Sorry for the silence, I was in Boston for a sports nutrition conference, promoting the Nordic Naturals line of fish oils. I've been sidelined from my half marathon training with a cranky knee, and it was so nice to get off of the elliptical trainer, get outside, and walk along the Charles River to and from my hotel and the conference!
Something I was very happy to see, throughout the conference, was the emphasis on nuts in general as a healthy food. I've been frustrated for a long, long time that the walnut people seemed to be the only nut commodity board with media contacts. Not that I don't like walnuts, but there's nothing wrong with other nuts as well.
I did an analysis for an article a few years ago, in which I compared the ratios of beneficial fats (omega-3's and monounsaturated) to potentially detrimental fats (omega-6's and polyunsaturated). And when they were all lined up in terms of most beneficial to least beneficial…walnuts actually turned up at the bottom of the list. Macadamias came out on top!
I use that analysis in my trainings, and dietitians will always immediately say,"But macadamias are so high in fat." Precisely. But it's the kind of fat that keeps us healthy. Lucky for me…my very favorite way to have nuts is macadamia nuts roasted in coffee, the way they fix them in Hawaii.
Anyway…(I tend to get distracted in this blog, don't I?)…
…one of the presentations showed data for macadamias, pecans, and pistachios, suggesting that they, too, are good foods to include in an anti-inflammatory (aka anti-PCOS and pro-fertility) diet. Nuts, in addition to good fats, have a variety of antioxidants that can delay and prevent aging and help fight stress. I even learned that the green part of pistachios contains lutein, which makes them good for eye health. Who knew a food so fun to eat would also be so helpful to my health?
Of course, there's a limit to how many nuts can be healthy, and fat has calories, no matter where it comes from. But if you're reaching for a handful of pistachios instead of a bag of Fritos, it's nice to know you're also reaching for better health.
Just a reminder that this coming Sunday I will be at the Venice Whole Foods for an inCYST Fertility Friendly Food Tour. We'll be talking about basic concepts of eating to improve your fertiliity, and we will be roaming through the store discussing foods and supplements that can be part of your program.
If you want to attend and guarantee your space, please call Whole Foods and RSVP. 310.566.9480. I am not in charge of reservations, you need to call the store.
We had a lot of fun with this event in Scottsdale and I'm excited to be able to bring it to Southern California…
This is to address some great questions about fish oil that Katie sent in.
Katie asked: after reading about fish oil and its obvious benefits, I finally bought some Carlson Super Omega-3 Fish Oil Concentrate soft gels yesterday at Whole Foods.
I have several questions I have tried to get answered via this site and the Internet, but can't seem to find clear answers, so I am throwing them out here, in hopes you can help.
1. The bottle says"Each Carlson Super Omega — 3 soft gel contains 1000 mg (1 gram) of a special concentrate of fish body oils from deep, cold-water fish which are especially rich in the important Omega-3's EPA and DHA." However, the Supplemental Facts read EPA 300 mg DHA 200 mg Other Omega-3's 100mg. I believe that adds up to 600mg. Right? There is no mention of the other 400 mg. Where are they? I'm very confused about this. Can you explain this to me? There is also Natural Vitamin E — 10 IU…incase that means something.
2. How many pills/mg am I supposed to take? I read between 1000 mg and 3000 mg. Which makes me confused again because even though the bottle says 1000 mg in each pill I can only find 600 of them! I want to make sure that I am taking enough, but not taking too much! How much do you take? Also, do I work up to that or just dive in?
3. Last question…is there anything else I should be taking with the fish oil? I know that sometimes if you take something you need to supplement with something else. Is that the case here?
Thank you in advance for your advice and information!
My response: Katie, these are really great questions and something that I am often asked by my clients. Here's the scoop:
1. The dosage on the ingredient list can indeed be very confusing and frankly I believe it is a way in which some supplement companies try to give the impression that you are getting a better product with higher potency, but it can be misleading. When the label states something like…"contains 1000 mg marine oil", you are not getting the complete information.
The critical ingredients and the amounts you need to know about are — how much EPA (eicosapentanoic acid) and DHA (docosahexaenoic acid) are contained in each capsule.
EPA and DHA have been shown to support healthy functioning of the cardiovascular, immune, gastrointestinal, and musculoskeletal systems. EPA is also an excellent anti-inflammatory and helpful in conditions such as insulin resistance, diabetes and auto-immune related inflammation.
DHA is an important factor for those with PCOS as it supports many aspects of health including pregnancy, fetal development, and healthy neurological function.
