In a study I did with over 1,000 women with PCOS who visited my website, over 85% described symptoms of anxiety and/or depression, conditions commonly treated with antidepressants. Therefore, any information I find regarding these medications and their effect on pregnancy is crucial to share.
In the study referenced in this post, over a period of almost 10 years, a total of 1,780 women who experienced 1,835 pregnancies over this time while also receiving either paroxetine (Paxil) or a combination of Paxil and at least one other antidepressants, during the first trimester of pregnancy. These women were compared to 9,008 women experiencing 9,134 pregnancies while on other antidepressants and antidepressant combinations that did not include paroxetine, in the first trimester of pregnancy, over the same period of time. The researchers report that there is a modest increased risk of congenital malformation (birth defects) in women who use paroxetine alone or in combination therapy during the first trimester of pregnancy.
Bottom line? Since often times you don't even know you're pregnant during that first trimester, if you are trying to conceive, or even having sex, and you are being treated for depression, it would be prudent to discuss an alternative to paroxetine with your caregiver.
Better safe than sorry!
Cole JA, Ephross SA, Cosmatos IS, Walker AM. Paroxetine in the first trimester and the prevalence of congenital malformations. Pharmacoepidemiol Drug Saf. 2007 Oct;16(10):1075-85. Comment in: Pharmacoepidemiol Drug Saf. 2007 Nov;16(11):1181-3.
This just in from registered dietitian and licensed acupuncturist Karen Siegel. Karen's practice is in Houston, Texas, if you are interested in consulting with her.
Acupuncture Benefit Seen In Pregnancy By SHIRLEY S. WANG
Acupuncture designed to treat depression appears to improve symptoms in pregnant women, suggesting it as an alternative to antidepressant medication during pregnancy, a study found.
The study, published Monday in the journal Obstetrics & Gynecology, is the largest to date examining the effectiveness of acupuncture to treat depression in pregnant women. It was funded by a grant from the government's Agency for Healthcare Research and Quality."Acupuncture that we have tested works for pregnant, depressed women," said Rachel Manber, a study author and professor at Stanford University. However,"no single study is enough to make policy recommendations," she said.
Depression in pregnancy is a risk factor for postpartum depression. Postpartum depression is associated in some studies with poorer cognitive and emotional development in children. Some have linked depression in pregnancy and low birth weight.
As many as 14% of pregnant women are thought to develop depression at some point during their pregnancy, according to the study authors, comparable to numbers who suffer from postpartum depression. Antidepressants are generally considered safe for use in pregnancy, but research has been limited and concerns continue to grow, according to the National Institute of Mental Health.
Acupuncture attempts to treat conditions by stimulating points on the body, most often with needles stuck in the skin and moved by hand or electrical stimulation, according to the National Center for Complementary and Alternative Medicine.
In the study, 150 clinically depressed pregnant women who weren't previously taking antidepressants were randomly assigned to get either acupuncture for depression, acupuncture not specifically designed for depression, or massage for eight weeks. Some 63% of women in the acupuncture-for-depression group responded to treatment, compared with 44% in the other groups.
Printed in The Wall Street Journal, page D3, February 23, 2010
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.
Knowing that PCOS often goes unrecognized, and that PCOS research often overlooks some of the most important issues cysters deal with, I'm trying to bring research to this blog you may not find if you're using"PCOS" as your search term but which may be entirely pertinent. In this case, I want to talk about antidepressants, which are very commonly prescribed in PCOS, whether it's officially diagnosed or unrecognized.
This study was conducted because of the number of women who use antidepressants. That increases the possibility that a woman may, intentionally or not, become pregnant while taking antidepressant medications. The researchers wanted to know if fetal exposure to antidepressants may influence brain and nervous system development. This particular study was done with mice, but it was previously determined that mice and humans demonstrate similar mother-fetal transfer with the medications being evaluated.
Fluvoxamine (Luvox) had a lower rate of transfer than did fluoxetine (Prozac). More offspring died in the group using fluoxetine, and most of these deaths were due to heart failure related to cardiac defects. The researchers reported no deaths related to fluvoxamine.
