because of the pain, making exercise so painful, you will develop a negative association with it. Don't let anyone who is not studying PCOS tell you that you need to work out harder. Listen to your body, and your target heart rate.
2. Drink plenty of water after you're finished. It does help to flush out any lactic acid you've accumulated, giving it less of an opportunity to hang around and cause pain.

Another likely consequence of this scenario is that because you're not burning fat, and you've used a lot of your muscle's carbohydrate stores, you are more likely to crave carbohydrates with exercise. So if exercise seems to be intensifying your cravings instead of tempering them…it could be a sign you're pushing yourself too hard. Women with PCOS often do that because they have been conditioned to believe they're not working hard enough at being healthy. Au contraire, they're often times working too hard at it…so hard the body fights back!

To calculate your THR:
1. Subtract your current age in years from 220.
2. Multipy this number by 0.65 and 0.8. The two numbers you get are the range between where your heart rate should be stabilizing during your exercise. If it's higher, dial it back…if it's lower, step it up.

Now go have some fun at the gym, in the yard, on the tennis court, wherever you enjoy moving!

In addition to PCOS, I specialize in the nutritional aspects of medications affecting the brain and nervous system. That includes psych meds, Parkinson's meds…pretty much any medication that has the potential to affect how the brain and nervous system function.

A few years ago, while compiling a series of fact sheets about the nutritional implications of these medications, I started reading about the anti-obesity medication called Meridia (generic name sibutramine). This drug appeared on the market after the famous phen-fen combination was deemed dangerous. It was supposed to be a kindler, gentler alternative. And it supposedly can reduce the severity of symptoms associated with PCOS.

I was floored by what was showing up, unedited, in the peer-reviewed literature about this medication. But not at all surprised with the announcement yesterday that this drug is potentially dangerous for people with heart conditions.

Repeatedly and consistently, researchers were reporting reactions. Some of the most common problems this medication seemed to incite, were anxiety, hypertension, and elevated heart rate.

If Meridia was a drug intended to treat cancer, or glaucoma, or hangnail, and it caused this battery of symptoms, I don't think the FDA would have tolerated consistent reports that it had the ability to send the cardiovascular system into a tailspin.

Yet, in the obese research subject, in the face of these observations, researchers continued to report some of the following conclusions:

**In a 21 patient study, 40% experienced sleep disturbances and 30% complained of irritability, unusual impatience, or"excitation".
RESEARCH CONCLUSION: Sibutramine, 5 and 20 mg, added to a multimodal program assisted participants in losing weight.
Weintraub M, Rubio A, Golik A, Byrne L, Scheinbaum ML. Sibutramine in weight control: a dose-ranging, efficacy study. Clin Pharmacol Ther. 1991 Sep;50(3):330-7.

**In a review study, the author reported,"In controlled studies, 84% of sibutramine-treated patients reported adverse events, compared with 71% of patients receiving placebo. The most frequently reported adverse events are related to pharmacological actions of sibutramine, and include dry mouth, decreased appetite, constipation and insomnia. Despite the high incidence of"side effects" in the control population, the author of this article attributed the problems in the tested population to"pharmacological actions of sibutramine".
Lean ME. Sibutramine--a review of clinical efficacy. Int J Obes Relat Metab Disord. 1997 Mar;21 Suppl 1:S30-6; discussion 37-9.

**In a study of 226 people comparing sibutramine to dexfenfluramine, researchers reported,"174 patients (77%) experienced adverse events; 17 patients withdrew due to adverse events. Pulse rate increased significantly in sibutramine-treated patients." Then they concluded,"Sibutramine (10 mg once daily) is at least as effective as dexfenfluramine (15 mg twice daily) in achieving weight loss in patients with obesity."
Hanotin C, Thomas F, Jones SP, Leutenegger E, Drouin P. A comparison of sibutramine and dexfenfluramine in the treatment of obesity. Obes Res. 1998 Jul;6(4):285-91.

**In a study of 235 people, the following was reported,"a significant increase in heart rate (about 4 beats/min) was noted for patients who received 10 mg or 15 mg sibutramine, compared with the placebo." Then it was concluded,"Doses of 10 mg and 15 mg once daily were shown to be similarly effective, well tolerated and significantly more effective than the placebo."
Hanotin C, Thomas F, Jones SP, Leutenegger E, Drouin P. Efficacy and tolerability of sibutramine in obese patients: a dose-ranging study. Int J Obes Relat Metab Disord. 1998 Jan;22(1):32-8.

**In a study of 11 men, it was observed that"the sibutramine-induced increase in energy expenditure was accompanied by an increase in plasma epinephrine, heart rate, blood pressure, and plasma glucose. The conclusion:"Sibutramine caused a significant increase in both energy expenditure and satiety, which may both contribute to its weight-reducing properties.
Hansen DL, Toubro S, Stock MJ, Macdonald IA, Astrup A. Thermogenic effects of sibutramine in humans. Am J Clin Nutr. 1998 Dec;68(6):1180-6.

As of 2006, I had found 14 studies reporting an elevated heart rate with use. You can easily find them yourself in http://www.ncbi.nlm.nih.gov/pubmed/; I encourage you to see for yourself. I've supported myself here with enough references and my Saturday has other obligations prohibiting me from using it to repeat work I've already done. I hope I've encouraged you to see for yourself what I've been talking about with colleagues for several years.

I like to call this the Biggest Loser Mentality. It doesn't matter if we make these people vomit, pull a muscle, or give them a bloody heart attack. This market of obese people is just too lucrative to ignore.

If you have PCOS and you are obese, you deserve better. You're not where you are because you have a deficiency of ANY kind of medication in your body. Don't let anyone convince you otherwise.

If cutting carbs was the only dietary strategy needed to help PCOS, this blog wouldn't exist. There are clearly thousands of women, based on the traffic statistics for this blog, who've tried that approach without success.

One of the food groups that gets cut out of the diet when we worry too much about carbohydrates, is fruit. And fruits are just loaded with antioxidants that are showing potential to help balance our biochemistry.

Resveratrol is one of those anti-oxidants. It is a compound well recognized for its benefits in reducing cancer risk, inflammation, cardiovascular disease, blood clotting, and other aging-related issues. It is actually a compound that some plants have the ability to produce to fight off pathogens that threaten their own health, that turns out to have the same ability in humans.

A recent study specifically done with PCOS suggests that it has potential for women with this syndrome.

In rats, resveratrol was shown to reduce the excess growth of ovarian tissue. It also inhibited the tendency for insulin to promote this type of excess tissue growth.

Where do you get this great stuff?

1. Red grapes, blueberries, bilberries, and cranberries. Bilberry extract is most commonly found in supplement form. The other fruits are often taken out of a low-carbohydrate diet. Don't make this mistake!

2. Red wine. For those of you who are trying to conceive, please exercise caution with this choice. It's best to pursue the nonalcoholic options provided here. But if you are not in that category, consider enjoying a glass of red wine with dinner tonight! Spanish red wines and New York pinot noirs are your best option, they've been found to have the highest resveratrol concentrations.

3. Peanuts and peanut butter. I love this one. Sometimes we think nutrition has to be complicated…but a PB and grape J sandwich is a perfect PCOS-friendly lunch!

