The Hemp Connection:
insulin resistance

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

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

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

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

Hello inCYST readers!

Just a quick thought for Earth Day. Have you ever considered how sustainable living and PCOS management go hand in hand?

If you walk more instead of driving, you use less gasoline and improve your insulin resistance.

If you choose less processed foods, you reduce your consumption of preservatives and unhealthy fats, in addition to your use of packaging and energy.

If you eat locally produced foods, you increase your antioxidant intake and reduce your consumption of fossil fuels.

If you eat organic foods, you reduce the amount of artificial estrogens you put into your body and into the surrounding environment.

If you eat lower on the food chain, you do a lot of all of the above.

If you improve your sleep hygiene and turn the lights out earlier, you improve your melatonin metabolism at the same time you reduce your electricity consumption.

It all fits together. If you sustain the planet, you bring your body into balance.

What are you going to do today, to pay homage to Mother Nature?

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

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!

…and I'm guessing it is, since our own research has shown that most women with PCOS simply do not get enough sleep…

…consider joining us in Los Angeles this July to learn more about how to change that.

Poor sleep can worsen insulin resistance, trigger carbohydrate cravings, promote weight gain, and, well…just make you crabby.

I've been working on a project with colleague Nancy Carballo, that is designed to give you some ideas for how to improve your sleep, hopefully eliminating the need for that godawful and totally unromantic CPAP machine that's all the rage in some circles. We decided to make it fun and interactive, because, well, when you're sleep-deprived, why the heck would you come out on a beautiful Saturday to fall asleep during a bunch of dry medical lectures?

We have a Facebook group if you'd like to learn more and be updated on our event details; you can find us at"Insomniacfest".

Please consider joining us! After all, there's no point losing sleep over your PCOS, your weight, your infertility…or your insomnia.

I received this question after my last Fitness Friday chat about learning that insulin resistant individuals lose their body protein at twice the rate of other people as they age. I have always thought that women with PCOS needed more protein than other people, for a variety of reasons, and this simply served to confirm that sentiment.

I do like the"40-30-30" rule (carbohydrates, protein, fat), and here are the calculations for the grams of protein you would need at a variety of representative calorie levels if you're striving to have 30% of your diet's calories come from protein.

1200 calories 90 grams
1300 calories 97 grams
1400 calories 105 grams
1500 calories 113 grams
1600 calories 120 grams
1700 calories 127 grams
1800 calories 135 grams
1900 calories 143 grams
2000 calories 150 grams
2100 calories 158 grams
2200 calories 165 grams
2300 calories 173 grams
2400 calories 180 grams
2500 calories 188 grams

Most clients I work with are surprised to find that it takes a concerted effort to actually reach this, and that it can be challenging on a vegetarian diet. If you're having trouble, this is a great reason to make an appointment with one of our inCYSTers, trained to help you find ways to get the protein you need to maintain your muscle mass and fight that dreaded insulin resistance.

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

Most women already know by the time they find my website, that a higher protein/lower carbohydrate diet will help them to manage their weight and their insulin resistance. But for some reason, people think that in order to eat better, it has to somehow be programmed and contain a lot of expensive foods. Absolutely not!

Peanut butter is one of my favorite protein foods. It's cheap. It's easy to use. You can keep a jar in your office, or in your suitcase when you travel. And the fat it contains, if you use old-fashioned style, is one of the healthier fats to include in your diet. (Trans fats are what happen when good fat is processed to keep the fat in regular peanut butter from separating out.)

I like to use a peanut butter sandwich as a way to eat more fruit. I don't use jelly, I put whatever is in season on my PB: peaches, pears, apples, berries, bananas…I've even used raisins in a pinch.

Don't get too caught up in thinking healthy has to be hard. It's probably already in your kitchen and there's more potential uses for this treat than your childrens' lunchboxes!