The other"marine lipids" are simply the total fat of the fish, where the EPA and DHA are the active portions of that fat. It is the"actives" that are providing the therapeutic value. The vitamin E in the capsules is for preservative purposes and helps prevent rancidity of the fat.
2. Regarding the dosage you should take, that is a harder question to answer because it will depend on what you are trying to target. Those with PCOS should be targeting anywhere from 500 — 1000 mg. DHA. So you need to know how much DHA is in each cap, for example if the capsule has only 200mg. of DHA, you'll need to take 3 of them to get approximately 500mg. You can then work up to a higher dose, always start with the lower dose and work your way up. Sometimes it is easier to get a liquid version that is high potency versus taking handfuls of pills to achieve the same dose.
I do not recommend that you take a liquid fish oil that is derived from Cod Liver Oil as the source as it usually has a high amount of Vitamin A and it is possible to get toxic doses of vitamin A. Another thing to note is that in a combination EPA/DHA cap, the dosage EPA will usually be higher than the amount of DHA, that is no problem. The EPA will only be of additional benefit.
Don't hesitate consulting with a registered dietitian knowledgeable both in PCOS and supplements in order to have your supplementation tailored to your specific health needs — remember we are all different, with unique physiology, medical history and requirements.
3. Fish Oil does not have to be taken with anything else to enhance its function. It can be taken all at once, with meals, between meals — it is very flexible this way.
Here are a couple of additional tips:
- if you tend to"burp" back fish oil, make sure to buy a brand that comes in an"enterically coated capsule", they might cost a few cents more, but it's worth it. - refrigerate your fish oil to protect it and this also can help reduce"burp back". - contributes to creating beautiful, healthy skin.
One last fun fact about fish oil. Most of it actually comes from the southern hemisphere not as you might think from the deep waters off Norway!
Here's to fish oil!
Carmina McGee, MS, RD, LE Ventura, California 805.816.2629 info@carminamcgee.com
Scientists have reported that myo-inositol can be a safe supplement to use to promote ovulation and fertility.
I have known about inositol for years, as it is also a supplement that can be helpful in the treatment of anxiety, obsessive-compulsive disorder, and panic disorder.
Since 80% of the women with PCOS coming to my website are reporting some kind of anxiety, depression, and/or mood swings, it seems that using inositol as part of your overall health and fertility program may not be a bad idea. Even if you don't have a DIAGNOSIS of anxiety, it's so easy to feel stressed out when all you want is to conceive!
The supplement can be a bit expensive…but it's far cheaper than in vitro fertilization. And it's simply a form of a water-soluble B vitamin. If it can't hurt, and it might help, at least one issue you are looking for help with…why not give it a shot?
Papaleo E, Unfer V, et al. A novel method for ovulation induction," Gynecol Endocrinol, 2007; 23(12): 700-3.
Harvey BH, Brink CB, Seedat S, Stein DJ. Defining the neuromolecular action of myo-inositol: application to obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2002 Jan;26(1):21-32.
Palatnik A, Frolov K, Fux M, Benjamin J. Double-blind, controlled, crossover trial of inositol versus fluvoxamine for the treatment of panic disorder. J Clin Psychopharmacol. 2001 Jun;21(3):335-9.
Last week on the PCOS Challenge Radio Show, I was asked about the relationship between CoQ10 and fertility. I promised Sasha I would investigate the issue, since I did not have an informed answer on the tip of my tongue. Here is that answer!
My gold standard for information is peer-reviewed literature in the National Library of Medicine database. When I used the keywords,"CoQ10" and"PCOS", there were no studies listed. When I used the keywords,"CoQ10" and"fertility", 16 different references appeared, but none of those references were about fertility in women. Two studies did report an association between low CoQ10 levels and miscarriage.
When I used the keywords,"fertilization" and"CoQ10", abstracts from the list of studies done on men were all that appeared.
Bottom line: CoQ10 could be important for conception and maintaining pregnancy, but there have been very few studies on the topic, and none of them that I found had a recommended dose. It may be important with this particular supplement to consider the father's regimen as well.
What is CoQ10, anyway? CoQ10 is an antioxidant made by our own bodies. As the Mayo Clinic writes, CoQ10 levels are reported to decrease with age and to be low in patients with some chronic diseases such as heart conditions, muscular dystrophies, Parkinson's disease, cancer, diabetes, and HIV/AIDS. Since PCOS is a pre-diabetic, inflammatory condition, it makes sense that there would be interest in its role in this diagnosis as well. The link I provided above also evaluates the strength of the evidence supporting the use of CoQ10 for a variety of medical conditions.
For adults, Mayo also reports a dose 50-1,200 milligrams of CoQ10, in divided doses, by mouth, to be what was commonly reported.