4. Resveratrol supplements. These are primarily made from extracts of the kojo-kon root. Not that supplementation is bad, but I've been around long enough to see that when you isolate a compound from its natural source, you often miss out on other factors and compounds that either help make that compound more effective, or that may be the really important compound in the first place. So I'd encourage the other choices over supplementing. Another consideration that is important is potential conception. I just don't like to recommend supplements to anyone who might become pregnant when I don't know for sure if they have more potential to be helpful or harmful.

5. Dark chocolate and non-dutched cocoa powder. So now if anyone, anyone at all, questions why that really, really high-cacao bittersweet chocolate jumped from the shelf in the Trader Joe's checkout line into your grocery bag…just tell them "the inCYST blog made me do it".

Just a note, in addition to pure chocolate squares, think hot chocolate and mole sauce!

One important point I need to make here is that when resveratrol-containing foods are included in a balanced diet, they can have benefit. It's important to not eliminate entire categories of food. Resveratrol, however, has the ability to affect estrogen levels, in both directions. It's best not to overdose on the supplement because it's"good". Balance is always the goal in PCOS.

Wong DH, Villanueva JA, Cress AB, Duleba AJ. Effects of resveratrol on proliferation and apoptosis in rat ovarian theca-interstitial cells. Mol Hum Reprod. 2010 Jan 12. [Epub ahead of print]

From inCYSTER Karen Siegel…contact information for her Houston clinic is listed below.

"Yes. Another reason to keep encouraging the fish oil supplementation."

Public release date: 16-Dec-2009

Contact: Public Affairs Office
public.affairs@apa.org
202-336-5700 202-336-5700
American Psychological Association

New study links DHA type of omega-3 to better nervous-system function
Deficiencies may factor into mental illnesses
WASHINGTON — The omega-3 essential fatty acids commonly found in fatty fish and algae help animals avoid sensory overload, according to research published by the American Psychological Association. The finding connects low omega-3s to the information-processing problems found in people with schizophrenia; bipolar, obsessive-compulsive, and attention-deficit hyperactivity disorders; Huntington's disease; and other afflictions of the nervous system.

The study, reported in the journal Behavioral Neuroscience, provides more evidence that fish is brain food. The key finding was that two omega-3 fatty acids – docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) – appear to be most useful in the nervous system, maybe by maintaining nerve-cell membranes.

"It is an uphill battle now to reverse the message that 'fats are bad,' and to increase omega-3 fats in our diet," said Norman Salem Jr., PhD, who led this study at the Laboratory of Membrane Biochemistry and Biophysics at the National Institute on Alcohol Abuse and Alcoholism.

The body cannot make these essential nutrients from scratch. It gets them by metabolizing their precursor, α-linolenic acid (LNA), or from foods or dietary supplements with DHA and EPA in a readily usable form."Humans can convert less than one percent of the precursor into DHA, making DHA an essential nutrient in the human diet," added Irina Fedorova, PhD, one of the paper's co-authors. EPA is already known for its anti-inflammatory and cardiovascular effects, but DHA makes up more than 90 percent of the omega-3s in the brain (which has no EPA), retina and nervous system in general.

In the study, the researchers fed four different diets with no or varying types and amounts of omega-3s to four groups of pregnant mice and then their offspring. They measured how the offspring, once grown, responded to a classic test of nervous-system function in which healthy animals are exposed to a sudden loud noise. Normally, animals flinch. However, when they hear a softer tone in advance, they flinch much less. It appears that normal nervous systems use that gentle warning to prepare instinctively for future stimuli, an adaptive process called sensorimotor gating.

Only the mice raised on DHA and EPA, but not their precursor of LNA, showed normal, adaptive sensorimotor gating by responding in a significantly calmer way to the loud noises that followed soft tones. The mice in all other groups, when warned, were startled nearly as much by the loud sound. When DHA was deficient, the nervous system most obviously did not downshift. That resulted in an abnormal state that could leave animals perpetually startled and easily overwhelmed by sensory stimuli.

The authors concluded that not enough DHA in the diet may reduce the ability to handle sensory input."It only takes a small decrement in brain DHA to produce losses in brain function," said Salem.

In humans, weak sensorimotor gating is a hallmark of many nervous-system disorders such as schizophrenia or ADHD. Given mounting evidence of the role omega-3s play in the nervous system, there is intense interest in their therapeutic potential, perhaps as a supplement to medicines. For example, people with schizophrenia have lower levels of essential fatty acids, possibly from a genetic variation that results in poor metabolism of these nutrients.

More broadly, the typical American diet is much lower in all types of omega-3 than in omega-6 essential fatty acids, according to Salem. High intake of omega-6, or linoleic acid, reduces the body's ability to incorporate omega-3s. As a result,"we have the double whammy of low omega-3 intake and high omega-6 intake," he said.

###
Article:"Deficit in Prepulse Inhibition in Mice Caused by Dietary n-3 Fatty Acid Deficiency"; Irina Fedorova, PhD, Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health; Anita R. Alvheim, PhD candidate, Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, and National Institute of Nutrition and Seafood Research, Bergen, Norway; and Nahed Hussein, PhD and Norman Salem Jr., PhD, Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health; Behavioral Neuroscience, Vol. 123, No. 6.

(Full text of the article is available from the APA Public Affairs Office)

Norman Salem Jr. can be reached at nsalem@martek.com or at (443) 542-2370 (443) 542-2370. He was with the National Institutes of Health until 2008, when he became the chief scientific officer and vice president of Martek Biosciences Corp. in Columbia, Md., an ingredient supplier of DHA. He states that he and his co-authors conducted this research while with the NIH.

The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States and is the world's largest association of psychologists. APA's membership includes more than 150,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting health, education and human welfare.
--
Karen Siegel, MPH, MS, RD, LD, LAc
Acupuncture & Nutrition Clinic
9660 Hillcroft, Suite 202
Houston, TX 77096
713/721-7755 713/721-7755
www.AcupunctureandNutritionClinic.com
or
www.Karensclinic.com

If you're trying to conceive, you likely know that it's important to be getting enough folate in your diet in order to prevent neural tube defects.

Even if you're NOT trying to get pregnant, folate is important for women with PCOS.

Homocysteine is a compound found in the blood, which, in elevated amounts, indicates increased cardiovascular risk and inflammation. It tends to be elevated in women with PCOS.

Fifty patients with PCOS, were divided into two groups receiving two different treatments. The first group received 1700 mg of metformin per day, along with 400 mug folate. The second group received metformin without folate.

Homocysteine levels were significantly increased in both groups, but to a lesser degree when they also supplemented with folate.

I was heartened to see this study, since so much research on PCOS focuses on the part of PCOS we can SEE (i.e., weight), and seems to ignore that biochemistry can be altered regardless of weight. In fact, another study I ran across while looking for a blog topic this morning, focused on the fact that metformin improved biochemistry even without diet or exercise modifications. Yes, you can make a study say anything you wish if you correctly design it, but it is not fair to women with PCOS to do that and falsely lead them to believe that medication is the only answer. And, you've got to understand that even if your weight is normal with PCOS, you still have to pay attention to what is happening metabolically.

You've got to care about what's under the hood, not just how pretty the paint job is.