Yup, you heard it here.
Nope, I’m not telling you to ditch the exercise.
I’m encouraging you to be sure you’re balancing exercise with rest, and not overtraining.
If you’re trying to lose weight, your focus is likely on losing fat. That’s a nice goal, and I’m guessing you’ll feel better about what you see when you look in the mirror if that results from your exercise, but it’s not really the main reason you’re exercising for PCOS.
You need to gain muscle. The more muscle mass you have, the harder it is to be insulin resistant. The act of exercise actually breaks muscle down. It rebuilds during periods of rest. It’s the balance of exercise and rest that matters, way more, than how many hours of exercise you’re actually doing.
It can be a vicious cycle to break out of, because insulin resistance itself actually breaks down muscle. So if it’s been awhile since you’ve actively exercised, and you’re not losing weight the way you’d hoped you would when you committed to the gym, consider that your ratio of muscle to fat is not high enough. Your priority, first and foremost, is to build and maintain that muscle.
Focusing too much on losing fat and overtraining in the process… will undermine your progress.
Exercising too late in the evening, getting up too early in the morning to get to the gym (it’s not uncommon to hear women say they’re up at 3 am to fit in the workout), or simply working out so much and so hard that you’re not sleeping well… are all easy ways to sabotage your success.
Things you need to keep in mind:
You need to eat enough protein so that your body builds muscle mass while you're not active.
2. You need to sleep enough so that you don’t promote insulin resistance.
3. You need to not push yourself so hard that you’ve stopped burning fat—monitor your heart rate!
4. You need to vary the workouts so all muscle groups are involved and have a chance to build up. Also, you need to develop the confidence to trust that PROACTIVE exercising, as opposed to REACTIVE exercising, is your path to success. Too often women with PCOS weigh themselves in the morning and if the weight is not what they want to see, react by doubling, even tripling their scheduled workout time in order to “get control” of the situation.
When you’re exercising with the goal of building muscles to reduce insulin resistance, you understand that overtraining is your enemy. You create an exercise plan that perhaps you even map out on your calendar, that you commit to regardless of how you’re feeling or what the scales says. For example, I just mapped out my spring training schedule. One of my friends and I have decided we’re going to take tennis lessons. We both own businesses, and committing to this ensure that we actually get out and move. I also love to swim, and it’s one way I can stay active as the weather in Arizona gets warm. And, I’ve been wanting to bump up my elliptical workouts and try spin classes. So, for the next three months, on my calendar, every fourth day, I’ve written “tennis”, every fourth day “spin”, every fourth day “swim”… and then I schedule a day off. It’s right there in my planner so when I start scheduling meetings and accepting social invitations, I only schedule in a way that does not take away from that commitment to myself. I varied the exercise to give my different muscle groups a rest, and to give me enough variety to not get bored.
And don’t get me wrong… I do relish the day off! We all need a little bit of laziness, sleeping in, and getting caught up. I find, personally, if I don’t have the day off, I have trouble sleeping and I have trouble keeping up with the appetite. I have designed this program to fit with the way I’ve learned my body works. If I like spin, I’ll keep it, or I may prioritize swimming during the heat of the summer. We’ll see. I kind of need to mix it up over time to stay interested.
The point of this post is, the reactive and self-punitive approach many of you have toward exercise, because of your focus on reducing body fat, is your absolute biggest enemy. Focus on building muscle, even though it may mean seeing your weight increase on occasion. It’s reflecting muscle, not fat, and it’s a good sign.
Muscle, muscle, muscle!

My blogger name is hormonewoman; I chose that for a reason. When hormones get out of balance, and out of balance is where they are when we don't take care of ourselves, that's when chronic diseases like PCOS become common…not to mention troublesome.

A relatively new hormone (well, it's been around as long as there have been humans but it's new as far as us scientists knowing it and understanding it) is adiponectin. This hormone helps to combat heart disease and diabetes. And it is apparently sensitive to the kinds of fats we choose to eat.

A population of mice was divided into four groups, each one receiving one of the four following fats: soybean oil, fish oil, coconut oil, or lard. Their biochemical response was measured after 2 days and 60 days on this diet. With every type of fat, except fish oil, adiponectin levels were reduced. Soybean oil and coconut oil produced the most significant reductions.

We're just not going to get around it, are we? Some kinds of fats just aren't health-friendly. Some food options, just need to be passed by.

Bueno AA, Oyama LM, de Oliveira C, Pisani LP, Ribeiro EB, Silveira VL, Oller do Nascimento CM. Effects of different fatty acids and dietary lipids on adiponectin gene expression in 3T3-L1 cells and C57BL/6J mice adipose tissue. Pflugers Arch. 2008 Jan;455(4):701-9. Epub 2007 Aug 24.