Even though CoQ10 may help prevent miscarriage, it has also been known to reduce blood glucose levels. This can be a plus…but when another life is being taken into consideration, and the detailed effects of exactly how blood glucose responds to CoQ10 in supplemental amounts, given the fact that the use of CoQ10 has not really been studied during pregnancy, my first inclination is to not recommend it for women with PCOS who are trying to conceive and who may be pregnant without knowing it.
CoQ10 levels have been found to be lower in people using certain medications, such as statins (which lower cholesterol), beta-blockers (which stabilize heart rate), and blood pressure medications. If you are not trying to conceive and you are on medications in any of these categories, it wouldn't hurt to ask your pharmacist and physician about the potential benefits of supplementation.
CoQ10 is an antioxidant. It makes sense to me that in an inflammatory condition such as PCOS, there would be a risk of lower levels. But rather than view this as a situation where you have PCOS because you have low levels of CoQ10, I encourage you to consider whether your CoQ10 levels are lower than they should be, because of choices you are making that promote inflammatory processes. This blog is full of information about ways to slow down inflammation (which, in essence, is accelerated aging). There are many things you can do which can head off the need for even needing a supplement.
And you thought this potentially magical compound was going to replace the need for healthy eating, activity, stress management, and sleep hygiene choices. Cyster friends, if that was true, you wouldn't have spent all that money on all that CoQ10 and still be here looking for another answer. Dang!
Mancini A, Leone E, Festa R, Grande G, Silvestrini A, de Marinis L, Pontecorvi A, Maira G, Littarru GP, Meucci E. Effects of testosterone on antioxidant systems in male secondary hypogonadism. J Androl. 2008 Nov-Dec;29(6):622-9. Epub 2008 Jul 17.
Littarru GP, Tiano L. Bioenergetic and antioxidant properties of coenzyme Q10: recent developments. Mol Biotechnol. 2007 Sep;37(1):31-7. Review.
Li W, Li K, Huang YF. [Biological function of CoQ10 and its effect on the quality of spermatozoa]. Zhonghua Nan Ke Xue. 2006 Dec;12(12):1119-22. Review. Chinese.
Mancini A, De Marinis L, Littarru GP, Balercia G. An update of Coenzyme Q10 implications in male infertility: biochemical and therapeutic aspects. Biofactors. 2005;25(1-4):165-74. Review.
Li K, Shi Y, Chen S, Li W, Shang X, Huang Y. Determination of coenzyme Q10 in human seminal plasma by high-performance liquid chromatography and its clinical application. Biomed Chromatogr. 2006 Oct;20(10):1082-6.
Sheweita SA, Tilmisany AM, Al-Sawaf H. Mechanisms of male infertility: role of antioxidants. Curr Drug Metab. 2005 Oct;6(5):495-501. Review.
Balercia G, Mosca F, Mantero F, Boscaro M, Mancini A, Ricciardo-Lamonica G, Littarru G. Coenzyme Q(10) supplementation in infertile men with idiopathic asthenozoospermia: an open, uncontrolled pilot study. Fertil Steril. 2004 Jan;81(1):93-8.
Mancini A, Milardi D, Conte G, Bianchi A, Balercia G, De Marinis L, Littarru GP. Coenzyme Q10: another biochemical alteration linked to infertility in varicocele patients? Metabolism. 2003 Apr;52(4):402-6.
Balercia G, Arnaldi G, Fazioli F, Serresi M, Alleva R, Mancini A, Mosca F, Lamonica GR, Mantero F, Littarru GP. Coenzyme Q10 levels in idiopathic and varicocele-associated asthenozoospermia. Andrologia. 2002 Apr;34(2):107-11.
Ducci M, Gazzano A, Tedeschi D, Sighieri C, Martelli F. Coenzyme Q10 levels in pigeon (Columba livia) spermatozoa. Asian J Androl. 2002 Mar;4(1):73-6.
Palmeira CM, Santos DL, Seiça R, Moreno AJ, Santos MS. Enhanced mitochondrial testicular antioxidant capacity in Goto-Kakizaki diabetic rats: role of coenzyme Q. Am J Physiol Cell Physiol. 2001 Sep;281(3):C1023-8.
Sinclair S. Male infertility: nutritional and environmental considerations. Altern Med Rev. 2000 Feb;5(1):28-38. Review.
Alleva R, Scararmucci A, Mantero F, Bompadre S, Leoni L, Littarru GP. The protective role of ubiquinol-10 against formation of lipid hydroperoxides in human seminal fluid. Mol Aspects Med. 1997;18 Suppl:S221-8.