In addition, the part of the brain that distributes serotonin to the rest of the brain, the raphe nucleus, did not function properly in the brains of rat pups whose mothers had been exposed to fluoxetine. Behaviorally, these rats exhibited more anxiety- and depression-related behaviors as adults than rats who had not been exposed.
So it seems that babies of moms who have depression may be set up to have the same problems when they become adults. Some of that may be genetic, but some of it may be perpetuated by the way the mother's biochemistry is treated by her caregivers.
Bottom line, if you're using antidepressants, even if you're NOT trying to become pregnant but you MIGHT become pregnant because you're sexually active, you may want to be sure that you discuss this with your physician and determine which treatment option is most appropriate.
Don't forget diet and fish oil--they can eliminate the need in many cases to even have to make this kind of decision!
Noorlander CW, Ververs FF, Nikkels PG, van Echteld CJ, Visser GH, Smidt MP. Modulation of serotonin transporter function during fetal development causes dilated heart cardiomyopathy and lifelong behavioral abnormalities. PLoS ONE. 2008 Jul 23;3(7):e2782.
Since we talk so much about the importance of fish oil for women's health, we get forwarded articles and studies from colleagues who'd like to know what we think.
Late last night, Minh-Hai Tran forwarded me an article entitled,"Healthy and Pregnant: Forget the Fish Oil".
The hairs on the back of my neck immediately prickled on seeing this title…knowing the potential for confusion this could cause with readers like ours, who've heard us talk so much about an opposing viewpoint.
Here's a closer look at what the article says and how it fits into our treatment model.
I've always followed the guidelines established by the International Society for the Study of Fatty Acids and Lipids (ISSFAL) when evaluating studies and formulating recommendations. Here are their recommendations, right off of their website. I comment on the current study's accommodation of these recommendations in italics below each item.
1. Dietary fat intake during pregnancy and lactation, as a proportion of energy intake, should be the same as that recommended for the general population.
I was not able to find if there was any standardization of diet during this study. This is a common error in study design when evaluating the effectiveness of a supplement. Any added chemical in any study is going to respond differently, depending on the biochemistry of the environment into which it is introduced.
The pre-pregnancy weights of the women in the study were not mentioned, either. I would imagine that this would potentially affect the outcome of the study.
2. The n-3 LC-PUFA, DHA, must be deposited in adequate amounts in brain and other tissues during fetal and early postnatal life. Several studies have shown an association between maternal dietary intake of oily fish or oils providing n-3 LC-PUFA during pregnancy and/or lactation and visual and cognitive development as well as other functional outcomes of the infants.Pregnant and lactating women should aim to achieve a dietary intake of n-3 LC-PUFA that supplies a DHA intake of at least 200 mg/d. Intakes of up to 1 g/d DHA or 2·7 g/d n-3 LC-PUFA have been used in randomized trials without occurrence of significant adverse effects.
It appears from the comment of the lead researcher that a dose of 200 mg DHA per day is what was used in the study. Our experience at inCYST is that it can take significantly more DHA than that to see benefit. This is especially true if the diet in which the supplement is included is high in omega-6 fatty acids, which interfere with omega-3 activity. The study size is large--around 2,400 women, which would have given these researchers an opportunity to collect dietary intake data and evaluate if there were different results in women whose diets were high in omega-6 fatty acids vs. those which were higher in omega-9 fatty acids. Huge opportunity lost, and important advice for anyone currently putting together any kind of study regarding omega-3 fatty acids. The entire diet, not just the dosed supplement, is important to standardize and measure.
I would have been interested to see various levels of DHA--200, 500, 750, 1000 mg, to see if the same results resulted. Using the lowest dose possible is going to be the treatment least likely to produce positive results.
3. Women of childbearing age can meet the recommended intake of DHA by consuming one to two portions of sea fish per week, including oily fish, which is a good source of n-3 LC-PUFA. This intake of oily fish rarely exceeds the tolerable intake of environmental contaminants. Dietary fish should be selected from a wide range of species without undue preference for large predatory fish, which are more likely to be contaminated with methylmercury.