Source: Uploaded by user via Monika on Pinterest

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

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

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

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

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

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

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

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

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

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

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

My clients' food diaries tell me a whole lot about current trends in diets in general, as well as what's being said about PCOS. More and more, I'm seeing women report eating coconut oil by the tablespoonful. So I thought I'd dissect the information and evaluate whether or not this is advisable.

Overall, the recommendations for a heart healthy, low glycemic diet, are to eat 30-35% of your calories as fat, equally distributed between saturated, polyunsaturated, and monounsaturated. Here is how that works out for most calorie levels you're likely to be on. First row is 30% of calories, second is 35% of calories.

1200 360 fat calories, 40 grams of fat, 120 calories/13.3 grams each, S-P-M
1200 420 fat calories, 47 grams of fat, 140 calories/15.5 grams each, S-P-M

1300 390 fat calories, 43.3 grams of fat, 130 calories/14.4 grams each, S-P-M
1300 455 fat calories, 50.6 grams of fat, 152 calories/17.0 grams each, S-P-M

1400 420 fat calories, 46.7 grams of fat, 126 calories/14.0 grams each, S-P-M
1400 490 fat calories, 54.4 grams of fat, 163 calories/18.1 grams each, S-P-M

1500 450 fat calories, 50.0 grams of fat, 150 calories/16.7 grams each, S-P-M
1500 525 fat calories, 58.3 grams of fat, 175 calories/19.4 grams each, S-P-M

1600 480 fat calories, 53.0 grams of fat, 160 calories/17.8 grams each, S-P-M
1600 560 fat calories, 62.2 grams of fat, 187 calories/20.7 grams each, S-P-M

1700 510 fat calories, 56.7 grams of fat, 170 calories/18.9 grams each, S-P-M
1700 595 fat calories, 66.1 grams of fat, 198 calories/22.0 grams each, S-P-M

1800 540 fat calories, 60.0 grams of fat, 180 calories/20.0 grams each, S-P-M
1800 630 fat calories, 70.0 grams of fat, 210 calories/23.3 grams each, S-P-M

1900 570 fat calories, 63.3 grams of fat, 190 calories/21.1 grams each, S-P-M
1900 665 fat calories, 73.9 grams of fat, 222 calories/24.6 grams each, S-P-M

2000 600 fat calories, 66.7 grams of fat, 200 calories/22.2 grams each, S-P-M
2000 700 fat calories, 77.8 grams of fat, 233 calories/25.9 grams each, S-P-M

One teaspoon of coconut oil contains 5 grams of saturated fat. Assuming that most fat that is found in milk and dairy is also saturated, let's work backwards and see on each of these calorie levels, at the two percentages, at any calorie level, you would not have any saturated fat left to allocate to your major sources of protein, calcium, and vitamin D. Keep in mind, women who consume at least one serving of fat-containing dairy a day are significantly more fertile than those who do not.

In the other direction, if you are eating entirely lean sources of protein (fish, poultry, lean red meat), and one serving of dairy a day, you should assume that about 23 grams of saturated fat will come from those sources. Again, even if you are aiming for 2000 calories a day, that leaves you room for 2.9 grams, or half a teaspoon of coconut oil per day.

Let's say you choose to switch out your unsaturated fat (where your pro-inflammatory omega-6 oils are found), for coconut oil. If, and only if, you had absolutely no other fats from these oils, you could include this much coconut oil in your diet.

1200 2.6 tsp/3.1 tsp
1300 2.7 tsp/3.4 tsp
1400 2.8 tsp/3.6 tsp
1500 3.3 tsp/3.9 tsp
1600 3.6 tsp/4.1 tsp
1700 3.8 tsp/4.4 tsp
1800 4.0 tsp/4.6 tsp
1900 4.2 tsp/4.9 tsp
2000 4.4 tsp/5.2 tsp

Even at the highest level I calculated, there is not enough room for 2 tablespoons of coconut oil in your diet. The excess calories will eventually set you up to gain weight. All oils, even healthy oils, in excess, promote weight gain.

There is some evidence to suggest that this proportion of saturated fat to monounsaturated fat may be too high, because fluidity of neuron membranes is important for healthy brain and nervous system function…and too much saturated fat of any kind, is correlated with rigid (undesirable) membranes.