Lewin A, Lavon H. The effect of coenzyme Q10 on sperm motility and function. Mol Aspects Med. 1997;18 Suppl:S213-9.
Angelitti AG, Colacicco L, Callà C, Arizzi M, Lippa S. Coenzyme Q: potentially useful index of bioenergetic and oxidative status of spermatozoa. Clin Chem. 1995 Feb;41(2):217-9.
Mancini A, Conte B, De Marinis L, Hallgass ME, Pozza D, Oradei A, Littarru GP. Coenzyme Q10 levels in human seminal fluid: diagnostic and clinical implications. Mol Aspects Med. 1994;15 Suppl:s249-55.
Noia G, Littarru GP, De Santis M, Oradei A, Mactromarino C, Trivellini C, Caruso A. Coenzyme Q10 in pregnancy. Fetal Diagn Ther. 1996 Jul-Aug;11(4):264-70.
Noia G, Romano D, De Santis M, Cavaliere AF, Straface G, Alcaino S, Di Domenico M, Petrone A, Caruso A, Mancuso S. [The antioxidants (coenzyme Q10) in materno-fetal physiopathology][Article in Italian] Minerva Ginecol. 1999 Oct;51(10):385-91.
This is actually a post from Ellen Goldfarb, who you can hear on Internet radio tomorrow (see previous post). I am pasting her link on my blog roll for anyone who wishes to continue to follow her. She'll be here…and there!
So, I got married at a later age than most, 38 and knew that I wanted to have a family and so did my husband. We succesfully got pregnant on our own a year and a half after we got married however, sadly this ended in a miscarriage in the 10th week, when I went to the doctor there was no heartbeat. I had no idea. It was what they call a missed AB and so I had to get a DNC procedure. They asked if I wanted to have the tissue examined by a lab to see what had gone wrong, I told them yes. The determined that the cause of the miscarriage was due to a chromosome issue and they said most likely had to do with my age. My husband and I were devastated! were we too late, he was 44 and I almost 40 and we had no children yet! what were our options? We then spent and enormous amount of money doing IVF, we did one round in which we made 3 healthy embroyos and inserted them but …alas… nothing! what were we to do? I then started to think about adoption, but in the meantime, in the back of my mind I thought to myself, there must be something else I can do Being a Dietitian, I started to research more about hormones, fertility and nutrition I began to find an number of correlations between certain dietary patterns, sleep and exercise and fertility I began to make changed in all of these areas and encouraged myhusband to do the same We then took a trip to Hawaii and relaxed to get our minds off things Right before I was to begin another round of fertility injections, we found out that I was pregnant(on my own) and we immediately stopped the injections Now I am a nervous wreck again thinking something bad was going to happen and the first trimester was hell just waiting it out, but fortunately everything went fine, we had a CVS done and they said we were going to have a healthy baby girl! I have birth to Arianna Belle on Sept 19th 2006, 4 months later, I was naturally pregnant again with my second healthy daugher Lauren Ivy who was born on October 10th 2007 These pregancies were both concieved naturally and both children are very healthy and doing great! I really believe that if you make lifestyle changes, it can really effect your body and outcome I now have expanded my private practice to support and help women who struggle with infertility and PCOS in addition to my specialty of treating Eating Disorders My goal is to get as many women pregnant as I can with good nutrition and healthy lifetstyle practices for more information about me, contact my website at www.ellenreissgoldfarb.com I would love to hear from you:)
If you have PCOS, and you’ve tried to get pregnant, you may have already discovered that you can add infertility to the list of “what’s wrong with my body.” Infertility often feels like one more failure of your body to perform as expected, and one more thing that feels out of control. There are actions you can pursue to shift your mind and shift your body, however:
Get out of denial – know the timeframes for diagnosing infertility (generally six months of trying without a successful pregnancy if you’re over 40; one year if you’re under 40). Know that infertility isn’t just a matter of stress or bad timing – although those can be contributing factors. Know that infertility is a treatable condition, but it takes finding the right medical team, and that may include some highly specialized people, like a reproductive endocrinologist.
Have your anger – infertility is definitely something to be angry about. You’re mad, you’re frustrated, you’re irritable, you feel deprived, you want what you want – something other people manage to have without even trying – and you are entitled to rant and rave about it. But don’t let anger become your primary way of experiencing your infertility. Take the energy that powers that anger and turn it towards a more productive experience.
Fully experience your regrets – as much as you can understand them in the moment, experience your regrets. These might include the fact that the romance and private experience of love and sexuality are separated from the process of reproduction. Perhaps it means acknowledging that you won’t have a biological child. Or it might even mean deciding that children are not part of your future, at least not right now.
