If you're trying to conceive, you likely know that it's important to be getting enough folate in your diet in order to prevent neural tube defects.
Even if you're NOT trying to get pregnant, folate is important for women with PCOS.
Homocysteine is a compound found in the blood, which, in elevated amounts, indicates increased cardiovascular risk and inflammation. It tends to be elevated in women with PCOS.
Fifty patients with PCOS, were divided into two groups receiving two different treatments. The first group received 1700 mg of metformin per day, along with 400 mug folate. The second group received metformin without folate.
Homocysteine levels were significantly increased in both groups, but to a lesser degree when they also supplemented with folate.
I was heartened to see this study, since so much research on PCOS focuses on the part of PCOS we can SEE (i.e., weight), and seems to ignore that biochemistry can be altered regardless of weight. In fact, another study I ran across while looking for a blog topic this morning, focused on the fact that metformin improved biochemistry even without diet or exercise modifications. Yes, you can make a study say anything you wish if you correctly design it, but it is not fair to women with PCOS to do that and falsely lead them to believe that medication is the only answer. And, you've got to understand that even if your weight is normal with PCOS, you still have to pay attention to what is happening metabolically.
You've got to care about what's under the hood, not just how pretty the paint job is.
Palomba S, Falbo A, Giallauria F, Russo T, Tolino A, Zullo F, Colao A, Orio F. Effects of metformin with or without supplementation with folate on homocysteine levels and vascular endothelium of women with polycystic ovary syndrome. Diabetes Care. 2009 Nov 23. [Epub ahead of print]
Oppelt PG, Mueller A, Janetsch K, Kronawitter D, Reissmann C, Dittrich R, Beckmann MW, Cupisti S. The Effect of Metformin Treatment for 2 Years without Caloric Restriction on Endocrine and Metabolic Parameters in Women with Polycystic Ovary Syndrome. Exp Clin Endocrinol Diabetes. 2009 Dec 8. [Epub ahead of print]
I'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.
I recently did a consultation with a young woman with a history of PCOS who was working with a reproductive endocrinologist to assist her with conception. I explained to her that even though she had chosen this route of treatment, nutrition could still be important to her overall success. Here is an important reason why.
Homocysteine is a marker of inflammation when elevated. High homocysteine levels can also interfere with brain development and promote congenital malformations in the developing fetus.
In a study done on rats in which elevated homocysteine levels were induced, the use of melatonin, a powerful anti-inflammatory/antioxidant, helped to reduce the incidence of learning disabilities seen in the offspring of rats with high homocysteine levels.
I cannot recommend the use of melatonin supplements during pregnancy as this is a preliminary study. However, I do know that the dietary pattern you see discussed on this blog is one that is correlated with reduced homocysteine levels. And…you know how much I talk about the importance of adequate sleep. If supplemental melatonin ends up to be beneficial, you can't deny that paying attention to your sleep patterns is a natural way to encourage the same outcome.
So we're not here just talking about how to get pregnant. It doesn't stop there, not at all! If you're going to go through all the expense and trouble to become pregnant, we want to be sure that once you get there, your pregnancy and the baby it produces are equally healthy.
Baydas G, Koz ST, Tuzcu M, Nedzvetsky VS. Melatonin prevents gestational hyperhomocysteinemia-associated alterations in neurobehavioral developments in rats. J Pineal Res. 2008 Mar;44(2):181-8.