Palomba S, Falbo A, Giallauria F, Russo T, Tolino A, Zullo F, Colao A, Orio F. Effects of metformin with or without supplementation with folate on homocysteine levels and vascular endothelium of women with polycystic ovary syndrome. Diabetes Care. 2009 Nov 23. [Epub ahead of print]

Oppelt PG, Mueller A, Janetsch K, Kronawitter D, Reissmann C, Dittrich R, Beckmann MW, Cupisti S. The Effect of Metformin Treatment for 2 Years without Caloric Restriction on Endocrine and Metabolic Parameters in Women with Polycystic Ovary Syndrome. Exp Clin Endocrinol Diabetes. 2009 Dec 8. [Epub ahead of print]

I've never experienced infertility. I was overweight as a child/teen, but I've been the same weight for most of my adult life. I'm relatively healthy. I'm not saying this to intimidate anyone, but rather to share an insecurity I've had about what I do for a living.

I always wonder how in the world women who have those issues can even find me relevant and helpful if I've never had to experience them?

The last two months have presented me with a situation that, even though it may not be apparent on the outside, has very much changed me on the inside. I've learned a lot about control, gratitude, and what is truly important in life.

And I feel like this journey, challenging as it is, is molding me into someone better equipped to help the people who come to inCYST for help.

Regular readers of the blog will remember that I wrote about my sick kitty in October. I thought I was dealing with a simple urine crystal issue that a diet change would fix. I'm a dietitian, I know how to change diets. This was simple, or so I thought.

Well, Rodeo simply never recovered from the crystal incident. He would not eat. He became lethargic. About a month after the vet visit, I noticed, he just wasn't breathing well. Being the data fiend that I am, I started monitoring his respirations. They seemed stable, so I figured maybe he was allergic to the new diet he'd been prescribed for his urine crystals. I changed back to the old diet and waited to see if he responded.

Then he crashed. I got the last appointment on a Friday evening with his vet, and learned that he was dealing with one of four potential diagnoses. One was a fungal infection (no problem), one of those was a 100% fatal virus (that would require euthanasia), one was cancer (fatal over time), one was heart disease (manageable but life-shortening).

I had to wait almost a week for the pathology report to come back, and to get an appointment for an ultrasound with a cardiologist. (Yes, my cat has more specialists in his Rolodex than I do at this point).

The good news is, it's not the fatal virus, and it's not cancer, but it is heart disease, and it's a serious problem. There is no cure, but there is a lot I can do to manage the situation.

Sound familiar?

I told the vet,"If you can give me heart disease, I'll take heart disease. I can do that." Two sentences I never, ever envisioned coming out of my mouth at any point in my life.

I can tell you this. I have a reputation for being pretty even-keeled in even the most adversarial of situations. During my eating disorder treatment center gig, it was not uncommon for cans of Ensure to be flung my way after a tough counseling session. Nothing phases me after that!

But the night I came home from the vet with a couple of medications and no idea what was happening, I laid on my bed and cried my heart out. I didn't even notice that Rodeo had jumped up on the bed. He felt like crap, and he was sitting there trying to take care of me. I realized, of my two kitties, he is the one most affected by my emotions. And here he was, more concerned about me than about the X-ray, the aspiration, and all the poking and prodding he'd been through.

That was reality check #1. I knew I needed to allow myself to feel what I was feeling, but I needed to learn how to do it in a way that didn't turn itself back on the problem in a negative way.

As I imagine has happened with many of you, my life changed in a mere instant. I became hyper aware of respiratory rates, fluid intake, food intake, urine output, medication times…my life was filled with new details I had no choice but to learn to live with.

Even though I run a business, it's the holidays, and I had committed to coordinating vendors for a huge market here in Phoenix. Even though my five major plans for December revenue pretty much collapsed within days of getting the kitty diagnosis. Somehow, I had to figure out how to make it all work.

This is where I started thinking of all of you. How many of you readers are busy, successful women, juggling a million different responsibilities, happily living out your lives…when you're told you have to start monitoring what you eat, when you eat it, when you ovulate, when you menstruate, what your blood glucose number is…and on top of it all, every expert on the planet expects you to figure out when to work out, to plan the perfect meal combination, each and every meal, to buy the supplements, and on top of it, manage your anxiety, frustration, and anger over the situation?

Do these health professionals even have a clue? Did I ever have a clue with any of my clients I thought I was helping with inCYST? That's what's been going on in my head in the two months since Rodeo's diagnosis.

Reality check #2 for me was realizing what I was doing any time I had a free moment, especially during the week when I didn't know what I was dealing with. I found myself surfing the Internet, Googling symptoms, reading everything I could find about lymphoma and cardiomyopathy, looking for the worst in kitty, looking for anyone, anyone at all, who could tell me that there was a supplement or pill I could give him that would just make this all go away.

That behavior is known as magical thinking. It is a very common thing to do when faced with a situation that leaves you feeling cornered. Getting older. Cancer. Weight that won't come off. Infertility. It's about trying to find something, anything at all, that can give you the illusion that you're in control of something. Note that I used the word illusion. You're really not in control. You've transferred your need to be in control of outcome to a concrete, more manageable option. That's all. The only thing magical thinking succeeds at, is allowing us to avoid the pain of a situation. In many cases, it keeps us distracted from constructive and helpful things we can be doing.

So…knowing from working with all of you that this is what I was doing, I told Rodeo's vet what I do for a living, that I'm a real biochem nerd, and that I was probably dealing with my stress by reading waaay too much about cardiomyopathy. I told him at any time I was becoming annoying and intefering with his treatment plan and Rodeo's progress, he had permission to put me in my place. We negotiated a few things I wanted to try, one we're using, most we're not.

And I am adhering completely to what the doctor ordered. Even if it means staying up past my bedtime to get a med in, even if it means passing on a social invitation if it interferes with the treatment plan, even if it means using money I wanted to spend on something else to buy medication. The vet is not cheap. But he's incredibly smart. If kitty is going to get better, I can't be bargaining with him because of the inconvenience the instructions impose on my life as I wish it was.

Reality check #3 has been about how much control issues can be triggered when life throws a curve ball. We can do everything exactly perfectly. And Rodeo has a bad day. Or Rodeo can go dumpster diving, eat a fish head, throw it up, and be perfectly fine. At least for a day. How Rodeo feels today, is not at all about what I did for him this morning. It is about the consistency of what we do over time.

Oh, I'm so embarrassed to even be saying this, but this simple reality took me awhile to"get". I wanted him to always breathe perfectly. To eat when I gave him the food. To love the deli turkey. It doesn't happen that way. Some days he eats like he's the size of Zenyatta, other days, nothing strikes his fancy. I have had to learn to roll with it, and to not view one incident as failure, but as a challenge to figure out what another option might be.

On the days when things don't go as planned, I have to adjust my life. Yesterday morning, for example, meds did not go in at 8 am as scheduled. I spent 4 hours getting them in, but realizing that the four hours it took to make that happen was four hours I'd planned to spend making my contribution for a holiday potluck I was to attend tonight…I made the choice to cancel my attendance, focus on medication, and spend the evening tonight taking care of myself here at home.

