The Hemp Connection:
cholesterol

First of all…it's great to be back! I was traveling, and while it's kind of fun to say I saw both the Atlantic and Pacific oceans in the period of a week, I do like my base camp and I really missed reading research. I'm looking forward to getting back into my daily groove.

Last week, I read an article in the New York Times about insurance companies, and how they are starting to ask consumers to absorb the cost of medications by asking that these medications be paid for not by flat copayment, but proportionate to the cost of the medication.

Nice. First we're convinced that we absolutely need all these drugs, and that we can get them for cheap, then once we're dependent on them…we're thrown under the financial bus.

Right now, the medications that are being sold under this new proportionate plan are not any of the medications that I focus on with this blog. However…since several of the medications you readers are on, are some of the most popular medications out there, I suspect it won't be long before these insurance companies start to see dollar signs in terms of the quantity of people they can expect to help finance this venture. Categories of medications like antidepressants…and insulin sensitizers and statins, which are commonly prescribed when the antidepressants start to mess with hormone balance.

That's the bad news.

The GOOD news is, I finally felt vindicated for having sat through this scenario for the last 25 years, wishing people would see what I have always seen…that when you take responsibility for your own health, and don't depend on people who make money off of you to help you, you have a good chance of getting better results. Think about it. Why would a drug company spend millions and millions of dollars to develop a product that you eventually wouldn't need once you started using it?

My goal, ever since I started what I do, is to put myself out of business. I started learning to play golf last year and it has been very frustrating to have to put it aside to attend to the demands of my growing business. I have a children's story I'd like to publish. And there are a couple of screenplays roaming around in my head that I'd love to get into theaters.

But the drug and insurance industries don't have that goal. Their goal, as is the goal of most corporations, is to increase market share and return on investment. Which means you can (1) increase the dosages of medications you sell to already existing customers, (2) find new customers for your medications by either creating new diagnoses or finding off-label uses for your already developed products, and/or (3) increase the price you charge for the product. Hmmmmm…nowhere in there do I see"helping the patient feel better".

Of course, I'm not naive. I know some medications are entirely necessary and even life-saving. But I also see so many conditions that could drastically improve with a few judicious lifestyle choices.

Last week I listened to the husband of a friend tell me what it was like to go through an in-vitro fertilization (IVF) procedure with his wife. He was near tears as he spoke about the trauma, the callousness of the providers, the emotional stress…the expense, and the feeling of failure as a human being when the entire investment of time, emotions and money did not produce the desired result.

He drove me to the bus stop, and I headed to the airport. As I was standing in line to board my plane, a colleague phoned me. She'd gone through my professional training and had been using my protocol on women with infertility. And she told me, that with just a few nutritional tweaks, these women were getting pregnant! Not only that, their depression was responding with equal profundity. Even the women who'd failed with the same IVF procedure as my other friend and who had given up on ever having children, were seeing results.

There's something very wrong with a system that promotes a $20,000 emotional and financial (mis)adventure over a $12 bottle of Coscto fish oil…but we as consumers need to shift our expectations for help from those who stand to make money off of our misfortunes and invest in choices, behaviors, and financial purchases that are empowering and affirming. You'll never get a company making money off of you to change how they do things if it means less money. But we can certainly get their attention if, collectively, we start to say"no" to some of their answers to our problems and"yes" to options that make more sense.

You bet the power of where you pull out your wallet is tremendous. And when groups of thousands of wallets get together…well, that's the vision I have that will finally get these screenplays out of my head!

Eating well. Physical activity. Adequate sleep. Less stress. It's that simple. It's incredible what prioritizing these four areas can do to your overall health. Not to mention your budget.

http://www.nytimes.com/2008/04/15/opinion/15tues1.html?hp

Not long ago I created a webinar about bioidentical hormone replacement therapy. I found a great graphic that explains something most people have not considered when it comes to reproductive hormone health. Many of the hormones that we need for proper function of our reproductive systems (whether we're trying to conceive or slow down aging), are made out of cholesterol. Just look at this picture below!

As you can see, we need a decent supply of cholesterol in the body in order to even make progesterone and estrogen! However, we've become very obsessed with the idea that cholesterol is a"bad" thing. So much so that in 2001 the National Cholesterol Education Program lowered the level of ideal cholesterol so much that the number of people who ideally should be on cholesterol-lowering medications…tripled.
This may be more pertinent to women with PCOS, approaching menopause, who are more likely to be placed on statin medications than younger women who are trying to conceive.
However, I just wonder, a lot, if it's not really a coincidence that as we focus on cholesterol and getting it out of our bodies, we also seem to be developing more problems related to hormone imbalances…infertility, early menopause, even Alzheimer's, which is starting to be recognized as a consequence of insulin resistance, which is associated with PCOS.
Bottom line: Eat well, and be careful of obnoxiously high cholesterol levels, but try to avoid an obsession with a"lower is better" mentality. Cholesterol is an essential compound, and not to be feared.

At the same time I have been encouraging all of you to eat more protein, I have been working with a vegan protein source that grows right here in my backyard that could be part of your own plan to get more. That source is tepary beans. This bean is native to Arizona and has been cultured by our local natives for thousands of years. It thrives here in the desert because of its heat and drought tolerance. So much so that it is now being introduced to drought-ridden parts of Africa plagued with famine.