I agree, that there may be more to this issue than DHA. For example, much information is coming out about the importance of adequate vitamin D for reproductive health. Is it the fish oil or the vitamin D in the salmon…or the interaction between the two that is important? Future studies need to separate out and explore these questions…in the presence of a controlled diet.
Intake of the precursor, a-linolenic acid, is far less effective with regard to DHA deposition in fetal brain than the intake of preformed DHA.
5. There is no evidence that women of childbearing age whose dietary intake of linoleic acid is adequate need an additional dietary intake of arachidonic acid.
This was not a concern with this study.
6. Some studies have shown that maternal intake of fish, fish oils or n-3 LC-PUFA results in a slightly longer duration of gestation, a somewhat higher birth weight and a reduced risk of early preterm delivery. The clinical importance of such effects with regard to infant health has not been fully elucidated.
This finding was confirmed in the new study. I look forward to future studies understanding why.
7. Screening for dietary inadequacies should be performed during pregnancy, preferably during the first trimester. If less than desirable dietary habits are detected, individual counselling should be offered during pregnancy as well as during lactation.
It does not appear that individual omega-3 fatty acid status was evaluated in the women in the new study. So if the womenwere deficient, a low DHA dosage likely would not have been enough to elucidate a treatment response. If the women had adequate DHA in their tissues before coming pregnant they likely would not have experienced a treatment response.
All due respect to the well-intended researchers, some important aspects of study design were not incorporated, limiting the conclusions that can be drawn from this study. I hope they include a dietitian in future studies.
All due respect to MSNBC, please consider the damage and suffering you potentially inflict on women who could drastically benefit from a simple dietary intervention, on behalf of titling an article purely with SEO (search engine optimization) in mind. Post partum depression is a serious disorder, hurting many others in addition to the woman whose biochemistry produces it.
I'm passing this along since the coexistence of depression and pregnancy is so very high amongst the readers of this blog. Findings like these are a huge reason I am so adamant about finding ways that nutrition and nonpharmacological treatments can keep both mother and baby healthy all the way through conception and pregnancy.
To see this story with its related links on the guardian.co. uk site, click here
Antidepressants linked to premature birth risk
Tuesday October 6 2009 BMJ Group
Mothers-to-be risk having a premature birth if they take commonly used antidepressants during pregnancy, a new study has found. Antidepressants called SSRIs (the group of drugs that includes Prozac) were also linked to a higher risk of babies needing treatment in intensive care soon after birth.What do we know already?
More than 1 in 10 women become depressed during pregnancy. In cases where doctors recommend drug treatment, the first choice is often a selective serotonin reuptake inhibitor (SSRI).
Doctors are advised that pregnant women should take SSRIs"only if potential benefit outweighs risk". Unfortunately, there's little research on how safe these drugs are during pregnancy. We do know that SSRIs get into the unborn baby's bloodstream, and that some babies get withdrawal symptoms soon after birth. Some research also suggests that babies may be more at risk of heart defects if their mother takes an SSRI called paroxetine in the first three months of pregnancy, although this problem is not common.
A new study has looked at 329 women who were taking SSRIs while pregnant. The health of their babies was compared with the health of babies born to women not taking antidepressants. Some of the women in this latter group had mental health problems, while others did not.What does the new study say?
Women taking an SSRI had twice the risk of a premature birth. On average, women gave birth four or five days sooner if they took an SSRI while pregnant. But the results don't tell us the actual numbers of women in each group who gave birth prematurely, so we can't say what the actual risk is.
About 16 in 100 babies needed treatment in an intensive care unit if their mother had taken an SSRI, compared with 7 in 100 babies whose mothers were healthy, and 9 in 100 babies whose mothers had a mental health problem but who weren't taking an SSRI.
Babies also appeared less healthy overall if their mother had taken an SSRI. This was measured looking at their skin colour, how much they moved about, their pulse rate and breathing, and how much they responded to stimulation.
SSRIs didn't increase the risk of having an underweight baby. The study only looked at what happened around birth, so we don't know whether or not SSRIs have longer-term consequences. How reliable are the findings?
This is a fairly good study. Since it also included a group of women who had mental health problems but who were not taking an SSRI, we can partly rule out the possibility that mental health issues affected the baby's health rather than antidepressants. However, it could still be that women taking SSRIs were more seriously depressed than the women they were compared with, or that they had worse overall health. This factor might have affected the health of the babies, and it makes the study less reliable.Where does the study come from?