Reality check #4. You know what happened when I stopped stressing about how I was going to do both the medications and the potluck and OMG what happens if I'm at the potluck and he bottoms out?!?!?! Rodeo settled in to one of the absolute best respiratory patterns and ate better for me than he did all week. I suspect he picked up on my more relaxed demeanor and was able to put energy into himself that he was putting into me. Some of the things I am inadvertently doing affect kitty as much, if not more, than the things I am supposed to be doing.

Reality check #5. I sometimes find myself getting annoyed at people complaining about things that now seem minor in the big scheme of things. All these people complaining about having to much to do for Christmas? In my eyes they are lucky they are able to participate. I have to remind myself, their situations are different and even though I might envy them, in their own scenarios are lessons from the Universe in action that may not include a cat. Still working on that one.

There are many early Christmas gifts this situation has brought me.

First of all, I have kitty happily sleeping on the bed today. He doesn't fit into a stocking and probably wouldn't consent to it if he did…but he's here compliments of two of Santa's finest elves…er…angels in elves' clothing, Dr. Oyan and Dr. Paige.

Secondly, my priorities, as healthy as I thought they were, needed some addressing. I have been able to let go of situations that I simply have no time to accommodate. I have more time to myself, since I'm home more, and that has given me quiet time to think about what inCYST will be for all of you in 2011. I hope you like the inspirations you'll see in the next 12 months.

Thirdly, I feel like I have a much better idea of what it is that you all need from inCYST in the first place. I am still at a disadvantage for not having experience every single thing you all have exactly as you have, but I have been humbled, I'm dealing with a challenge, and it cause me to consider every inCYST choice I make in an entirely different fashion. Humility is never a bad thing on which to base intention.

Fourthly, I've learned that it's not always bad if success has to be redefined. Of course I'd love it if there was a cure for cardiomyopathy. But there isn't. I can be angry about it, not follow the vet's instructions because I managed to find an obscure website on the Internet that contradicted them, turn to supplements which would put more control in my hands than his, or do nothing and hope the Calgon cardiomyopathy fairy will just swoop in and whisk us away to Kitty Tahiti.

None of that is going to happen. I got over it, decided to listen to the vet, and to redefine success as staying informed, being proactive and communicative with new information, and to the best of my ability, prioritize my life so that I can enact the recommendations I've been provided with. It's slowly turning things around. Not curing them. But, gratefully, allowing kitty to breathe. Oxygen in heart cells…is a lot more important than a complete and total cure. We have learned to think simply.

Finally, I still don't know what it is like to be infertile, not be able to lose weight, or live with insulin resistance. But at least I am more aware of how important it is to always remember that no matter who are you are, when you look to inCYST for help, guidance, support, inspiration, your story, especially the part we don't know about, or cannot immediately relate to, is important to consider in everything we say and do.

I hope all of you are enjoying your holiday season, whatever customs you practice.

One last thing. To all of my friends who are tired of hearing me talk endlessly about the cat, now that he's stabilizing I can get back to the gym and put the stress there. I appreciate all of your ears and support.

I thought I'd shine a little light on one of the season's antioxidant powerhouses — cranberries. We tend to associate antioxidants with summer foods such as berries, but check out some of the things cranberries can do for you!

--They may keep ulcer-causing bacteria from attaching to the stomach lining.

--They help to prevent cancer

--They help to protect against cardiovascular disease

Cranberries contain the same antioxidant, anthocyanin, as blueberries. What is interesting about cranberries, though, is that they are grown on the water, which helps to increase their anthocyanin content. Antioxidants aren't just created for humans, they're found in plants where they are doing their protective work. You can say that in cranberries, these anthocyanins are working kind of like sunscreen does for us! And they do double duty when you eat them yourself.

Cranberries are most likely to provide the highest benefit when eaten whole (not as a sauce or in a Cape Codder)…so since most of us don't really know what to do with cranberries outside of those two things, I looked up a few cranberry recipes. The salsa recipe comes from http://www.allrecipes.com/, and the rest come from the Cape Cod Cranberry Grower's Association, where you might want to visit for even more ideas.

Here's to red food keeping us healthy!

Cranberry Salsa

1 (12 ounce) bag cranberries, fresh or frozen
1 bunch cilantro, chopped
1 bunch green onions, cut into 3 inch lengths
1 jalapeno pepper, seeded and minced
2 limes, juiced
3/4 cup white sugar
1 pinch salt

Combine cranberries, cilantro, green onions, jalapeno pepper, lime juice, sugar, and salt in the bowl of a food processor fitted with a medium blade. Chop to medium consistency. Refrigerate if not using immediately. Serve at room temperature.

Cranberry Almond Goat Cheese Log

Servings: 2 logs
11oz goat cheese
1 tablespoon orange zest
1/3 cup chopped dried cranberries
1 cup natural sliced almonds — divided

wax paper

Place goat cheese in food processor work bowl.

Pulse several times until cheese is crumbled.

Add orange zest and chopped dried cranberry to crumbled goat cheese. Pulse for 5 seconds, or until cheese mixture will start to form a ball.

Remove cheese mixture from work bowl and separate into two balls. Form each cheese balls into a log shape approximately 2x4 inches each.

Place half of the almonds onto a piece of wax paper. Roll one goat cheese log over almonds, covering the entire surface of the log, gently pressing to assure the almonds stick.

Repeat with the remaining second log and almonds. Wrap the logs individually in plastic wrap and refrigerate for 3 hours before serving. Serve on Baguette Croutes (see recipe below).

Cranberry Almond Goat Cheese Logs will keep in the refrigerator for 1 week.

Bake until just golden, 10-12 minutes.
Transfer to a serving tray and let cool.
Spread Cranberry Almond Goat Cheese Log on Baguette Croutes and serve.

Warm Baby Spinach and Cranberry Salad

6 servings

1 package baby spinach, washed and cleaned thoroughly
½ cup sweetened dried cranberries
¼ cup pine nuts
¼ cup Italian Salad Dressing
2 clove garlic, minced
2 tablespoon olive oil
Place cleaned baby spinach in serving bowl.

Place sauté pan over medium heat. Add oil.

Add pine nuts and sauté quickly until lightly browned.

Add minced garlic and sweetened dried cranberries and stir quickly to coat with oil.

Let simmer for about 30 seconds.

Add Zesty Italian Dressing, stir, remove from heat and pour over baby spinach.

Serve immediately with entrée as a side dish.

Cranberry Couscous

4 servings
2 tablespoons olive oil
¼ cup chopped white onion
1 ½ cups cranberry juice cocktail, heated to a simmer
1 cup couscous
¼ cup chopped pistachios
2 scallions green parts only
½ cup sweetened dried cranberries
salt and pepper (to taste)

In a medium saucepan add olive oil.

Add the white onion, sweetened dried cranberries and pistachios, and saute gently over low heat until onion is translucent and slightly fragrant.

Add the couscous and the warm cranberry juice cocktail.

Stir with a fork to combine, cover.

Let sit for 10 minutes.

Add the scallions. Fluff with fork.

Season, to taste, with salt and pepper. Toss gently to combine.

Turn into serving dish.

Serve hot.
.