My favorite tepary fun fact is the origin of its name. It is the English spelling for the native"t'pawi", literally meaning,"it's a bean". So I am guessing some Spaniard cruising through Arizona a few hundred years ago stopped, looked and pointed at a plant, and got that response. (Kinda makes me think though, as silly a question as it must have sounded to the natives, if it really translates into,"well, duh…it's a bean!")

Back to hard science.

Tepary beans have been tested in the lab and have been found, when eaten in conjunction with exercise, to improve insulin resistance, lower blood lipids, and help with weight loss. Not bad for a humble little legume that, when it has its way, happily hides out in remote desert washes! It's actually thought that one of the reasons the rate of diabetes has soared so much in Native Americans is because they have strayed away from eating natives foods like the tepary.

They contain 24 grams of protein per 100 grams in their dry state, which is slightly higher than black beans. Which is why they are being profiled on Fitness Friday today!

We recently started sharing tepary beans in our share boxes at Chow Locally, and our customers have been making everything with them from veggie burgers to hummous. They have a slightly nutty flavor which people seem to like. Now that I've seen a group of people try them and enjoy them, I wanted to share them with you!



Add caption  We get our beans from Ramona Farms on the Gila River Indian Reservation, just south of Phoenix. Ramona Farms recently showcased their tepary beans at Natural Products West in Anaheim, and got a lot of attention from high-end chefs and natural foods experts looking for the next best super food. This is me with Ramona and Leslie, two members of the Akimel O'odham tribe. They're super nice and they want you to try their beans…me too!

Ramona Farms is in the process of setting up a web store; in the meantime you can order their beans by phone.
Give them a try and let me know what you think!

The day after the FDA warning about pistachio nuts came out, I was in a local grocery store. As I walked through the produce aisle, I noticed the produce manager and his clerk with a huge bin; they were emptying out their inventory of pistachio nuts into a huge garbage bin. They had no idea where their pistachios had come from, and they had to throw them away.

I felt sad that so much food had to be wasted.

The day that the FDA warning about pistachio nuts came out, I received a note from Whole Foods Market. They were working to source where all their pistachio nuts came from. A detailed memo was released later in the week regarding the safety of pistachios in their many stores.

Please read this blog post and make your own decisions. But do consider the value in being an informed consumer. If you are judicious about where you shop, it may be worth a little extra investment. If you make a choice to purchase locally grown products at your farmer's market, you're not only supporting a local small business, you know exactly what hands your food passed through before it fell into yours.

There will come a time when pistachios will be considered generally healthy to eat, no matter what the source. And when that comes, keep these pistachio fun facts in mind:

--a one ounce serving of pistachio nuts scores higher on the USDA's antioxidant scorecard than a cup of green tea.
--pistachio nuts can help to reduce bad cholesterol and raise good cholesterol
--pistachio nuts are high in lutein and can help prevent macular degeneration, a leading cause of blindness
--pistachio nuts are a good source of many vitamins and minerals, including: thiamin, vitamin B6, copper, manganese, potassium, dietary fiber, phosphorus and magnesium
--pistachio nuts are a good source of healthy fats, including omega-3's

My point is…I hope you don't eliminate pistachios completely from your diet because of what you've heard in the news. The pistachio recall was specifically for pistachios from Setton Farms. If you can shop at a store or farmer's market where you can be assured pistachios did not pass through this processing plant, they can be a wonderful addition to your PCOS eating plan.

Here's a recipe for white bean pistachio chili to get you started!

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!

I have heard the following recommendations made by the American Heart Association repeatedly for years now. And I hear them parroted everywhere by well-intended medical experts who, it seems, did not stop to check the math on which the recommendations are based:

Population Recommendation
Patients without documented coronary heart disease (CHD)
Eat a variety of (preferably fatty) fish at least twice a week.
Include oils and foods rich in alpha-linolenic acid (flaxseed, canola
and soybean oils; flaxseed and walnuts).

Patients with documented CHD Consume about 1 g of EPA+DHA per day,
preferably from fatty fish. EPA+DHA in capsule form could be
considered in consultation with the physician.

Patients who need to lower triglycerides 2 to 4 grams of EPA+DHA per
day provided as capsules under a physician's care.

Patients taking more than 3 grams of omega-3 fatty acids from
capsules should do so only under a physician's care. High intakes
could cause excessive bleeding in some people.

Evidence from prospective secondary prevention studies suggests that
taking EPA+DHA ranging from 0.5 to 1.8 grams per day (either as fatty
fish or supplements) significantly reduces deaths from heart disease
and all causes. For alpha-linolenic acid, a total intake of 1.5–3
grams per day seems beneficial.

I couldn't sit back anymore. Ellen Reiss Goldfarb, RD, a member of this blog's inCYST Network for Women With PCOS collaborated with me on hopefully setting the record straight. We hope it helps, especially to get a mathematically-correct set of recommendations out to the public so they can go grocery shopping with a better sense of empowerment.