Grieve what you need to grieve – this might include some of the regrets mentioned above, or whatever else you feel or define – loss of womanhood, loss of health, loss of a specific type of relationship. Get support for this grieving if you need it, from other women in the same situation, or from a professional counselor.
Refocus your dreams – now that you’ve moved out of the hope or fantasy of “accidental” or sort-of-planned pregnancy, cried, had your rage, and gathered some support, decide what’s next – assisted reproductive technology, adoption, surrogacy, or a child-free life.
Take action to achieve that dream – make sure you’re on the same page with your spouse or partner, if you have one. Do the research to find a great reproductive endocrinologist, a supportive counselor, a knowledgeable dietician, and any other resources you need. Join online support communities that are specific to infertility, just as you joined this PCOS-specific community. Make a plan – give yourself some general timeframes and budgets for what you are willing to do.
With luck, planning, focus, and support, you may well be able to achieve the family you’ve been dreaming of, in spite of infertility.
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.
One of my biggest frustrations with dietary advice I see for PCOS, is that the first word out of anyone's mouth regarding the issue, is"lose weight". I don't disagree, for some women there are hormone issues related to weight that are important to consider. Extra weight, while it does not CAUSE PCOS, does tend to worsen existing symptoms. Additionally, for the lean woman with PCOS, and there are many, it's simply useless to recommend weight loss as a fertility strategy. It certainly doesn't help your credibility to only have this advice to offer.
Now research suggests that how you eat, especially if you're unnecessarily restricting, in your perinatal years, has far reaching effects. It could hurt the baby you're trying to have, to restrict excessively during the time you are trying to conceive.
Researchers in this study used genealogical records in Finnish churches and plotted births against information about agricultural trends, mainly crop yields for rye and barley). The time period they researched was the 18th century. The analysis consistently showed that individuals who were born in a year in which crop yields were low (in other words, when they were in the wombs of women who were not eating adequately), had a strong predilection to not bear children as adults. Babies born in years in which there was a bumper harvest would have at least one child later in life.
Bottom line: How you eat affects how your child reproduces. Rigid dieting may not interfere with YOUR fertility, but it's a short sighted strategy. It may prevent you from becoming a grandparent.
A side note: the two crops studied in this research, barley and rye, that promoted fertility, are both gluten-containing. So for those of you who are restricting gluten who have not officially confirmed that you have trouble with gluten, you may be barking up the wrong nutritional tree. Best not to restrict a food unless you are absolutely sure you do not tolerate it.
If you eat well, learn to deal with stress in ways other than binge eating and dieting, and if you are carrying extra weight when you include these changes in your eating style, chances are you WILL lose weight. But you will be better nourished and better able to create a healthy baby.
If you're going to work as hard as you're working to conceive…don't you want the end product to be as healthy as possible?
Ian J. Rickard, Jari Holopainen, Samuli Helama, Samuli Helle, Andrew F. Russell, Virpi Lummaa. Food availability at birth limited reproductive success in historical humans. Ecology 91:3515–3525
If you're a frequent traveler, chances are you have already had an opportunity to experience the new security measures at the airport, which include the new full body scanner.
One of the biggest concerns about this scanner has been the radiation exposure these scanners emit. Because radiation can affect fertility, a concern of many readers of this blog, I did some fact checking.
What is interesting to note is that before these scanners were even in existence, anyone stepping on an airplane was already increasing their exposure to radiation! In a 1998 study published in Aviation, Space, and Environmental Medicine, scientists concluded that an airline captain is exposed to 37% more radiation per year (219 millirem) than a nuclear power plant worker in the same period of time (160 millirem). For the pilot, that is the equivalent to 22 chest x-rays, for the power plant worker, 16 chest x-rays.
The National Institute of Standards and Technology, in an independent study, reported that the average scan with the TSA backscatter x-ray scanner provides 0.0024 millirem of radiation exposure. Meaning, you would have to have 4,000 TSA scans to equal one x-ray. The people at greatest risk for increased radiation exposure from these machines is most likely the TSA workers themselves, who conduct their work in the presence of the scanners for hours at a time.