The women who took part in the research all had antenatal care at a hospital in Aarhus, Denmark. The study appeared in a journal called Archives of Pediatrics & Adolescent Medicine, published by the American Medical Association. Some of the funding came from the Danish Medical Research Council.What does this mean for me?
The study suggests that, in the short term at least, there could be some negative consequences to taking SSRIs while pregnant. What the research doesn't tell us is how the risks of SSRIs in pregnancy compare with the dangers of untreated depression.
Depression itself can affect how babies grow. It can also cause unpleasant symptoms for the mother. There's a high chance of becoming depressed again when women stop taking antidepressants when they're pregnant. So, we can't simply say that pregnant women should completely avoid SSRIs.What should I do now?
If you're pregnant and taking an antidepressant, don't stop treatment suddenly. You could put yourself at risk of unpleasant withdrawal symptoms, and your depression could come back. Your doctor can help you weigh up the risks and benefits of treatment. If you and your doctor decide it's the right thing to do, you'll need to come off your medicine gradually. You could also ask about other types of treatment, such as talking therapy.
If you're taking antidepressants and you want to get pregnant, talk to your doctor. Depending on how severe your depression is, your doctor might suggest slowly coming off your medicine, or continuing to take it.From:
Lund N, Pedersen LH, Henriksen TB. Selective serotonin reuptake inhibitor exposure in utero and pregnancy outcomes. Archives of Pediatrics & Adolescent Medicine. 2009; 163: 949-954. BMJ Publishing Group Limited ("BMJ Group") 2009
Something I am committed to with this work is making sure that every mother out there who plans to get pregnant or who is pregnant understands, is that they need marine oils in their diet. I don't care if you get them from algae, I don't care if you get them from fish…I care that you get them.
We've gone so overboard in steering women away from fish that we're creating more problems than we're solving.
Our brains and nervous systems are in large part made of marine oils. When pregnant, especially in the final trimester, a significant percentage of those oils are given to our developing babies. That is the time during pregnancy when the brain and nervous system develop. In one study, between the 28th week and delivery, blood DHA levels were measured and found to decrease. It didn't matter if the baby was born prematurely, to term, or late, the trend persisted. It happened even in women who were eating what they considered to be a lot of fish.
It bothers me greatly that a population that may actually need to be supplemented with fish…is encouraged to stay away from the very nutrient they need larger quantities of. And then we wonder why problems such as autism are epidemic.
I am hoping that the pregnant and future pregnant readers of this blog use this information to their benefit, and share it with anyone who could use it. We just aren't making sense with our recommendations when it comes to this crucial nutrient.
Bonham MP, Duffy EM, Wallace JM, Robson PJ, Myers GJ, Davidson PW, Clarkson TW, Shamlaye CF, Strain JJ. Habitual fish consumption does not prevent a decrease in LCPUFA status in pregnant women (the Seychelles Child Development Nutrition Study). Prostaglandins Leukot Essent Fatty Acids. 2008 Jun;78(6):343-350. Epub 2008 Jun 26.
A few months ago I had a Whole Foods class and no one came. But a Whole Foods employee said she was interested in the material so I stayed and did an individual class just for her.
I just received this email…
It meant a lot to me that you were so open to helping me. I am pregnant!!! Going into my 10th week! We are so excited and blessed!!!!! I’m due Easter Sunday! WOW!!!!!
This conception occurred approximately 2 1/2 weeks after our consultation.
I am so grateful to Whole Foods for letting us use their store and the best ever thank you I could imagine giving…is adding a member to the Whole Foods family.
I find it so interesting that we only seem to think exercise is good for losing weight and toning muscle. There are so many other benefits! Exercise helps to combat depression, it can clear your head when you've been sitting at your computer, it can help you better use anti-oxidants…and now, researchers believe it can help you have a healthier pregnancy.