Regarding the omega-3 recommendations recently discussed, you all may want to consider that there are several contradictions within that make it very difficult (maybe even impossible) for the average American to follow them. As dietitians, it is important that we understand this math so that we help, not confuse or hurt, people who look to us for advice.

First of all, we are telling people that they are not to eat more than 3 grams of omega-3's per day unless they are under a physician's care. However, if you try to get 1.8 mg of combined EPA + DHA combined, in the form of food first, 3 ounces of Alaskan salmon, which contains 384 mg of EPA plus DHA, would have to be eaten in a DAILY QUANTITY OF 14 ounces in order to get there. Are you really saying that if you're eating enough fish to get the amount of omega-3's we recommend, that the MD has to manage it??? You are unnecessarily putting yourself out of business if you are!!!

Secondly, given those numbers for salmon, the densest seafood source of omega-3's, there is no way eating fish just a few times a week is going to get you to the level of omega-3 intake these recommendations are making. It is so frustrating watching colleagues parrot these recommendations and wondering if we're the only ones who've actually sat down and done this math.

We also went to three popular fish oil brands and calculated out how many pills you would need to get the upper level of DHA + EPA recommended. Two of those, Nordic Naturals and Carlson's, if taken at the level needed to get there, would also place your client at levels you say a physician needs to manage.

Realistically and honestly, how many of you are really doing that?

With regards to bleeding, in all of our collective years actively recommending fish oil, only one client encountered a bleeding problem. The people at greatest risk for that are people who are on medications such as coumadin…and if you work closely with a physician who"gets it"--the dose of that medication can be dropped as EPA levels rise and help normalize blood clotting function. Always start low, titrate up, look closely for symptoms in people not on contraindicated medicatoins and let the MD check blood levels in people who are…and work very hard to minimize omega-6 intake. You'll get a lot more bang out of your omega-3 buck if you focus on the omega 6 to omega 3 ratio than if you only think about one.

If you don't know how to use omega-3's to promote health, you may actually CREATE health risks for your clients, which I don't think any of you want to do.

Here are the numbers from our calculations for your reference.

EPA + DHA, total mg
3 ounces salmon 384 mg
Nordic Naturals 550 mg
Carlson's 500 mg
Barlean's 600 mg

Total omega-3 content
3 ounces salmon 3250 mg
Nordic Naturals 690 mg
Carlson's 600 mg
Barlean's 780 mg

Amount needed to meet n-3's needed to meet upper DHA + EPA recommendation/total omega-3 content of that amount
3 ounces salmon 14 oz DAILY/15.2 total gms n-3
Nordic Naturals 3.27 capsules/3.6 gm total n-3
Carlson's 3.6 capsules/6.0 gm total n-3
Barlean's 3.0 capsules/2.3 gm total n-3

Monika M. Woolsey, MS, RD
Ellen Reiss Goldfarb, RD

A study was recently released suggesting that dark chocolate can help to reduce cholesterol in diabetics! Whoo hoo! Here's the article summarizing some of the benefits of chocolate.

http://www.drcutler.com/cholesterol/dark-chocolate-may-help-lower-cholesterol-in-diabetics-800137266/

Note in the article, however, researchers are still weighing the evidence about whether or not the fat and sugar in chocolate the way we like to eat it outweighs some of these benefits.

You can't binge on it or replace other foods with it…chocolate should be a component of a healthy, balanced diet.

Here are my five favorite ways to include chocolate in ways that reduce the downsides.

1. Used in mole sauce. Mole sauce is a complex Mexican delicacy made from a combination of cocoa and other spices such as cinnamon. It's not something you'll find in your average Tex-Mex restaurant, but look for it in more upscale venues like our own local (James Beard nominated) Barrio Cafe, often with chicken or turkey.

2. In hot chocolate. Cocoa powder (undutched) in lowfat milk is always a great bedtime treat! I kind of like the Abuelita brand Mexican hot chocolate because it too has the cinnamon touch.

3. In chocolate milk. Remember, women who have one fat-containing source of dairy per day are more fertile than women who do not. Chocolate milk is a double whammy of goodness!

4. As cacao nibs, in your morning oatmeal. Cacao nibs are the dried cacao seed, from which chocolate is derived. You can buy them in stores like Whole Foods and they're a great way to flavor your breakfast.

5. As cacao nibs, in your afternoon trail mix. Frequent a store with bulk food bins and create your own concoction of cacao, healthy nuts, a little bit of dried fruit…and voila! You've got something to nibble on when the afternoon munchies hit.

Chocolate galore…and no candy bar in sight. Enjoy!

I finished up my nutrition education during the height of cholesterol phobia/low fat mania. The message we were taught to teach about egg yolks dies hard.

Several years ago colleague Susan Kleiner, Ph.D., R.D., shared in a presentation I attended, that there really isn't hard research that shows, without a doubt, that eating egg yolks increases cholesterol. Neither is there really evidence to show that removing egg yolks from your diet reduces cholesterol. Other dietary choices, such as the ones we teach on this blog, are far more effective at normalizing your blood lipid tests.

Eggs are such a cheap, easy source of protein. Scrambling them with vegetables is my favorite way to clean out my vegetable bin.