Bottom line:
1. Your biggest dose of radiation exposure is actually coming from the time you spend on the airplane at altitude, not the short amount of time in the scanner. 2. If you are a pilot, flight attendant, or frequent flyer with concerns about fertility, it certainly is a good strategy to start being more diligent about your intake of antioxidants. I've listed the important ones below that are consistently recommended as cancer fighters. 3. If you are a reporter researching the scanner issue, instead of scaring travelers, perhaps the more relevant issue is why TSA is not requiring its employees to wear dosimeters to be sure their own exposure over time is not an occupational risk. It might also be a very quick way to identify a machine that is malfunctioning and exposing flyers to unnecessary additional radiation. 4. Flight crews and TSA employees might want to consider packing their bags with more fruits and vegetables. Especially since these are not items commonly available in airport food courts. 5. In addition to the standard security questions TSA members should ask for your 24 hour diet recall to be sure you're sufficiently protected for your flight. (Couldn't resist that one…just KIDDING!) 6. For our specific population most likely reading this post, I strongly recommend you discuss your travel strategy with the appropriate caregiver if you have a history of cancer, are in the middle of infertility treatment, or have a history of sexual abuse. It's best to know what choices are most appropriate for your personal situation before standing in the TSA line.
So if you're heading home at altitude for Thanksgiving, consider that the broccoli, cranberries, and sweet potatoes (even a small extra sliver of pumpkin pie) aren't all that bad if you're going to have seconds. Enjoy them, as well as your family.
BEST ANTIOXIDANTS FOR COUNTERING RADIATION
Vitamin C parsley, broccoli, bell pepper, strawberries, oranges, lemon juice, papaya, cauliflower, kale, mustard greens, and Brussels sprouts.
Vitamin E mustard greens, chard, sunflower seeds, turnip greens
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.
Due to some unusual cramping and bleeding, I went in to see my reproductive endocrinologist (RE), who is dually board certified as a gynecologist and an endocrinologist. If you have PCOS, and especially if you’ve ever tried to get pregnant and had a problem doing so, you have probably been referred to a RE. REs have a specialized understanding of the way our hormones affect our fertility, blood sugars, insulin resistance, and other PCOS-related conditions. They treat many PCOS patients, because PCOS is a primary cause of infertility.
One vaginal ultrasound and one pregnancy test later (the doctor and I duly noting that I am well over 40, infertile by all medical definitions, and just about as likely to be pregnant as Mother Teresa), it was determined that there’s a UFO in my uterus! Well, not really, but that’s what it looks like on the ultrasound screen. So, if it’s not a polyp, a cyst, a fibroid, or a baby, what is it?
Cancer comes to mind, and the possibility of cancer necessitated an endometrial biopsy, which is a very uncomfortable procedure in which the tissue in your uterus (the endometrium) is sampled (that’s medical-speak for pulled out in tiny chunks) and sent to the laboratory to be tested. Fortunately, no cancer was found. However, given that PCOS patients are much more prone than average to conditions such as hyperplasia (a proliferation of sometimes questionable looking cells) and endometrial cancers, the recommendation is almost always surgery to remove the tissue, be it a polyp, a cyst, or in this case, something unidentified. I am fortunate to have a highly skilled, aggressive doctor, who knows me and my condition very well, and I agree with this recommendation.
That was the good news, but then I learned the bad news – that my eggs had officially expired. While some doctors question the accuracy of the anti-mullerian hormone assessor, it’s a pretty accurate way to determine whether your eggs are still of use (and to what degree), or if you are pre-menopausal or post-menopausal. No longer having viable eggs was not unexpected, given my age. Nonetheless, there’s an emotional hit to all of this. There is a sense of loss, of unrealized potential, and a need to acknowledge that the door on having a biologically related child, created with my own eggs, has officially closed. At the same time, there is a surprising sense of freedom and relief accompanying this news. Given my personal and family medical history, I no longer have to make an active choice about passing on my genes. With assisted reproductive technology, the doors are open to carrying a pregnancy anytime up to age 53. I just know now for certain that, for me, a pregnancy would mean using donor eggs.
A visit to the RE can be painful or uncomfortable, confusing, enthralling, educational, inspiring, or worrisome – all at the same time. Surgical procedures and testing add to the complex mix of emotions aroused by having a condition or conditions you don’t entirely understand, an equally confusing array of treatment options, time pressures, and a host of medical practitioners, all with their own particular slant on what constitutes your best treatment plan, and why.
For me, that means surgery next month to remove the UFO, continued monitoring of my endometrial condition, and of course, more visits to the RE, especially should I decide to pursue a pregnancy with donor eggs in the future. I like the idea that I still have options, the immediately pressing medical concern is being addressed appropriately, and some aspects of my fertility still offer possibilities. PCOS has a rhythm and a flow of its own, shifting in prominence at various stages in your life and reproductive cycle, and contributes to a mix of emotional experiences. In choosing how to manage your care, your fertility, and your emotions, I hope you too are able to focus on the positive.