Pre-eclampsia is a greater risk for women with PCOS. It is a condition characterized by high blood pressure and protein in the urine. It is the most common pregnancy complication, and it can affect both mother and baby. Doctors often deliver babies early when pre-eclampsia occurs. We're learning that, in order for the brain and nervous system to develop as much as it possibly can, it is important to keep the baby in utero as long as possible. So there would be great benefit to preventing pre-eclampsia whenever possible.
2241 pregnant women were interviewed at their 15th week of pregnancy. They were found to have a lower risk of pre-eclampsia if they participated in recreational activity in the year before becoming pregnant.
Wow! A simple choice with profound effects! A little bit of exercise can go such a long way. You'll feel better, sleep better, have a less troublesome pregnancy…and who knows, if you're feeling better, sleeping better, and participating in an activity you enjoy, there may be less temptation to eat out of emotional stress. Calories in and calories out may be more easily balanced, and you might actually lose weight, too. But the important thing is, if you practice good self care right now…today…someone else down the road…someone you've not even had the chance to meet yet…may have much to thank you for.
Rudra CB, Sorenson TK, Luthy DA, Williams MA. A Prospective Analysis of Recreational Physical Activity and Preeclampsia Risk. Med Sci Sports Exerc 2008; 40(9): 1581-1588.
It's great to be back with the new team of PCOS course graduates! I hope you enjoyed Susan Dopart's recipe and that other contributions will be educational and practically useful.
Today I wanted to share some recent findings about the effects of elevated glucose on a developing baby. If you have PCOS and you are pregnant, you are at risk for gestational diabetes. I realized while reading this study that rarely is the effect of hyperglycemia on the fetus ever discussed. You might hear that it can effect your weight and the baby's weight, but can it do anything else? Some researchers think so.
A group of chick eggs were injected with glucose. Significant changes were found in the babies that developed from those eggs, including: --their own hyperglycemia --elevated oxidative (degenerative) activity in body and brain tissue --lower body weight --lower brain weight There also seems to be lower levels of DHA in babies exposed to hyperglycemia. This may be due to the elevated oxidative activity destroying any DHA that might be there.
You're likely aware that taking folate is pretty much an across the board recommendation to pregnant women. In this study, hyperglycemia seemed to induce a level of oxidation/inflammation that was not significantly helped with a folate supplement.
Bottom line, it's important to eat well not just to avoid weight gain or to keep your blood sugar low to keep your doctor and dietitian happy, but because your baby's brain and body depend on you to do so.
I did not write this post to scare you, I did it to make you aware. However, if you're feeling as if you now don't know what's right to eat, or you're trying and having a hard time, please take a look at the right hand of this blog screen. There is a whole list of professionals ready and waiting to help you figure it out.
Most of my clients express surprise that healthy eating includes as many tasty foods as it does. So before you write off a visit to the dietitian because you're afraid of what you WON'T be able to eat, consider that it may be your ticket to freedom and guilt relief to work with someone who can introduce you to the many foods that will BENEFIT you and baby!
Cole NW, Weaver KR, Walcher BN, Adams ZF, Miller RR Jr. Hyperglycemia-induced membrane lipid peroxidation and elevated homocysteine levels are poorly attenuated by exogenous folate in embryonic chick brains. Comp Biochem Physiol B Biochem Mol Biol. 2008 Jul;150(3):338-43.
This comes to us from Michal Hogan, who I'm going to work to convince to come on board as a contributor. She is a wealth of knowledge when it comes to food sensitivities as they relate to PCOS.
In the meantime, this link will take you to a CBS story about"pregorexia". http://www.cbsnews.com/stories/2008/08/11/earlyshow/health/main4337521.shtml
Many of you are so concerned about gestational diabetes you might just take things in the opposite direction. There is definitely a concept to remember--balance.
And if you have food sensitivities, consider contacting Michal. Here is her website: www.nutritionresults.com
Last night I had a consultation with a client who is in her mid 50's. She doesn't officially have PCOS, but she has many of the symptoms, and I believe if she were younger, trying to have children, she might have the diagnosis. What is really interesting about this case is that this woman was born 2 months prematurely and spent several weeks in a neonatal intensive care unit before being able to go home. This was long before this was commonplace.