If you're trying to increase and maintain your vitamin D levels, keep in mind that it is found in egg yolks. And the levels of vitamin D in egg yolks, according to the US Agricultural Research Service, is higher than thought. Each large standard egg contains 41 IU.

If you're still not convinced and questioning, consider that this same analysis showed that the amount of cholesterol in eggs is 14% lower than previously reported, 185 milligrams per egg.

Egg yolks also contain choline, the precursor for acetylcholine, the neurotransmitter involved in memory. It's not easy to find in food…if brain fog and memory are problems your PCOS has brought you, perhaps rethinking your relationship with egg yolks could be helpful.

I'm not sure what the change is, perhaps farmers have been changing the composition of poultry feed in response to the dietary concerns of their customers.

Whatever it is, I'm hoping the new results in a few more egg yolks showing up on diet diaries I review here in the office!

I've gotten a handful of questions about almonds recently so it seemed like it was time to give them their own personal blog post. It's a good day to talk about the benefits of a handful of almonds, since it's also National Wear Red Day and heart disease is an important risk factor for women with PCOS. They're repeatedly shown to have heart healthy benefits. Eight peer-reviewed studies reported at www.almondsarein.com consistently produced the same results: lower LDL and lower total cholesterol. Other findings included increased HDL, and lower triglycerides.

The disclaimer is that the almonds were used to replace other foods in the diet. In other words, if you know your diet needs some"cleaning up", it won't help to keep eating the problem foods and add the almonds. You need to simultaneously reduce intake of other foods and replace those calories with almonds.

Fortunately, almonds are a tasty snack and can be added to your morning oatmeal, your lunchtime salad, or your favorite muffin recipe. If you'd like to take it one step further and cook more with almonds, the almond people have a great web page with a search engine to give you some ideas.

Anyone living out West has had a week of comfort food weather! Here in Phoenix we had as much rain in a week as we normally get in a year. I haven't felt like venturing out, and I want foods that warm me from the inside out.

And that has had me thinking about leeks.

Leeks are the onion's, unfortunately less popular and often forgotten, cousin. I say that because leeks are milder than onions, with a lot of the same health benefits. Many of those benefits are related to PCOS health risks.

Vegetables in the onion/leek/garlic family help to:
--reduce LDL cholesterol and raise HDL cholesterol
--lower blood pressure
--reduce risk of ovarian cancer
--stabilize blood glucose

Most of you probably think of leeks in leek potato soup…but there are so many more ways to cook them! Here's a great feature from Cooking Light to get you started.

So comfort food and PCOS help, unite!

A few weeks ago I was visiting my parents in Tucson. You could tell the holidays were coming, because the corner lots were all occupied by chili ristra vendors. These chilis, popular in the Southwest, are crafted into artistic wreaths and strands that hang on doors, gates, and walls, everywhere you look. Traditional wisdom says that a house with a ristra hanging out front is a happy household.

I thought this would make a fun food for a holiday greeting, and perhaps if we hung a ristra on this blog, we'd radiate electronic happiness and goodwill.

What is so great about chilis? Well…what isn't?

They are a great anti-inflammatory. Capsaicin, a compound in chilis, has been found to delay the onset of arthritis, and to be therapeutic for diabetic neuropathy. Both of these conditions are more likely to be issues in people prone to inflammatory disorders.

Chilis can reduce cholesterol and heart attack risk. They can reduce the risk of diabetes.

From a practical standpoint, chilis make food interesting. It's easy to eat healthfully if you like what you're eating!

Here is a recipe for Mexican Red Chile Sauce, a staple in New Mexico and excellent on pork…or leftover turkey.

Whether you like Mexican, Szechuan, Indian, or Thai food, don't forget the chilis.

I've been reading a lot about inflammation recently, and thought the next few posts I would focus on foods that can reduce inflammation, which is the driving process behind PCOS. One of the most important nutrients you can get in your diet is magnesium. I thought for the next few weeks I'd highlight a food high in magnesium to help drive home the fact that these foods are crucial for everything from preserving fertility to keeping cholesterol low to protecting your mental health.

Several of my Facebook friends mentioned in their status reports that they were cooking pumpkin seeds from their Halloween pumpkins, so I thought I would take advantage of the fact that this food is a little plentiful in some households, and perhaps I can convince some of you procrastinators to not pitch a wonderful nutrient into the garbage! (Here you see my friend Tracey's daughter Reese creating her own stash.)

One-quarter cup of pumpkins seeds (AKA pepitas) contains almost half of your daily magnesium requirement. That's not shabby. Except…how the heck are you going to include that much on a regular basis? Here are some ideas:

1. Make your own trail mix for snacks and include them.
2. Sprinkle them on a sandwich.
3. Sprinkle them on salads.
4. If you're ever breading meat, grind some and add them to the flour.
5. Add them to your baking.
6. Buy them already shelled so they're handy for snacking.
7. Go to this website and look at some of their tasty recipes.

That should get you started!

Since vitamin D deficiency has been identified with a long list of health issues, including PCOS, I've been hearing readers, clients, colleagues, and friends talk about loading up on this nutrient with supplements. They're going about it in a not-so-scientific fashion, and I've wondered if that wasn't going to introduce a whole new spectrum of health issues.