If you have not had the opportunity to hear Gretchen's interviews with pcoschallenge.com, please take the time to do so! Gretchen will also be hosting a PCOS expert webinar next Tuesday…to attend please contact www.pcoschallenge.net for more details on how to do so.
You all are must be sooooooooooooooooooooooooooo tired of hearing me talk about the benefits of sleep. But I work with a sleepless population and it takes a few times to present my case before I make my point. I figure if I hammer at this from as many different angles as I can, and present as many examples of how poor sleep quality can interfere with your health, at least one of my examples will hit home and inspire you to consider your sleep habits and choices.
This doesn't bode well for Jay Leno and David Letterman…unless they team up with TiVo for advertising!
Women whose eggs had been examined and found to be of poor quality had those eggs examined by researchers. It was found that levels of chemicals indicative of oxidative stress were higher in those eggs than they were in the eggs of women whose eggs had been determined to be of good quality.
Taking this one step further, 18 women with low quality eggs were divided into one of three groups and given one of the following 3 regimens: (1) 3 mg melatonin per day, (2) 600 mg vitamin E per day, or (3) 3 mg melatonin AND 600 mg vitamin E per day. Oxidative stress markers were reduced in all three scenarios.
And THEN…in the final phase, 115 women who had not become pregnant with in vitro fertilization (IVF) were divided into two groups. The first group received 3 mg melatonin per day and the second group received no supplement. Melatonin significantly improved the rate of fertilization.
The researchers concluded that oxidative stress (which is what happens when you stress all day and don't sleep well all night), damages the quality of eggs. They also concluded that melatonin supplements can help improve fertilization rate.
Just a note--take melatonin if you want, but don't lose sight of the big picture. If you backed yourself into a corner because you weren't managing your stress and sleep, a pill may not be the complete solution to the entire problem.
Tamura H, Takasaki A, Miwa I, Taniguchi K, Maekawa R, Asada H, Taketani T, Matsuoka A, Yamagata Y, Shimamura K, Morioka H, Ishikawa H, Reiter RJ, Sugino N. Oxidative stress impairs oocyte quality and melatonin protects oocytes from free radical damage and improves fertilization rate. J Pineal Res. 2008 Apr;44(3):280-7.
Last night I settled in to watch the evening news, in time to see an ad for Country Crock's Omega 3 Plus brand margarine. With my reputation as somewhat of an"omega 3 queen," I figured I'd better pay attention. And by the time the ad was over, I knew I had today's post.
This label is a perfect example of why consumers are confused, and why they can have a hard time achieving the benefits of good nutritional choices.
First, the good news.
The margarine has no trans fats, because it contains no hydrogenated or partially hydrogenated oils. For fertility, this is a huge plus--with as little as 2% of your total calories per day coming from trans fats (about 2/3 tsp for the average woman), fertility can drop by as much as 73%.
Secondly, one serving provides 500 mg of omega-3's in the form of ALA.
Now for the confusing and potentially detrimental news.
When the professionals on this blog talk about what we're doing to enhance fertility and reduce inflammation, and we refer to omega-3's, we are primarily referring to EPA and DHA, the omega-3's that, except for omega-3 eggs and foods supplemented with algal DHA, contain either fish or fish oil. (Menhaden oil, which is what is found in Smart Balance Omega 3 Margarine, is a type of fish oil.)
Any other type of omega-3 is likely to be ALA. This type of omega-3 is found in canola oil, and flaxseed oil, among other things. In this margarine, the ALA source is canola oil.
But there is no fish oil or marine algae to provide a similar nutritional feature.
There are some things that flax and canola can do, and there are some that flax and canola simply cannot do.
Many people, nutritionists included, operate on the assumption that since the omega-3 found in canola and flax can be converted into EPA and DHA, that you can get enough of the latter two without having to eat fish. Most respected omega-3 chemists will tell you this is highly unlikely.
On a good day, when your diet is as perfect as it can possibly be (which, even in the case of the person writing this post is never), only about 2-3% of your flax and canola can be converted into the other omega-3's.
Bottom line, it's pretty non-negotiable, you are highly unlikely to get the amount of omega-3's your body needs, especially if you are trying to conceive, if you are assuming you can do it without fish.
Secondly, the primary oil in the margarine appears to be liquid soybean oil. Remember the rule about"S" and"C" oils? Soybean is one of those"S" oils with a tendency to be pro-inflammatory. It was impossible to tell from the label what the ratio of soybean to canola oil was, and I would suspect that it was higher than you're going to want if you're trying to choose fertility-friendly foods.