A very high percentage of my clients were born prematurely. This is a huge risk factor because it is during the last trimester of pregnancy that the brain and nervous system does the majority of its development. When the baby's nervous system is forced to grow and develop in an unfamiliar and unnatural…and stressful…environment, it just can't thrive like a nervous system that is at home in the womb.
Secondly, inside momma, there is at least a little bit of exposure to nutrients that are needed for this development. Outside the womb, we can do our best, but we can never completely replicate nature. In the case of my client, her intensive care stay happened long before we even knew much of this, and before omega-3 fatty acids were added to the feedings of babies in intensive care units. So my client, essentially, has been playing catch up at least since the day she was born.
A recent study confirmed what I just described, and what I've been teaching for several years. In a study comparing 28 babies categorized as"small for gestational age", 28 babies whose weight was statistically normal, and 56 normal-weight babies. An additional comparison was made between 60 premature babies, 20 of which were"small for gestational age" and 40 whose weight was normal.
Preterm babies seemed to have higher levels of building blocks of essential fatty acids, but the important omegas that they needed were not there, indicating that something about preterm birth may impair the conversion process. Term, normal weight babies had higher levels of DHA (one of those essential omegas), and higher ratios of endpoint to building block compounds. This suggested that the term babies were better able to convert building blocks into active omega-3's.
Term but small babies had higher levels of eicosapentaenoic acid, which is an intermediate in the conversion, meaning perhaps that lower weight babies also have important metabolic differences.
So, it seems, there are two important goals: (1) keep that baby in utero as long as possible, and (2) don't get so caught up in your pregnancy weight gain that you restrict your baby's development. Goal #1, interestingly, has been shown to be more achievable in mothers who consume adequate omega-3s! Goal #2 is a little more challenging, especially if you are being managed for gestational diabetes and your weight is being more closely monitored. That's when quality or what you do eat becomes important. It's going to be hard to get enough omega-3's, optimize your baby's weight gain, and keep your insulin function under control, if your focus is not on nutritionally dense foods that give you a bang for your buck.
That's why inCYST works so hard to train its professionals. They love to do this work, and they would love to help you figure it out!
Agostoni C, Marangoni F, Stival G, Gatelli I, Pinto F, Risé P, Giovannini M, Galli C, Riva E. Whole Blood Fatty Acid Composition Differs in Term Vs Mildly Preterm Infants: Small Vs Matched Appropriate For Gestational Age. Pediatr Res. 2008 Apr 3.
Everyone’s telling you to “just relax and you’ll get pregnant,” or “take a vacation and it’ll happen.” Isn’t that a huge pressure, besides the basic fact that getting pregnant hasn’t proven to be so easy for you? Getting pregnant can be so frustrating when it involves medical procedures, carefully timed intercourse, self-tests and monitoring, medication, and the like. With PCOS, it’s even more complicated. The good news is, even when it seems like your body just won’t mind your wishes, there are relatively simple and inexpensive things you can do on your own to support yourself in your fertility journey.
If you’ve been dealing with infertility for a while, you’ve likely tried or at least considered some alternative medicine or holistic health practices that you hope will help you conceive. Here’s why you should consider some of the more common approaches to decreasing stress and improving overall health, which include:
Acupuncture is an ancient healing art, part of the system of Traditional Oriental Medicine. It has been used successfully for thousands of years to enhance fertility; you may even find that your physician is able to offer you a referral. Acupuncture is nearly painless – in spite of the needles – and works in conjunction with your traditional treatments. Many acupuncturists also offer nutritional support. Most larger communities have at least one acupuncture school, and their student clinics offer carefully supervised sessions for as little as $20/treatment.
Nutrition – Decreasing or eliminating caffeine, refined sugar, and refined flour will give your body a rest, reduce stress on your digestive system, enhance your immunity, and make your body an optimally healthy place for both you and a baby. If you’re saying “yeah, yeah, yeah, I know all that – and it’s too overwhelming” – start today with a small change, like switching out regular coffee for decaf, or trading in a soda for some iced herbal tea. Your nerves will thank you too.