A friend and colleague recently mentioned that she had just had a cholesterol test taken, and the LDL (bad cholesterol) reading had increased since her previous test. One of the changes she could identify was between the two tests, she had started to supplement with vitamin D.

I did a pretty thorough search both on the Internet and Pub Med to see if this was a common problem and didn't find anything. I then went to a listserve of about 1,000 nutrition colleagues to see if they'd seen it. Turns out, a few of them had also seen their cholesterols increase with vitamin D supplementation.

There is a tendency with nutrition, to adopt an"if a little is good, a whole lot is better" attitude. Unfortunately, imbalance in either direction, be it deficiency or excess, can be problematic.

The old recommendations for vitamin D were 200 IU per day. All of a sudden, a website popped up recommending 5000 IU per day. I couldn't find any research to support this magnificent dosage leap. I would have thought, given that magnitude, that some kind of dosing study that had ruled out that 500, 1500, 2000 IU were not sufficient. But no, the recommendations simply jumped without explanation.

And every time I tried to find out what the basis for this jump was, I kept being referred back to the website making the recommendation.

My points are:

1. Know your vitamin D and your cholesterol levels.
2. Start out with 200 IU or even 400 IU per day and see how that affects both your vitamin D levels and your cholesterol levels.
3. Consider that the reason vitamin D levels may be deficient is more complex than the simple fact that dietary vitamin D is low…did you know that many of the same health issues associated with vitamin D deficiency are also related to omega 3 fatty deficiency as well as omega 6 fatty acid excess? Most nutritional problems, if they are related to imbalance, cannot be corrected with a supplement. The overall balance of the diet needs to be considered in the plan of correction.

Something that struck me very early on working with PCOS was how often I heard,"Just tell me what to do." It was clear that a big part of the problem women asking for help was having was feeling out of control. In every other part of their lives, it seemed, they'd been rewarded for hard work and diligence.

PCOS just doesn't work that way.

And when the solution isn't always about DOING something to fix the problem, you can feel completely out of control…tied down…trapped…

For a problem solving personality, a doer, this can leave you feeling completely stressed.

Research has actually studied this phenomenon, it's called"restraint stress."

Restraint stress is any kind of condition that leaves you feeling as if nothing you do can alleviate your discomfort, as if you are destined to live with your situation without any relief. It is the most damaging kind of stress, as it is the kind of stress that best elevates blood pressure, blood glucose, and cholesterol, interferes with sleep…

…can you see where this is going? Not only are you living with a seemingly unsolvable problem, but how you perceive that problem has the power to worsen that problem completely.

Sometimes what I see, is that a person focuses so completely on the problem that they perceive, that they lose perspective with regard to just what they CAN control.

They CAN make healthy food choices.
They CAN be more physically active.
They CAN set boundaries with people and limit their stress.
They CAN surround themselves with positive, supportive people.
They CAN turn the computer off and engage in activities other than surfing and reading about the problem.
They CAN be kind to themselves.

I find that those clients who are most creative at finding ways to repaint their picture, are the ones with the best chance of succeeding in the long run.

It's ironic, but then PCOS is ironic.

Stop focusing on the problem, stop thinking of yourself as an unfixable pathology, start believing you are a whole person with many talents and ideas to contribute to making our planet a great home…and all of a sudden things that felt so elusive start showing up when you least expect it.

This post is part of the Women's Health Blogfest. Please click on the links below to read more from other contributors! And thanks to everyone who took the time to participate!

In the almost 10 years I have been studying PCOS, I've learned much about what drives a woman's motivation to seek out information. The top reasons women find this blog are:

1. to improve their fertility,
2. to more effectively manage their weight, and
3. to feel and look better

As I've read and met women with the syndrome, I've learned that PCOS is about a whole lot more.

1. A woman's breastfeeding practices seem to significantly influence her child's hormonal health. Many women I've worked with were formula fed at a time when baby formula did not contain essential nutrients.
2. Whether or not you as a woman with PCOS were born to term, and potentially whether or not you were part of a multiple birth, seem to be red flags for PCOS risk later in life.
3. Just because you're a teenager, too young to want to conceive, or a woman who has already had her children, doesn't mean PCOS isn't something to be concerned about. It can mess with your mood, and in turn your energy level and relationships. It can provoke eating disorders. It can elevate your cholesterol. And…through its link to diabetes, it may increase your risk for Alzheimer's disease.

A blog attempting to tackle a syndrome with such widespread effects is not easy to manage. I've been working since we've started to find experts in areas outside of nutrition to complement what I as a dietitian can discuss and promote. I'm really excited to be partnering with lactation consultants to address breastfeeding issues specific to PCOS, and to have Gretchen Kubacky, PsyD, on board, to help us understand what PCOS can do to thinking, mood, and energy. We have one dietitian, Karen Siegel, who is also an acupuncturist, and another acupuncturist will soon be contributing her insight as well.

For the very first time, we are collaborating with Green Mountain at Fox Run in Ludlow, Vermont, to offer PCOS Program weeks this coming September! It's been a dream of mine to see this kind of program and there is no better place where it could be launched. Green Mountain is also participating in this blogfest, if you'd like to learn even more, be sure to read their contribution.