I double checked peer-reviewed references in Pub Med and was not able to find any articles describing studies that would have been the source for this dose. I did find some cautionary information, however.

A high-fat diet, when the fat is coconut oil, in one study, was associated with lower bone density than high-fat diets based on either flaxseed (omega-3) or safflower oil (omega-6).

Yes, a diet that is 10% coconut oil, as described above, has been reported to improve metabolic parameters. However, when the amount of fat is increased, to 25%, increased blood free fatty levels, insulin resistance, and hypertension, all increase as well. The incidence of atherosclerosis in this study also doubled.

It looks to me like what may be going on here, is that one study was taken out of context and used as a promotional piece of information by companies with much to gain if their sales of coconut oil increase. When you're looking for good information, go to the source. Websites primarily intended to sell a product, even if they provide references, are not"the source". Chances are, they will omit any references that encourage any kind of limitation of use of their product.

I have more information on coconut oil in future posts. I don't think it's bad, I just think it's being over-hyped and misused, in a way that can be especially problematic for women highly at risk of metabolic and hormonal disorders.

Lau BY, Fajardo VA, McMeekin L, Sacco SM, Ward WE, Roy BD, Peters SJ, Leblanc PJ. Influence of high-fat diet from differential dietary sources on bone mineral density, bone strength, and bone fatty acid composition in rats. Appl Physiol Nutr Metab. 2010 Oct;35(5):598-606.

Waqar AB, Koike T, Yu Y, Inoue T, Aoki T, Liu E, Fan J. High-fat diet without excess calories induces metabolic disorders and enhances atherosclerosis in rabbits. Atherosclerosis. 2010 Nov;213(1):148-55. Epub 2010 Aug 11.

Here's an interesting Cochrane Review hot off the presses, evaluating the effects of insulin-sensitizing agents on fertility.

A group of 31 studies that compared the effectiveness of these agents to a placebo were evaluated for what they said overall about the potential benefit for their use in women with PCOS who are trying to conceive. Of these, 27 were studies about metformin (likely because it is the most widely researched/used and more studies exist in the first place).

What the researchers concluded:

There is no evidence that metformin improves live birth rates whether it is used alone or in combination with clomiphene. However, metformin does improve ovulation and pregnancy rates. (Interpreted, this suggests that metformin does not help to prevent miscarriage.)

Metformin was also associated with a significantly higher incidence of gastrointestinal disturbance, but no serious adverse effects were reported. (I don't know about those of you reading this blog post who have tried metformin, but I would question the assertion that the gastrointestinal disturbance this medication causes is not a"serious adverse effect"!

IN THE WORDS OF THE AUTHORS:"In agreement with the previous review, metformin is still of benefit in improving clinical pregnancy and ovulation rates. However, there is no evidence that metformin improves live birth rates whether it is used alone or in combination with clomiphene, or when compared with clomiphene. Therefore, the use of metformin in improving reproductive outcomes in women with PCOS appears to be limited."

D-chiro-inositol was not even mentioned in the abstract, suggesting that the findings were not significant.

As with any information shared in this blog, only you and your provider can make the ultimate decision. I can tell you what went through my own mind--and heart--as I read this, was that this medication may create a lot of false hope and hurt for those who trust that it has more power than it actually does. I wouldn't wish a miscarriage on anyone.

Tang T, Lord JM, Norman RJ, Yasmin E, Balen AH. Insulin-sensitising drugs (metformin, rosiglitazone, pioglitazone, D-chiro-inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD003053.

Just saw on the nightly news that researchers are reporting a connection between caffeine intake and miscarriage.

Here is the link to the story:

http://health.usnews.com/usnews/health/healthday/080121/once-again-caffeine-linked-to-miscarriage.htm

What surprised me about the report is that they only focused on COFFEE. In working with women who are trying to lose weight, and consuming a lot of diet shakes and energy bars in the process…they also consume a lot of chocolate, which also contains caffeine.

Caffeine also impairs sleep, and people who sleep less have more problems with insulin resistance and weight management.

I've never understood why all these products have to contain chocolate. Not only is this counterproductive hormonally, but it is not realistic for anyone to eat in a way that defines normal eating as that in which the main course is regularly an ingredient that is supposed to be an add-on once you've eaten all the things that balance your diet!