I've gotten a couple of questions about fish oil lately that are very common. Thought I'd put them up in a blog post so that anyone who has these questions now has the answers now, and this post is available for future times when the questions are also asked.

1. Isn't fish oil full of mercury and therefore something to avoid?

Actually, fish oil is very heavily processed to removed the mercury. The technique used by most companies is called molecular distillation. Organizations like Consumer Reports routinely do random checks by pulling bottles off of a typical drugstore and testing the purity of the product they find. And, routinely, the findings are that the fish oil products tested are practically always pure. Of course, there's the occasional issue, but when it happens, the brand tends to be publicized and it takes care of the problem.

Brands I know and trust include: Kirkland Costco, Barlean's, Coromega, Omega 3 Brain Booster, Carlson's, and Nordic Naturals. That does not mean these are the only safe brands, these just happen to be the brands with which I am most familiar.

Look at it this way. The liability associated with not being careful to remove fish oil is so great that it would be a foolish business to not go through the trouble of distilling out the mercury.

Bottom line: Fish oil, especially if has been molecularly distilled, is relatively mercury free.

2. Is there an upper limit to fish oil?

The American Heart Association recommends no more than 4 grams of fish oil per day. I am guessing that the reason this upper limit exists is because fish oil can affect clotting time, cardiologists treat clotting disorders, and they want their demographic to be kept safe.

However…a 4 ounce serving of salmon has about 2 grams of omega-3's. I have never heard anyone, ever, suggest that we should restrict our intake of fish! So there is a bit of an inconsistency in how we disseminate this information.

Here is the advice I like to give. If you are concerned about getting too many omega-3's, and/or you have a history of blood clotting problems, it's best to be conservative. Start low and increase your dose as you gauge you are tolerating the omega-3's. If you are on any kind of medication such as coumadin, it's best to do this under the supervision of a physician, as your medication dose may need to be shifted as your body accumulates omega-3's. If you notice that you start to bruise more easily after starting fish oil supplementation, this may be an indication that your clotting time has changed and that you should drop back on your dose until you can meet with your physician.

My personal feeling is that in many cases, adequate omega-3 intake may help reduce the need for the medication, but the ultimate decision in each individual case must be one made between you and your physician.

I recently spoke to a gentleman whose lab has developed a test that can ascertain whether or not you have too many omega-3's in your diet. I am not completely versed on how the test works or what it measures, but if you are interested, you can get more information at www.metametrix.com.

One of the most frequent search terms bringing readers to this blog is"coenzyme Q10". I wrote a research-based post a little while ago exploring its use in addressing infertility.

Recently, my cat was diagnosed with cardiomyopathy and congestive heart failure, and since coenzyme Q10 was the most frequently recommended natural supplement for these conditions, I had the opportunity to look at this compound as a health store shopper might. Here are some basic recommendations for choosing your brand and incorporating it into your program.

Coq10 can interact with many different types of medications, including: chemotherapy agents, statins, blood pressure medications, blood thinners, and beta-blockers. Therefore, it is important if you are on ANY of these medications that you do not use coq10 without first discussing it with your prescribing physician(s).

Most of the coQ10 that you find in supplement forms is manufactured in Japan; it is made by fermenting beets and sugar cane with a special strain of yeast. If you would like to increase your dietary intake of this compound, the best sources are rice bran, soya beans, nuts (notably hazel and pistachio), fish (especially mackerel and sardines), sesame seeds, and certain vegetables (cabbage, spinach, potato, onion, carrot).

Coenzyme Q-10 is available in several forms: powder encased in a capsule, soft gels, and liquid. Each one is fine to use. The coQ10 form known as ubiquinol is apparently the highest quality, most biologically active form.

Because coQ10 is a fat soluble compound, it is best absorbed if taken with a fat-containing food.

As far as dosages go, it's not appropriate for us to make those recommendations here, as each of you has a different clinical situation requiring more personalization than that.

However, if you're interested in using this supplement and have the blessing of your caregivers to do so, hopefully these basic user recommendations will be helpful.

I engaged in a Facebook discussion about grapefruit recently. Ruby Reds are currently cheap at Trader Joe's, a fact which made one friend very happy. One of HER friends cautioned that grapefruits have been associated with breast cancer.

I promised to look into it and blog, which is what you're reading now!

In a survey of 50,000 women, researchers found that grapefruit may increase estrogen levels, a known breast cancer risk. It is thought that this relationship may be related to the fact that grapefruits alter a metabolic pathway involved in estrogen metabolism, called"cytochrome p450".

The cytochrome P450 pathway is also important for the metabolism of many medications commonly used with PCOS. Grapefruit and grapefruit juice may alter the metabolism of this pathway in the following ways:
--may induce excessive sedation with benzodiazepenes
--may induce rhabdomyolysis with statins
--may cause hypotension with calcium antagonists
--may alter electrocardiograms with astemizole, cisapride, pimozide, and terfenadine
--may induce overdose with SSRI medications such as Paxil

Wow…sounds like grapefruit could be the kiss of death, doesn't it? Well, those studies certainly sell newspapers and drive up advertising rates on websites who post them, but that's not the whole story.

First of all…when it comes to your medications, if you eat grapefruit regularly, tell your physician. She can calibrate the dose of the medication to reduce the risk of these side effects. Since grapefruits are a winter fruit, you may need to communicate with your physician to account for seasonal changes in your diet.

With regard to breast cancer, even though a couple of years ago the grapefruit/breast cancer link got lots of press time…a recent study reported no association between the two. None of the studies looked specifically at this issue with PCOS, but I suspect with the already present tendency toward high estrogen, there may be an altered metabolic system that could be grapefruit sensitive…and could be problematic…IF YOUR RELATIONSHIP WITH GRAPEFRUIT IS NOT ONE OF MODERATION.

Where women with PCOS might go wrong is if they cycle in and out of diets with limited variety and which focus on grapefruit…um…THE GRAPEFRUIT DIET. If you have PCOS, you may already have a tendency to be hyperestrogenemic. You may be on at least one of the medications mentioned above. And your relationship with food may be more one of feast/famine than one of moderation and variety.

Also, if you have a family history of breast cancer, eating too much grapefruit, all the time, may not be a good idea. Enjoying a seasonal box of Ruby Reds once a year…probably isn't going to be the worst thing you could do to yourself. Even if you have PCOS.

If you moderate the diet, so that grapefruit is one of many fruits you enjoy, and you practice moderation instead of yo-yo dieting, you should be ok with grapefruit.

And you might even get yourself off of some of the medications that were of concern in the first place.: )

http://www.globalrph.com/gfruit.htm

Monroe KR, Murphy SP, Kolonel LN, Pike MC. Prospective study of grapefruit intake and risk of breast cancer in postmenopausal women: the Multiethnic Cohort Study. Br J Cancer. 2007 Aug 6;97(3):440-5. Epub 2007 Jul 10.

Spencer EA, Key TJ, Appleby PN, van Gils CH, Olsen A, Tjønneland A, Clavel-Chapelon F, Boutron-Ruault MC, Touillaud M, Sánchez MJ, Bingham S, Khaw KT, Slimani N, Kaaks R, Riboli E. Prospective study of the association between grapefruit intake and risk of breast cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC). Cancer Causes Control. 2009 Aug;20(6):803-9. Epub 2009 Feb 18.