We don't just care about your ovaries. We care about all of you, from birth through retirement, and we hope that as we grow and diversify, the expert opinions you will see expressed here on this blog will address the many important ways we can keep our hormones working positively for us.

Thanks for stopping by our contribution to the Women's Health blogfest. If you enjoyed us, you can follow us with the signups you see here on the blog, through our Facebook inCYST group, or through Twitter, via @incyst.

For more information on women's health:

Angela White at Blisstree’s Breastfeeding 1-2-3 – Helpful Skills of Breastfeeding Counselors
Angie Tillman, RD, LDN, CDE – You Are Beautiful Today
Anthony J. Sepe – Women's Health and Migraines
Ashley Colpaart – Women's health through women
Charisse McElwaine – Spending too much time on the"throne?
Danielle Omar – Yoga, Mindful Eating and Food Confidence
Diane Preves M.S.,R.D – Balance for Health
Joan Sather A Woman's Healthy Choices Affect More Than Herself
Laura Wittke – Fibro Study Recruits Participants
Liz Marr, MS, RD – Reflecting on Family Food Ways and Women's Work
Marjorie Geiser, MBA, RD, NSCA-CPT – Healthy Women, Healthy Business: How Your Health Impacts a Powerful Business
Marsha Hudnall – Breakfast Protein Helps Light Eaters Feel Full
Michelle Loy, MPH, MS, RD – A Nutritionista’s Super Foods for Super Skin
Motherwear Breastfeeding Blog – How breastfeeding helps you, too
Rebecca Scritchfield, MA, RD, LD – Four Keys to Wellness, Just for Women
Renata Mangrum, MPH, RD – The busy busy woman
Robin Plotkin, RD, LD – Feeding the Appetites of the Culinary, Epicurious and Nutrition Worlds-One Bite at a Time
Sharon Salomon, MS, RD – Calories, longevity and do I care
Terri L Mozingo, RD, CDN & D. Milton Stokes, MPH, RD, CDN of One Source Nutrition, LLC – Crossing the Line: From Health to Hurt
Wendy Jo Peterson, RD – Watch Your Garden Grow

I'm hearing more and more that many of you are switching to raw eating, and you're asking me if it's good for PCOS. It's not something that has been formally researched, so my answer is pulled together using what I do know about nutrition.

"Raw" refers to whether or not a food's temperature has exceeded a certain temperature during preparation. I actually tried to write a blog post about this several years ago and at the time could not find a specified temperature defining"raw" for a long time. I finally found something that suggested if it stayed below 124 degrees it would be considered raw. Then, last year, I ate lunch at the Whole Foods Venice, and decided to try a raw lunch for myself. The name of the restaurant that prepared my food was"118 Degrees," referring to the threshold raw temperature. This week, when researching it again, found everything from 104 to 118 degrees listed, without any scientific references for any of those values. It's one reason the diet can't be studied easily — those who follow it have yet to consistently define it.

One of the issues I have with any of those temperatures is that some of the foods popular in the raw community, by virtue of the fact that they grow in tropical climates, are regularly exposed to temperatures exceeding even the highest threshold. The mesquite trees growing in my backyard, yesterday alone, were exposed to an ambient temperature of 118 degrees the entire afternoon. The mesquite beans are dark, meaning they absorb heat and get even hotter. The flour made from them would not technically be raw, though mesquite flour is valued by the raw community. Coconuts, rice…both grow in tropical climates and therefore cannot be guaranteed to be"raw" if the benchmark is the definition above.

I'm assuming for the average person, for whom food is sustenance and not a religion,"raw" more likely means food that was not formally heated during preparation, and for the rest of this article that is the definition I will use.

Though raw eating has not been studied with regards to PCOS, it has been studied. It has been found to have both risks and benefits. The very first study of a raw food diet, published in 1985, found that after 7 months, subjects following this diet dropped their blood pressure, lost weight, and tended to spontaneously give up smoking and drinking.

One study found that raw foodists have lower cholesterol and triglyceride concentrations. However, a couple of other cardiovascular risk factors, serum homocysteine and HDL, were elevated, likely because a raw diet tends to be low in vitamin B12. It would be wise to take a multi-vitamin just to be safe.

Another study reported more dental caries in raw foodists. I'm assuming this is related to the increased carbohydrate and simple sugar content of the diet. So don't forget to brush and floss!

Here's what all you readers really need to pay attention to. One study specifically looked at menstrual function and raw food. It found that about 30% of women studied who were under 45 years of age had partial to complete amenorrhea, with subjects eating high amounts of raw food (>90%) being more affected than moderate raw food dieters. Ouch, ouch, OUCH.

A raw diet is also low in DHA and EPA, the omega-3 fatty acids primarily found in fish. If you're a raw foodist and also vegan, consider taking an omega-3 supplement derived from marine algae.

One benefit to a raw diet is that most people who consume it eat far more fruits and dark green leafy vegetables than they used to. Yay for antioxidants! Interestingly, however, one study found that though raw foodists had higher beta-carotene levels than average, their serum lycopene levels were low. Since lycopene is found in easily found fresh fruits and vegetables like tomatoes and watermelon, this suggests that even when eating raw, it's important to make conscious choices and not limit yourself to a few favorites. It can't just be about carrot juice!