Just wanted to pass this along in case it prevents unnecessary problems for someone who's working hard to be a mom.: )

OK. Today's the day. There was finally a quiet morning to read the research about d-chiro inositol. Ever since I posted a link to Sasha Ottey's interview on the topic on her PCOS Challenge radio show, traffic linking to us with that keyword has been very high. I've known we needed a blog post, but I just wanted to be sure it was scientifically accurate and presented information in a way that was beneficial, not hurtful.

What is inositol? It is a chemical that is necessary for several body functions, including: cell structure, insulin function, nerve function, fat breakdown, and maintenance of healthy cholesterol levels.

Inositol comes in nine different forms. Two of those types of inositol, myo-inositol and d-chiro-inositol, have been found to have therapeutic value. Myo-inositol supplementation has been found to alleviate symptoms of bulimia, panic disorder, obsessive-compulsive disorder, agoraphobia, depression, and bipolar disorder. d-chiro-inositol supplementation has been found to be useful for symptoms associated with insulin, high androgen levels, and menstrual irregularity. It is also reported that myoinositol can help prevent hair loss.

Both categories of symptoms are common in PCOS, so it appears that inositol levels and metabolism may be problematic with a high percentage of readers of this blog.

One thing you can do to help improve your levels of both myo- and d-chiro-inositol is to know their dietary sources. Myo-inositol is found in brewer's yeast, liver, milk, whole grains, brown rice, oats, nuts, citrus fruits, molasses, legumes, raisins, and bananas. The best sources of d-chiro-inositol are buckwheat and garbanzo beans (hummous, anyone?)

The theory is, that women with PCOS have trouble converting myo-inositol into d-chiro-inositol. So they need to bypass that metabolic bottleneck with a supplement.

I haven't had the opportunity to use d-chiro-inositol with my clients yet. I haven't wanted to recommend anything unless I'd researched it. But I had a client once, with severe OCD, who responded well to myo-inositol in a way medication and behavioral therapy never achieved. The only issue she had with the supplement was the large dose she needed to take (10 grams per day) in order to see benefit.

Fast forward to today, I've been wondering for awhile if maybe the symptoms attributed to myoinositol deficiency weren't actually myoinositol issues at all, but d-chiro-inositol issues, and the large dose needed was because the conversion in this population is so low.

So here's the best way I would think it would work to determine if d-chiro-inositol deficiency is your problem.

1. Be sure to include all the foods I mentioned above in your diet on a regular basis.

2. Try d-chiro-inositol. Give it three months of regular use to see if it helps.
--If it helps with your insulin levels, androgen levels, and menstrual cycles, then by all means continue using it!
--If it helps with the above, but doesn't help with binge eating, mood, or obsessive thinking, then consider adding some myoinositol to the mix.

3. And please, check back with us. I'm really curious to know what happens. If d-chiro-inositol also helps with mood, etc., that's very important information.

Recommended doses of each: myo-inositol 12-30 grams per day
d-chiro-inositol 100 mg, twice per day

I know, I know, if you're obsessive, you're going to want to take the higher dose of myo-inositol, or even double the dose I've listed.: ) I strongly encourage you to resist the temptation and start low and titrate up as you need to.

I spent quite a bit of time in the supplement department at Whole Foods, to get an idea of what readers would find if they went to buy inositol. As you can see at this link, the options on amazon.com, as they are in most health food stores, are primarily myoinositol.

If you'd like to purchase d-chiro-inositol, the most popular source for women with PCOS appears to be www.chiralbalance.com.

I'm hearing from some of you that you're having fun learning about new and different foods, so I thought I'd pass along an idea for the more adventurous readers!

My mom was just telling me that she and my dad went to a Peruvian restaurant recently, and they tried a traditional drink called chicha morada. It is made with purple corn and has a much higher resveratrol content than red wine. It's also high in anthocyanin, the powerhouse commonly associated with blueberries. I did some checking, and found that there is research suggesting that purple corn may help to fight insulin resistance (reference below).

I'm posting a link to a video that shows you how to make the drink. Note that it includes cinnamon, another ingredient many of you are already using for insulin resistance.

http://renegadehealth.com/blog/2010/07/07/how-to-make-the-chicha-morada-super-peruvian-resveratrol-drink/

If you can't find purple corn anywhere near you, you can find it on amazon.com

When you think of your PCOS journey as an adventure, instead of something that limits you, it's amazing how much fun you can have in the kitchen.