It's not uncommon to read blog posts, tweets, and chat room conversations in which women with PCOS describe their depression, and attribute it to the weight gain and appearance that their PCOS has promoted. It can be easy to blame the discomfort, fatigue, restless, and anxiety that depression provokes, on tangible and unwanted physical changes

A recent study helps to verify what I've believed all along…that depression, like hirsutism, weight gain, and infertility, is another condition that PCOS has potential to create. It is not the result of other symptoms associated with PCOS.

Here's the study.

Thirty women with PCOS and thirty women without PCOS participated in this study. All subjects had similar BMI's/weights. Only women who were not on any psychotropic medication were included. Women with PCOS scored higher on an anxiety scale than women without PCOS. They also slept less, worried more, and experienced more phobias than women without PCOS. Weight was not associated with any of the symptoms, except for sleep.

In other words, regardless of your weight, you can be depressed if you have PCOS.

If you attach or blame your depression on your weight, your appearance, or your infertility:

--you can set yourself up for an eating disorder…if you actually lose weight and discover it didn't change how you feel.
--you can feel even worse if you spend time and money on cosmetic surgery, only to realize you don't feel as good as you hoped you would.
--you can put yourself through the tremendous stress of infertility treatment, and get the baby, only to discover that you still feel depressed, and now you've got a baby who isn't sleeping through the night who is dependent on you.

That's the bad news. The good news is that the inCYST program is very helpful at reducing anxiety and depression. So in addition to helping you normalize your weight, reducing the progression of testosterone-related programs, and increasing your fertility, it helps you to feel better. It literally rebuilds your nervous system so it can reduce the influence depression can have. And in rebuilding the nervous system, it helps to balance hormones so that symptoms can lessen.

We like to focus on feeling better, since we know that in women who do, the other problems tend to fall into place. That's not to say that being anxious about your PCOS doesn't worsen when you focus on your symptoms, and that when you learn better coping skills you won't feel even better. Gretchen Kubacky has done a great job of discussing that here, on her blog, and on PCOS Challenge.

It's just that you want to be sure you're tackling the core cause of the problem, and not simply putting band-aids on the symptoms. Nothing can be more frustrating than investing all your time, resources, and money into diets and medical procedures, only to feel the same or even worse once you've done so.

Anxiety and depression symptoms in women with polycystic ovary syndrome compared with controls matched for body mass index

REFERENCE
E. Jedel1, M. Waern2, D. Gustafson2,3, M. Landén4, E. Eriksson5, G. Holm6, L. Nilsson7, A.-K. Lind7, P.O. Janson7 and E. Stener-Victorin8,9 Anxiety and depression symptoms in women with polycystic ovary syndrome compared with controls matched for body mass index

1 Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden 2 Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 3 Rush University Medical Center, Chicago, IL, USA 4 Department of Clinical Neuroscience, Section of Psychiatry, Karolinska Institutet, Stockholm, Sweden 5 Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 6 Department of Metabolism and Cardiovascular Disease, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 7 Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 8 Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 434, 40530 Gothenburg, Sweden

Blood platelets are blood components that are important for blood clotting function. Platelet levels are very important to balance--if you don't have enough, you will have a difficult time stopping bleed from a cut or scrape. Too many, and you may have trouble with blood clots, which can block blood flow. Depending on where these blockages are, they can cause heart attacks, strokes, and thromboembolism.

Inflammatory diseases like PCOS are associated with changes in platelet function. In fact, women with PCOS do have problems with"sticky blood"--that is, blood that forms clots too easily. This aspect of PCOS is not weight dependent--you can have the same problem if you are lean as a woman who has weight to lose. Some of the changes in your clotting function are a function of the disease and likely would exist without any medical intervention. Other changes may be due to medications you are being prescribed. Birth control pills promote platelet activity, while metformin, decreases it.

Did you know that the same lifestyle choices inCYST promotes for weight loss, better fertility, healthier skin, and every other aspect of PCOS, is also good for healthier platelets?

1. Omega-3 fatty acids promote healthy blood clotting function. They also help to promote better melatonin balance. Melatonin is an important compound to platelets; it helps them to be less"sticky".

2. Physical activity improves circulation. Blood that is not moving is blood that has a tendency to coagulate. The more physically active you are, the less opportunity you have for platelets to collect and decide they should stick together.

3. As I just mentioned, melatonin is important to platelet function. If you're prioritizing sleep, you're giving melatonin a chance to do its job. Deprive yourself, and you give platelets the go-ahead to congregate. Melatonin is so important for platelet function, some researchers believe it may be a therapeutic supplement in people with heart disease, with similar functions to aspirin and Plavix. Who knew, a little bit of extra shut eye might be equally as powerful?*

*Any medication you have been prescribed for the purpose of altering how your blood flows and clots should not be discontinued without the consent of the physician who prescribed it. This could be a deadly choice. For anyone who is interested, I do have research I found describing some of the benefits of melatonin supplementation in heart disease. I'm happy to share it. Please share with your physician and discuss before making any changes.

If you're on any medication for blood thinning or platelet management, consider making some simple changes in your overall lifestyle that may have far-reaching benefit.

Luque-Ramírez M, Mendieta-Azcona C, del Rey Sánchez JM, Matíes M, Escobar-Morreale HF. Effects of an antiandrogenic oral contraceptive pill compared with metformin on blood coagulation tests and endothelial function in women with the polycystic ovary syndrome: influence of obesity and smoking. Eur J Endocrinol. 2009 Mar;160(3):469-80. Epub 2009 Jan 12.

Dereli D, Ozgen G, Buyukkececi F, Guney E, Yilmaz C. Platelet dysfunction in lean women with polycystic ovary syndrome and association with insulin sensitivity. J Clin Endocrinol Metab. 2003 May;88(5):2263-8.
Rajendran S, Willoughby SR, Chan WP, Liberts EA, Heresztyn T, Saha M, Marber MS, Norman RJ, Horowitz JD. Polycystic ovary syndrome is associated with severe platelet and endothelial dysfunction in both obese and lean subjects. Atherosclerosis. 2009 Jun;204(2):509-14. Epub 2008 Sep 17.

Amowitz LL, Sobel BE. Cardiovascular consequences of polycystic ovary syndrome. Endocrinol Metab Clin North Am. 1999 Jun;28(2):439-58, viii.

Kebapcilar L, Taner CE, Kebapcilar AG, Sari I. High mean platelet volume, low-grade systemic coagulation and fibrinolytic activation are associated with androgen and insulin levels in polycystic ovary syndrome. Arch Gynecol Obstet. 2009 Aug;280(2):187-93. Epub 2008 Dec 24.

Knowing that PCOS often goes unrecognized, and that PCOS research often overlooks some of the most important issues cysters deal with, I'm trying to bring research to this blog you may not find if you're using"PCOS" as your search term but which may be entirely pertinent. In this case, I want to talk about antidepressants, which are very commonly prescribed in PCOS, whether it's officially diagnosed or unrecognized.

This study was conducted because of the number of women who use antidepressants. That increases the possibility that a woman may, intentionally or not, become pregnant while taking antidepressant medications. The researchers wanted to know if fetal exposure to antidepressants may influence brain and nervous system development. This particular study was done with mice, but it was previously determined that mice and humans demonstrate similar mother-fetal transfer with the medications being evaluated.