The flip side of all those fruits and vegetables, however, is that protein is a difficult nutrient to get with this diet without soaking and sprouting legumes, in adequate quantities to balance out all of that carbohydrate. It may aggravate your insulin resistance. Be sure to add some protein powder to your cooking to prevent that from happening. Growing Naturals organic brown rice protein isolate powder has designed its product to be raw-compatible; be sure to check them out!

Another natural consequence of cutting out so much protein is that the fat content of the diet naturally increases. And even if it's raw fat, and good fat, it still has calories. I would recommend working out some menus on paper or running them through http://www.fitday.com/ just to be sure the diet doesn't push you in the wrong direction.

How your diet affects your health appears to be more determined by the proportions of carbohydrate, protein, fat, vitamins, minerals, and antioxidants that your diet contains. If you want to do that with raw foods, just be sure you do it right.

Douglass JM, Rasgon IM, Fleiss PM, Schmidt RD, Peters SN, Abelmann EA. Effects of a raw food diet on hypertension and obesity. South Med J. 1985 Jul;78(7):841-4.

Koebnick C, Garcia AL, Dagnelie PC, Strassner C, Lindemans J, Katz N, Leitzmann C, Hoffmann I. Long-term consumption of a raw food diet is associated with favorable serum LDL cholesterol and triglycerides but also with elevated plasma homocysteine and low serum HDL cholesterol in humans. J Nutr. 2005 Oct;135(10):2372-8.

Ganss C, Schlechtriemen M, Klimek J. Dental erosions in subjects living on a raw food diet. Caries Res. 1999;33(1):74-80.

Koebnick C, Strassner C, Hoffmann I, Leitzmann C. Consequences of a long-term raw food diet on body weight and menstruation: results of a questionnaire survey. Ann Nutr Metab. 1999;43(2):69-79.

Garcia AL, Koebnick C, Dagnelie PC, Strassner C, Elmadfa I, Katz N, Leitzmann C, Hoffmann I. Long-term strict raw food diet is associated with favourable plasma beta-carotene and low plasma lycopene concentrations in Germans. Br J Nutr. 2008 Jun;99(6):1293-300. Epub 2007 Nov 21.

My parents have a time share on the island of Kauai. In a recent conversation they mentioned that they are gearing up for their every-other-year trip, and what came to mind? Not the beaches, not the snorkeling, not the sunsets…but the coffee-crusted macadamia nuts they always bring back.

When I started in this profession waaaay back when, I was taught to teach that nuts were to be avoided. And that macadamia nuts were the worst of the worst.

Recently, a colleague and I did an analysis of all nuts. Using a nutrient database, we developed a ratio: pro-inflammatory fats (saturated and omega-6) to anti-inflammatory fats (monounsaturated and omega-3). What we discovered when we did this was that the highest anti-inflammatory rating belonged to macadamia nuts. The reason is that macadamias proportionately have a very high monounsaturated fat content. Monounsaturated fats are the healthy fats often associated with olive oil and avocados.

Was I ever stoked!

Sometimes I feel like I'm in a"Where's Waldo?" drawing…and consumers have to find me in the middle of the crowd, the lone nutritionist who's encouraging them to eat all nuts, not just walnuts. It's not that I don't like walnuts, I just think they get way too much attention considering the health values of other nuts.

Looks like other researchers are making the same discovery. Recently a laboratory at Pennsylvania State University reported that an ounce and a half of macadamia nuts daily helped to reduce total cholesterol, low density lipoprotein (LDL), and triglycerides.

Macadamia oil is also a popular ingredient in acne lotions. And it is being researched as a potential anti-aging agent for skin preparations.

Of course, eating any nut in excess is as potentially detrimental as eating any food in excess. But I know in my counseling that clients are always looking for good snack ideas. It's so fun to help them learn how that ounce of nuts, in the middle of the afternoon, can help stave off hunger until dinnertime.

Nuts are not to be feared…anymore.

Griel AE, Cao Y, Bagshaw DD, Cifelli AM, Holub B, Kris-Etherton PM. A macadamia nut-rich diet reduces total and LDL-cholesterol in mildly hypercholesterolemic men and women. J Nutr. 2008 Apr;138(4):761-7.

Akhtar N, Yazan Y. Formulation and in-vivo evaluation of a cosmetic multiple emulsion containing vitamin C and wheat protein. Pak J Pharm Sci. 2008 Jan;21(1):45-50.

And that is because I'm a strawberry nut. It's my absolute favorite fruit. I learned while researching this blog post that the average American eats 156 lbs. of added sugar a year…and only 8 lbs. of strawberries in the same time period.

Of course, the fact that you all are not eating enough strawberries means there's more for ME! Ha!

Seriously, though, this fruit is a wonderfully easy food to add to any diet. Put them in your cereal. In a smoothie. On waffles or pancakes. On top of ricotta cheese, sprinkled with almonds, on a Bran Crispbread. On a salad. Freeze them to eat like candy on a hot summer night. (That last one is my favorite.)