Yoga is another traditional dating back thousands of years. Yoga is said to massage and stimulate or “tonify” the internal organs, thereby leading to increased health. The slower-paced forms of yoga, such as hatha yoga, or yin yoga, are relaxing practices. But in my opinion, the best thing about yoga is that it helps you love and accept your body, precisely where it is today – not where you hope it will be. If you’re daunted by those fancy yoga studios, head on over to your nearest YMCA or other gym for some great introductory classes. Many yoga studios offer community days, or donation classes, where you pay what you can afford for the class.
Meditation can be as simple as closing your eyes and focusing on the sound and rhythm of your own breath for just five minutes. If you can’t handle five minutes, try three minutes. It can also be a complex and evolving process, if you choose to expand your practice. Regulating your breathing, clearing your mind, and giving yourself time for introspection are all benefits of meditation. If you want more information, do a search for the terms “meditation” or “the relaxation response.”
Positive Thinking/Mindfulness/Visualization – although these are all distinct techniques, the overlap is that they are conscious ways of re-orienting yourself towards remaining in the present, focusing on what is, and using the power of your mind to create the future – or at least improve your experience of the future. As with meditation, the internet is full of information on these techniques, or you may wish to consult with a mental health clinician who utilizes such techniques in her practice.
Optimizing fertility is an activity in which you, the patient, play a very active role. You are already learning how to become proactive in managing your PCOS; this is just an extension of that. Of course your doctor will want to know what other things you’re doing to support your fertility, but you can start right now to take steps to improve your overall physical health and state of mind, thereby reducing the stress actively, instead of just hoping that it will happen “somehow.”
Dr. Gretchen Kubacky is a Health Psychologist in private practice in West Los Angeles. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders. 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 atwww.drhousemd.com, or e-mail her atGretchen@drhousemd.com. You can also follow her on Twitter @askdrhousemd.
I was asked my thoughts about this beverage, popular in some circles. I knew nothing about it, except that my taste buds don't embrace the flavor. Even though I didn't think it had much to do with PCOS, it turned out it actually does.
Kombucha is simply tea that has been brewed, had sugar and probiotics added to it, and then allowed to ferment for several days, allowing a"mushroom" to grow on top of the brew (see photo).
(I think I've inadvertently made kombucha in my sun tea jar when I let it sit too long…but that belongs in another post detailing my long list of bad kitchen incidents…)
The kombucha mushroom is actually quite similar to the"mother" that grows on top of some vinegars. And it turns out, kombucha has a pH similar to vinegar. Its similar potential benefits arise from the similar pH. As you recall, I've written a little bit recently about the usefulness of vinegars taken just before mealtime to help mediate post-meal blood glucose spikes. I am assuming you could use a few swigs of Kombucha just before a meal in a similar fashion. That could be a great research study, come to think of it.
But beware, as too much vinegar can cause detrimental shifts in overall body pH, so can kombucha. Interestingly, a kombucha brewer I found online recommended that adults should not consume more than 4 to 8 fluid ounces daily. Most commercial kombucha is sold in 14 to 20 ounce bottles, which is up to 5 times that amount. It's important to keep in mind that it's not something to swig all day long as your source of hydration, it's something to consume in metered amounts for a specific health purpose. And if you're doing the vinegar thing, best not to do the kombucha thing. And vice versa.
I was most concerned about whether or not kombucha was safe for women who are pregnant, either knowingly or unknowingly, or are trying to conceive. It's been around for thousands of years, which indicates that it's relatively safe. However…the Happy Herbalist I linked to above had an interesting list of other things that can grow in homemade kombucha with funky names like vinegar eels and vinegar worms that really didn't sound like anything I should be messing with…if I was spending thousands of dollars on an IVF procedure…that without interference from eels and worms, only has a 40% chance of succeeding. Not my most evidence-based observation ever posted on this blog, but sometimes the"Eeeeuuuuwww factor" and common sense preclude the need for peer-reviewed citations.
Drink kombucha if you must, but if you're trying to conceive, I strongly recommend you stick with commercially prepared options to reduce your chance of exposing your baby to things it's probably not going to enjoy. Do not try this at home!
In the research files, Indian scientists have reported improved antioxidant activity in animals given kombucha. In rats, particularly male rats, kombucha appeared to prolong life.