Fluvoxamine (Luvox) had a lower rate of transfer than did fluoxetine (Prozac). More offspring died in the group using fluoxetine, and most of these deaths were due to heart failure related to cardiac defects. The researchers reported no deaths related to fluvoxamine.

In addition, the part of the brain that distributes serotonin to the rest of the brain, the raphe nucleus, did not function properly in the brains of rat pups whose mothers had been exposed to fluoxetine. Behaviorally, these rats exhibited more anxiety- and depression-related behaviors as adults than rats who had not been exposed.

So it seems that babies of moms who have depression may be set up to have the same problems when they become adults. Some of that may be genetic, but some of it may be perpetuated by the way the mother's biochemistry is treated by her caregivers.

Bottom line, if you're using antidepressants, even if you're NOT trying to become pregnant but you MIGHT become pregnant because you're sexually active, you may want to be sure that you discuss this with your physician and determine which treatment option is most appropriate.

Don't forget diet and fish oil--they can eliminate the need in many cases to even have to make this kind of decision!

Noorlander CW, Ververs FF, Nikkels PG, van Echteld CJ, Visser GH, Smidt MP. Modulation of serotonin transporter function during fetal development causes dilated heart cardiomyopathy and lifelong behavioral abnormalities. PLoS ONE. 2008 Jul 23;3(7):e2782.

I have heard from friends who were at the recent American Dietetic Association Food and Nutrition Conference and Exposition in Boston, that a panel of four experts on fats, asserted that omega-6 fatty acids are not pro-inflammatory. This is in contradiction to what you will see on this blog and what we teach, so I wanted to address it.

My primary source of information regarding fats is the International Association for the Study of Fatty Acids and Lipids (ISSFAL). This organization is not sponsored by any commodities organizations with anything to gain or lose from the outcome of good, hard, science.

The American Dietetic Association, on the other hand, is heavily sponsored by commodities and food manufacturers. I actually went to a meeting sponsored by one of their special practice groups a few years ago, the major sponsor of which was Frito-Lay. Over the weekend, Twitter was a-flutter with dietitians aglow from the SWAG they were filling their suitcases with. So much so, that at one point I tweeted back, that for that meeting,"stuff we all get" should be called"food we all get".

This is an association that has backed itself into a huge corner with regards to the money it receives in order to pay its bills. Look hard, and you will find Pepsi, Coca-Cola, Hershey's…for starters. (Actually you don't have to look hard at all…they seem to be proud of these associations.) So you have to understand that if you attend their conferences, you're most likely to get information that is nice, and promotes the sale of the trade show floor of products simultaneously being exhibited in hopes of gaining"official" endorsement. ADA is not going to hurt its sponsors.

Look outside of the ADA and this is what you will see. The relationship between omega-6 fatty acid intake and inflammation is so strong, that Wake Forest University and Harvard University have teamed up to open up a Center for Botanical Lipids and Inflammatory Disease Prevention. Would they do that if they believed they'd be sending renowned scientists on a wild goose chase? I don't think so.

I have posted their mission statement, right off of their website, below.

I ask you to consider, why it is, that there is an international association devoted to research about omega-6's, omega-3's, and inflammation, and a center devoted to the study of these fats, both committed to studying fat, that says that omega-6's are inflammatory, while dietitians are hearing at their meeting that this isn't so? Apparently a little bit of FWAG buys you a whole lot of loyalty.

It doesn't seem to matter what the scientists are saying as long as product gets pushed on the front lines.

Research indicates poor diets, including high concentrations of saturated and omega-6 (ω6) polyunsaturated fatty acids (PUFAs) but lacking omega-3 (ω3) PUFAs, can initiate and exacerbate underlying inflammation associated with cardiovascular disease (heart disease and stroke), metabolic syndrome, diabetes and asthma. Overwhelming evidence demonstrates that ω3 PUFAs naturally found in fatty fish and fish oil reduce cardiovascular diseases; however, US consumption of fish oils is low due to the taste, smell, and fear of contaminants. This proposal postulates that botanical-based oil supplements offer a potential solution to several of these challenging problems. The Wake Forest Center for Botanical Lipids and Inflammatory Disease Prevention brings together investigators from four internationally-recognized lipid groups and a world-renowned human genomics center to examine the cellular and molecular mechanisms and clinical potential of botanical fatty acids currently available as dietary supplements with a focus on enhancing wellness and preventing disease. Center projects will examine the health effects of adding medium chain botanical fatty acids that bypass the rate limiting Δ6-desaturase step of PUFA biosynthesis in humans. A central hypothesis of this proposal is that this approach markedly enhances conversion of botanical PUFAs to long chain beneficial PUFAs. Projects 1 and 3 examine the mechanisms behind the pleiotropic effects of botanical PUFAs with regard to macrophage/monocyte activation, inflammatory states and eicosanoid generation related to atherosclerosis and asthmatic inflammation, respectively. Project 2 examines differences in PUFA biosynthesis between African Americans and age- and sex- matched Caucasians within both healthy and metabolic syndrome populations to better understand who may be most responsive to fatty acid-based botanical supplements. These interactive and synergistic studies have a strong, contemporary and translational scientific basis and should allow this team of scientist to identify additional targets of prevention and therapy, and permit further refinement of dietary supplementation to maximize its effects on human wellness.

Numerous lines of scientific evidence indicate that poor diets including the ingestion of unhealthy concentrations and ratios of short, medium and long chain polyunsaturated fatty acids (PUFAs) have played a key role in the initiation and exacerbation of chronic inflammatory diseases including cardiovascular disease (heart disease and stroke), metabolic syndrome, diabetes and asthma over the past 40 years. The central objective of The Wake Forest Center for Botanical Lipids and Inflammatory Disease Prevention is to test several key hypotheses thatwill fill significant knowledge gaps regarding how fatty acid-based botanical supplements or supplement combinations work to prevent human disease. This information can then be employed to determine the best use and refinement of supplements to maximize their effectiveness for human wellness.

Click here for the top ten list of superfoods! Eat these foods and live 10 years longer!

The world has gone koo-koo for antioxidants!

I've been encouraging readers to increase their antioxidant intake, too…but did you know too many antioxidants can be a bad thing?

If you've been reading up on antioxidants, the word polyphenols may sound familiar. They are a category of antioxidants that are believed to reduce the risk of cardiovascular disease and cancer. Foods high in polyphenol content routinely show up on"superfood" lists and include: tea, wine, berries, beer, grapes, olive oil, chocolate, walnuts, peanuts, and pomegranates.

Before antioxidants were trendy, they were known as tannins. In some circles, tannins were even called"anti-nutrients". They may make protein difficult to digest and absorb, and they can bind and reduce the absorption of non-heme iron, a primary source of iron for vegetarians. If you're juicing and emphasizing any of the above foods, you may also be at risk for issues with protein and iron.

I'm not sure if the the term"polyphenol" has come into vogue to increase the marketability of a compound formerly associated with nutritional problems, or if we simply have learned more about their benefits over time. The important thing is, as with every food you can choose to include in your day, balance, moderation, and respectful use are all key if you truly want to capitalize on their nutritional gifts.