Strawberries are high in vitamin C, which is an important antioxidant. It's also important for the production of collagen, which keeps your skin looking young. As far as antioxidants go, it's the third best source of antioxidants when compared to the same serving size of other fruits.

And…did you know…even though they contain sugar, strawberries can also help reduce blood sugar spikes caused by other foods? I wouldn't recommend eating strawberries to counter a carbohydrate binge, but you certainly may want to consider including more strawberries in your overall diet as a way to make it easier for your body to handle carbohydrates. If you're enjoying the sweetness of the berries, you are likely going to want to eat less sugary food anyway, reducing your insulin load even more.

For those of you with high cholesterol, strawberries have also been shown to decrease markers of atherosclerotic disease. The benefits these tasty fruits provide far outweigh the sugar content many of you are concerned about.

One last thing, a recent study reported that organic strawberries are actually higher in antioxidants. So it may be worth it to spend a little extra, avoid the pesticides, and get the extra metabolic boost. If you don't have access to a farmer's market, look for the Driscoll's brand in your grocery store.

Basu A, Fu DX, Wilkinson M, Simmons B, Wu M, Betts NM, Du M, Lyons TJ. Berries modify the postprandial plasma glucose response to sucrose in healthy subjects. Br J Nutr. 2010 Apr;103(8):1094-7. Epub 2009 Nov 24.

Törrönen R, Sarkkinen E, Tapola N, Hautaniemi E, Kilpi K, Niskanen L. Strawberries decrease atherosclerotic markers in subjects with metabolic syndrome. Nutr Res. 2010 Jul;30(7):462-9.

http://articles.latimes.com/2010/sep/02/science/la-sci-organic-strawberries-20100902

Aaahhh eggs, the misunderstood member of the nutrition family. Poor guys…when I graduated from college, in the height of the low cholesterol-low fat craze, we were indoctrinated to teach that"egg" was just another word for poison.

My how things have changed!

A couple of months ago I heard Dr. Susan Kleiner (www.goodmooddiet.com) speak at a conference. She shared that not once has there been a research study demonstrating that when you take eggs out of the diet, that this dietary change reduces cholesterol. As well, there has been research demonstrating that adding eggs (plus yolks) to the diet does NOT raise cholesterol. All those yolks I threw down the drain all those years…for nothing.

I figured I'd better find some hard research to back THAT one up, so here's a quick list of interesting titles I found in PubMed:
Dietary cholesterol from eggs increases plasma HDL cholesterol in
overweight men consuming a carbohydrate-restricted diet
Egg yolk improves lipid profile, lipid peroxidation and retinal abnormalities
in a murine model of genetic hypercholesterolemia.
There are many more, but here I just wanted to make my point. Egg yolks are not the ugly stepchild of the protein family anymore.

In fact, there are some great nutrients to be found in eggs.

1. Lutein and xeanthin are two carotenoid compounds that can help maintain visual health. One group of researchers reported that 6 eggs per week can help increase lutein and xeanthin levels in the macula, the part of the eye that degenerates in this country's leading cause of blindness, macular degeneration.

2. Eggs contain choline. This compound is very important for brain function. Choline is the building block for acetylcholine, the neurotransmitter involved in memory, and the one that many Alzheimer's medications seek to increase.

This compound is exceedingly hard to get in the diet. In fact, about the only two places you can find it, are egg yolks, and soy. (Well, also in cooked chicken, beef, veal, and turkey livers, but I didn't think that would have any of you running for your grocery lists so it goes in parentheses.)

If you've got PCOS, you've probably been told to avoid soy. So that leaves egg yolks for getting this very important memory booster.

3. If you hate fish but you need to increase your fish-based omega-3 intake, omega-3 eggs are a very cost-effective option. If you struggle to get enough vegetables in your diet, omelets and frittatas are great ways to get them in. Just be sure you use olive oil when you cook them.

I thought it might be timely to include eggs on this blog, because as food prices rise, they can certainly be much more cost-effective than salmon, as well as other proteins that are now taxing your grocery bill.

Mutungi G, Ratliff J, Puglisi M, Torres-Gonzalez M, Vaishnav U, Leite JO, Quann E, Volek JS, Fernandez ML. Dietary cholesterol from eggs increases plasma HDL cholesterol in overweight men consuming a carbohydrate-restricted diet. J Nutr. 2008 Feb;138(2):272-6.

Fernández-Robredo P, Rodríguez JA, Sádaba LM, Recalde S, García-Layana A.
Egg yolk improves lipid profile, lipid peroxidation and retinal abnormalities in a murine model of genetic hypercholesterolemia. J Nutr Biochem. 2008 Jan;19(1):40-8.

Wenzel AJ, Gerweck C, Barbato D, Nicolosi RJ, Handelman GJ, Curran-Celentano J. A 12-wk egg intervention increases serum zeaxanthin and macular pigment optical density in women. J Nutr. 2006 Oct;136(10):2568-73.

Goodrow EF, Wilson TA, Houde SC, Vishwanathan R, Scollin PA, Handelman G, Nicolosi RJ. Consumption of one egg per day increases serum lutein and zeaxanthin concentrations in older adults without altering serum lipid and lipoprotein cholesterol concentrations. J Nutr. 2006 Oct;136(10):2519-24.