Dietary cyanidin 3-O-beta-D-glucoside-rich purple corn color prevents obesity and ameliorates hyperglycemia in mice. J Nutr. 2003 Jul;133(7):2125-30.

Why is it that we have a need to wear on our sleeves how little we sleep, as if it's a badge of honor?

People who don't sleep are physically hurting themselves in ways that diet and exercise can't always repair.

The large and famous nurses' study showed that women working night shifts had a greater incidence of breast cancer than those working during the day.

Accumulating research is connecting poor sleep with weight gain, insulin resistance, and diabetes.

What is it about sleep that is so crucial?

Melatonin. It's our body's most powerful antioxidant. It literally acts like a scrubbing bubble when we sleep, scouring that inflammatory damage from a day's worth of living, thinking, and stressing, leaving the brain and nervous system clean and ready to go the next day.

When we cut ourselves short on sleep, we don't give melatonin a chance to do its job.

We age ourselves much more quickly than we do when sleep is something we prioritize.

First thing you need to do to change things, is change your attitude about sleep.

You are not a better person because you deprive yourself of it.

You can't make up for what you lost during the week, over the weekend. Once it's lost, it's lost.

You may not be able to overcome the damaging effects of too little sleep with better eating and more exercise. In fact, it may be harder to achieve this while sleep deprived, because you are more likely to accelerate aging even more with the caffeine and sugar you're using to get through the day.

Want to get your weight under control? Reduce your cancer risk? Improve your fertility?

Sleep. It's that simple.

Last night I was watching"The Biggest Loser" while taking down my Christmas decorations. It's not that I agree with everything the show says or does…but it helps me to understand where the people I work with get their ideas about nutrition and exercise.

Anyway…the first pair to be removed from the competition was a father and daughter team. The father was not too motivated to participate in the competition, much to the frustration of his daughter. Adding to this woman's frustration was the fact that, despite her being in the gym and working at least twice as hard as her father, she lost only 1/3 of the weight.

And every season it seems to be just like that. The women who work the hardest see the least weight loss. And every time I see some woman removed from the show for her low weight loss…I want to throw something at my television and scream,"DUH…insulin resistance!!!"

A few years ago I participated in a local TV station's version of this program. Four teams of two screened videos in order to choose the people who would be competing under our guidance. The trainer I was teamed with actually turned to me in the middle of watching a video of a woman with a PCOS-type body and said…"I hate working with this type of person" I asked why, and he responded,"Because it takes them forever to lose weight."

If you happen to be one of these people who would be kicked off of national TV for not losing weight quickly enough, or if your doctor rolls her eyes when you mention that you're eating less and exercising more with no results…take heart.

It's not that you can't lose weight and get into shape, it's more that the ways we tend to believe it needs to be done in our culture are working against the hormone profile your body has drifted into when it was not getting the right mix of good nutrition, physical activity, sleep, and relaxation.

If you watch to the end of the show, these women always do lose weight, it just takes longer for their body to respond to the new way of doing things.

So don't take these messages or slow weight loss as signs that you're destined to have the body you currently have. Just remember that your body is one that responds better to consistency and diligence and slow changes better than it does to quick fixes.

One of the more frequent searches bringing readers to our blog is"vegetarian" and"fertility"…and"vegetarian" and"pcos". I've also noticed when doing Fertility Friendly Food Tours at Whole Foods, that a disproportionate percentage of women attending these classes, are vegetarian. And, in my individual counseling, it's not uncommon to learn during an assessment that if a client is not currently vegetarian, she was at some point in her life.

So I wasn't surprised to find this study reporting that women with PCOS tend to be deficient in vitamin B12.

I often teach that PCOS is a counterintuitive illness. By that, I mean that what often needs to be done is the opposite of what you might think. In this case, rather than immediately assuming that the most important strategy is to restrict food choices because your appearance suggests overnutrition, it may actually be to add foods back into your diet to correct underlying deficiencies.

This B vitamin is found almost exclusively in animal products, including fish, meat, poultry, eggs, milk, and milk products. It is also found in some fortified breakfast cereals, but if you're avoiding carbohydrates as well as trying to be vegetarian, you're likely not getting enough vitamin B12 in your diet.