Here are some simple things you can do that can allow you to capitalize on the benefits of polyphenols while minimizing the problems they pose.

1. Avoid falling into the"top ten" trap and eat a wide variety of foods. Mix things up! I like to throw a shot of pomegranate juice into my carrot juice.

2. Be sure your daily diet is adequate in vitamin C, which can help to increase iron absorption. Vitamin C sources lower in tannins include: guava, parsley, broccoli, lychee, persimmon, papaya, canteloupe, and garlic.

3. If you drink orange juice, go for the all-natural kind. Commercial brands often ADD tannins in order to increase the"pucker factor" consumers associate with their product.

4. Enjoy coffee and tea in moderation. Even the"healthy" green kind.

And remember…variety…variety…variety!

I don't like avocado. I grew up with avocado trees in my own yard and all my neighbors' yards, and never, ever, ever (did I mention EVER?) could I stand the taste of avocado, no matter how it was presented to me. I figured, I probably wasn't missing out on anything anyway. Even at Mexican restaurants, while everyone dug into the guacamole with gusto, I enjoyed the salsa on my chips just fine without the green stuff.

Imagine my surprise, when I started learning about good nutrition and healthy cooking and discovered I was in fact missing out. I learned that avocados are high in monounsaturated fat, which is said to help lower cholesterol, or keep it low. They're also a great source of potassium, fiber, folate — all good for your cardiovascular health!

So here I was, wondering if I'd ever find a recipe using avocados that would actually make this fruit palatable to me (yes, it's a fruit!). I wasn't necessarily going out of my way to find a recipe, but serendipitously, as I clicked through various websites, I came across this recipe for a chocolate avocado cake on Joy the Baker's blog, and the curiosity of baking with this healthier fat source instead of butter was too strong to resist. Plus, I love chocolate.

Monika Woolsey and I have been talking about this cake — and about baking with avocado in general — for weeks now. Today was the day. I didn't follow the recipe to the letter, because I didn't have enough powdered sugar, but really, it could use a little less anyway! Also, I used macadamia nut oil instead of whatever the recipe called for.

The outcome was REALLY surprising, in a good way! The cake itself is moist, but not greasy, definitely chocolatey, without even a hint of avocado. Instead it has a hint of macadamia nut! YUM!

The frosting is another story. I couldn't leave it green, the way it is in the original recipe — 3 avocados and powdered sugar = green frosting. It looked like the slime from Nickelodeon and the sight of it turned my stomach. So I added 3 tbsp cocoa powder, crossed my fingers and turned on the mixer one more time. The result: chocolate frosting. Unfortunately, the frosting doesn't taste as good on its own as the cake does, so I wasn't wild about licking the spatula.

The combination of the two, however, was very good! I will definitely play with this recipe a little more and maybe even make some cupcakes or a batch of brownies like this!

And yes, there are still several cups of sugar and 3 cups of flour, so it's not a miracle food that's great for your health. However, it could work with a little less sugar, and all the good stuff from the avocado bring it up a notch or two in the"good for you" department.

By the way, if you'd like to learn a little more about the avocado, check out the World's Healthiest Foods website — it's a great resource!

Here's the recipe, I'll note my deviations in parentheses…

Chocolate Avocado Cake, with Avocado Frosting

• 3 cups all-purpose flour


• 6 Tablespoons unsweetened cocoa powder


• 1/2 teaspoon salt


• 2 teaspoons baking powder


• 2 teaspoons baking soda


• 2 cups granulated sugar


• 1/4 cup vegetable oil (I used macadamia nut oil)


• 1/2 cup soft avocado, well mashed, about 1 medium avocado (I ended up needing two since the ones I had were so small)


• 2 cups water


• 2 Tablespoons white vinegar


• 2 teaspoons vanilla extract

2. Sift together all of the dry ingredients except the sugar. Set that aside too.

3. Mix all the wet ingredients together in a bowl, including the super mashed avocado.

4. Add sugar into the wet mix and stir.

5. Mix the wet with the dry all at once, and beat with a whisk (by hand) until smooth.

6. Pour batter into a greased cake tins. Bake for 30 to 40 minutes, until a toothpick inserted comes out clean.

7. Let cakes cool in pan for 15 minutes, then turn out onto cooling racks to cool completely before frosting.

Avocado Buttercream Frosting from Alton Brown
(honestly, it's FAR from resembling buttercream!)

• 8 ounces of avocado meat, about 2 small to medium, very ripe avocados (I used 3 small avocados, which only yielded 6.5 oz)


• 2 teaspoons lemon juice (I didn't have lemon juice so I used lime juice)


• 1 pound powdered sugar, sifted (I only had 1/2 pound of powdered sugar, so that's what I used, 8oz)


• 1/2 teaspoon vanilla extract

1. Peel and pit the soft avocados. It’s important to use the ripest avocados you can get your hands on. If the avocados have brown spots in the meat, avoid those spots when you scoop the meat into the bowl.

2. Place the avocado meat into the bowl of a stand mixer fit with the whisk attachment. Add lemon juice and whisk the avocado on medium speed, until slightly lightened in color and smooth, about 2-3 minutes.

3. Add the powdered sugar a little at a time and beat. Add vanilla extract until combined. If not using right away, store in the refrigerator. Don’t worry. It won’t turn brown!

***NOTE: The stand mixer didn't do a good enough job of making this even remotely close to frosting-like, so I took out my handy immersion blender and went to town on it. The result was a really smooth and shiny frosting with no visible bits and pieces of avocado!

Hello everyone,

I had a wonderful time in Michigan getting to know some new inCYSTERs in our training. I wanted to highlight them in this post, plus mention some new names you will be seeing more often here on the blog.

JACKIE SMIERTKA is a nurse who specializes in bariatric medicine. She has worked in that field for many, many years, and she recognized that PCOS was coming through her door. She was my initial Detroit contact, and she hosted my training. She is passionate, not to mention compassionate. She owns the Quality of Life Center, a one-stop center for people who have needs associated with their bariatric surgery. That center now has the ability to help women with PCOS who are either contemplating such a surgery or who have had one and would like to work with someone who understands PCOS.

SALLY MYERS is the dietitian who introduced me to Jackie! She is currently in Herndon, Virginia, she is well known as a bariatric nutrition specialist, and I am really excited to have her in the network as a resource on nutrition for bariatric surgery when PCOS is an associated condition. Sally is also a competetive racewalker! I enjoyed learning more about that sport during our lunch breaks.

TERRIE HOLIEWINSKI is a dietitian at the University of Michigan at Ann Arbor, who specializes in working with cardiovascular issues and PCOS. She is passionate about this work, and loves working with PCOS!

IVONNE BERKOWITZ officially finished her inCYST training this past Sunday. She is a certified wellness coach and she loves to write. I hope you enjoyed her post on labels, her style is very"tell it exactly like it is without pulling punches," and she's got some great ideas that can help you with the practical application of what you see on the blog.
I am adding links and contact information as I have them…please seek these professionals out if they are in your area! The amount of work they have put into learning about PCOS and their passion for wanting to help is a fabulous combination just waiting for you to take advantage of!