I immediately became suspicious about this Country Crock product when I went to the website and nowhere, I mean absolutely nowhere, could I find a plainly stated ingredient list. Sure, there's a label to look at, but it's strategically posted in a way that all the nutritional information is there except for the ingredients. Hmmmm…
…so I went to the FAQ section. Couldn't find it there either. I found a lot of long-winded explanations of trans-fat labeling, and that was my second red flag.
Since I had to go to the grocery store anyway, I stopped in and looked at the label. Here, for the benefit of the rest of the people on the Internet, is the list of ingredients from the side of the container of this product:
For more information on healthy fats, go to http://www.zingbars.com/science-of-zing.html, where my Zing Bar friends describe why they did--and didn't--include certain fats in their new product.
Any fat that is going to be solid at room temperature is going to have to have some saturated fat in its formula. Otherwise, it would melt. So even though the total saturated fat content is low, the type of fat being used to provide the solid quality is not one you want to get much of in your diet.
I'm not really a butter or margarine person so giving those up was not an issue for me. But I did start my career in the Chicago area, and I remember how people used to look at me like I was purple-polka-dotted if I even hinted that dairy intake might need to be adjusted. So I know it's an issue for some of you.
Bottom line--if you choose to use the product, do so only once in awhile and sparingly. I'd rather see people use olive oil-based dipping sauces for breads and cook with either canola or olive oil.
If you're interested in learning more, the authors of the study below also wrote a recently released book in plain English entitled, The Fertility Diet. I'd check it out.
Chavarro JE, Rich-Edwards JW, Rosner BA, Willett WC. Diet and lifestyle in the prevention of ovulatory disorder infertility. Obstet Gynecol. 2007 Nov;110(5):1050-8.
I hope you all are not tired of my drumming into you the importance of sleep! This time, I want to look at a study about menopause. A 7 1/2 year study (which really is long and not common to see), discovered that administering melatonin delayed the events of menopause.
If you think of melatonin as one of the body's most powerful (potentially THE most powerful) antioxidant, this makes sense.
What does this have to do with PCOS? My personal feeling is that seeing all the symptoms of PCOS in the age demographic I've watch those symptoms drift down to means I'm seeing old people walk around in young peoples' bodies. I've been in this field for 26 years now, and when I first started out, it was rare to see anyone with insulin resistance or diabetes who was younger than the age of 40.
Fast forward to 5 years ago when I worked with a 9 year old girl. Not only was she insulin resistant, but she was complaining of joint pain that sounded like arthritis, hair loss, and memory problems at school. That's when the lightbulb went off for me. In at least a few cases, it seems as though PCOS is what happens when diseases of old age creep into the reproductive system.
The way we live, which is hard, fast, and with the expectation that pills and procedures can make up for those choices, eventually catches up with us. Pay attention to a few simple things which involve better balance and self care…and we can put off some of the yucky parts about having more birthdays under our belts.
The good news is, if you decide to take action, much of this can reverse. I received an excited phone call not too long ago from a colleague who's been through my PCOS training. She told me that the last 5 clients who she'd advised regarding their infertility had all become pregnant. One of them had failed with in vitro fertilization and was beginning to resign herself to the possibility that she'd never have kids.
My colleague's caveat: The clients who succeed are the ones who are willing to do the work.
We had a discussion about how being a dietitian working in reproduction is really a challenging proposition. Practically everyone else who offers a solution is the one who does the work, while the patient is relatively passive. It can create the impression that fertility is something you can have, if you have enough money to throw at the best experts out there.
Pay someone else to do the work? Do some work yourself? We've really got a hard sell.
But when I received this phone call I literally had chills. All this studying, writing, promoting, training, stressing over how we're going to get this program to take hold…for those five new lives, is completely worth it.
Trust me, it took me awhile to admit to myself, and I do this for a living, that I could improve on my own habits. But as I've realized how much better I feel, I've become very protective of my sleep. I'm rarely even awake anymore to watch the evening news. And when I miss my sleep, I can really see what it does to my body. I'm spacy, moody, stiff, I crave sweets, and I am lethargic. I'm not nearly as creative or productive.
I've also started imposing a rule on myself, if I don't have a good night's sleep, I don't work out the next day. I do go for a walk, but I focus on stress management and I try to time my activity so that I can get some ultraviolet light and hopefully correct my sleep clock. But I've learned, at least for myself, that when I push it, and expect to be able to work long hours AND exercise AND socialize, etc., etc., etc., something always gives.
Maybe that's the good part of having more birthdays under my belt…some wisdom has funally sunk in.
Diaz BL, Llaneza PC. Endocrine regulation of the course of menopause by oral melatonin: first case report. Menopause. 2008 Mar-Apr;15(2):388-92.