Some fermented soy products, namely tofu, tempeh, miso, and tamari, may contain vitamin B12, if the bacteria, molds, and fungi used to produce them were vitamin B12 producing. This is a project I'll look into and blog about in a later post.

Finally, some nutritional yeast products also contain vitamin B12. Lucky for you Aussies reading this blog, that means Vegemite and Marmite, made from yeast extracts, can be excellent choices to include in your diet!

It is possible to obtain vitamin B12 by taking a vitamin supplement, but the amount of the vitamin that is actually absorbed through the digestive tract may be very low. For this reason, physicians who note a low vitamin B12 level may recommend an injection, to bypass the digestive tract.

Women over 14 years of age, if not pregnant, should be consuming 2.4 mcg of vitamin B12 per day. They should aim for 2.6 mcg per day when pregnant, and 2.6 mcg per day when breastfeeding.

It's clear, if you don't do vegetarian eating in a thoughtful, proactive way, it carries considerable health risks. As you've seen before in this blog, inCYST believes that healthy vegetarian eating is about what you DO choose to eat, more than what you DON'T choose to eat.

It is a good idea, if you're vegetarian, or ever have been, to ask your physician to check your vitamin B12 levels. A low status is easy to correct and that can be part of your strong foundation for managing your PCOS and improving your mood, insulin function, and fertility.

Kaya C, Cengiz SD, Satiroğlu H. Obesity and insulin resistance associated with lower plasma vitamin B12 in PCOS. Reprod Biomed Online. 2009 Nov;19(5):721-6.

Many of you already know you're insulin resistant, and are receiving medical attention for that. Here are the basic nutrition and lifestyle actions you can take to further help minimize the impact of that issue on your pregnancy success.

1. Move! I'm a distance runner. As much as I love running, however, I have a lot of other activities I love to do. Having a variety of activities to rotate through prevents boredom, and it involves different muscle groups in exercise. I learned to vary after a ski injury that sidelined my running for a year. You don't want that to happen, to become so dependent on one activity that you set yourself up to lose activity completely. These days I run, but I also walk, rollerblade, garden, hike, golf, swim and do yoga. (Ivonne recently talked me into trying a tango class. I think dancing is my new favorite!) Any little thing you can do that tells your body it needs to get better at moving glucose into muscle cells…is what you need to do.

2. Commit yourself to better sleeping habits. Poor sleep, either few hours or bad quality, interferes with insulin function. The clients I work with who prioritize better sleep are the ones who notice feeling better the soonest. It can be a hard one if you love the late night shows, easily get lost in the Internet, or don't set good boundaries with others. But good sleep is one of the most important things you can give yourself. If you search"sleep" in this blog there is a lot of information about how to achieve this.

3. Watch the caffeine. This goes hand in hand with #2. Caffeine in coffee, tea (it's in green tea, too, so be aware), chocolate…it all challenges healthy sleep. It's something you are best to live without during pregnancy anyway, so why not get used to decaffeinated life now if that's where you want to be?

4. Be aware of glycemic index. Foods with a low glycemic index are foods that don't challenge your insulin function as much as other foods. It's not that high glycemic foods are"bad", it's just that they should not be eaten as often. In order to make a MEAL lower-glycemic, be sure you have a good balance of carbs, fats, and proteins. People eating on the run tend to challenge glycemic function either by eating large quantities of fast food or nibbling all day long on carbs without making time for protein.

5. Pay attention to your fats. One reason I push the fish oil so much is that it really helps to improve insulin function."S" and"C" oils--safflower, sunflower, soybean, corn, cottonseed…tend to worsen glycemic function. They're found in processed foods, baked goods, and salad dressings. One reason I love teaching my classes at Whole Foods is that their entire deli uses only olive and canola (the only"C" exception) and you can literally choose what you want without ingredient anxiety.

6. Add a little cinnamon to your low-glycemic oatmeal. It has been found to improve insulin function…and it's tasty!

A word about metformin. Some women complain about digestive disturbances with this medication. A physician once shared that if you eat a lot of carbs (particularly sweets) while on the medication, it can cause diarrhea. So be forewarned, taking the medication is not a license to eat what you want, assuming metformin is going to do all the work. Metformin is most effective if you use it in conjunction with the guidelines in this post.

Next progesterone post we'll talk about poor nutrition. It is very important!