However, a German complementary medicine journal made the following conclusion: No clinical studies were found relating to the efficacy of this remedy. Several case reports and case series raise doubts about the safety of kombucha. They include suspected liver damage, metabolic acidosis and cutaneous anthrax infections. One fatality is on record. Germans in general are more open to complementary medicine modalities; taken in that context this is a strong conclusion.
I know that vinegar researchers had a very hard time being taken seriously when they first started submitting studies to the journals, and they were eventually accepted. So there exists the strong possibility that with the right kind of studies kombucha could eventually earn respect.
That being said, be advised that it may be beneficial, but it does not deserve the health halo it often gets, and there have been problems associated with its use, most likely its overconsumption. Use with respect, and use with caution.
Sai Ram M, Anju B, Pauline T, Dipti P, Kain AK, Mongia SS, Sharma SK, Singh B, Singh R, Ilavazhagan G, Kumar D, Selvamurthy W. Effect of Kombucha tea on chromate(VI)-induced oxidative stress in albino rats. J Ethnopharmacol. 2000 Jul;71(1-2):235-40.
Hartmann AM, Burleson LE, Holmes AK, Geist CR. Effects of chronic kombucha ingestion on open-field behaviors, longevity, appetitive behaviors, and organs in c57-bl/6 mice: a pilot study. Nutrition. 2000 Sep;16(9):755-61.
Ernst E. Kombucha: a systematic review of the clinical evidence. Forsch Komplementarmed Klass Naturheilkd. 2003 Apr;10(2):85-7.
This question comes up from time to time, and since inCYST is so big on flaxseed, it's a good idea to have information at your fingertips.
Around the Internet, caution regarding the use of flax while pregnant is easy to find. The rationale for this caution is that mothers and fetuses are especially sensitive to hormones.
The Internet is also full of advice from flaxseed manufacturers promoting its use, because it can be converted to DHA, which as this blog consistently discusses, is crucial for conception, pregnancy, and development of a healthy baby.
Neither of those assertions is totally correct.
I dove into Pub Med last night and looked for any research to support the advice against flax during pregnancy. I couldn't find it. What I DID find was a whole host of animal studies, primarily done on pigs and cows, with mostly positive findings. It's always important to remember that animal studies do not always extrapolate completely to humans, but they do give us an idea of what's going on.
Effects of flaxseed consumption during pregnancy (again, in pigs and cows) included: --healthier immune systems in babies --better growth in babies --after having one baby, a shorter time to ovulation (restored fertility) --breast milk with a higher omega-3 fatty acid content and a lower omega-6 to omega-3 fatty acid ratio --higher brain omega-3 content in babies --increased levels of EPA, another omega-3 important for prostaglandin function and healthy blood clotting --higher pregnancy rates --larger follicle size --higher conception rates --lower miscarriage rates --higher progesterone levels
IMPORTANT DISCLAIMERS While I'm always excited to report positive links between nutrition and fertility, you all should know when I look through the research I am actually searching hard for the BAD news. This is such a high-risk specialty! The very last thing I would want to do is encourage our readers to make choices leading to frustration, disappointment, heartache, and loss of our own credibility. So I want to make it clear, the benefits of flax can be achieved only if it's used with respect.
Flax cannot replace fish oil. Some flax supplement manufacturers promote its use because it is converted into DHA and therefore can be used as a supplement for flax. Not true! The studies I perused found different effects for both, meaning you need both in your diet.
If your diet is imbalanced, flax won't make up for it. One study I found showed that when protein intake was low, flax supplementation was not beneficial. This would be a scenario not uncommon with our vegetarian readers, if their definition of vegetarian eating focuses more on what to eliminate rather than what to include, or is the remnant of an eating disorder. As always, supplements work best in a well-nourished environment; they cannot replace balanced, nourished eating.
Finally, if you choose to use flax…IT MUST BE GROUND. In other words, the flaxseed tortilla chips at Trader Joe's were not what made these studies work.: )
I've heavily referenced this post to save the skeptics the work.
I hope you find this helpful!
Rao SS, Kale AA, Joshi SR, Mahadik SP. Sensitivity of fetus and pups to excess levels of maternal intakes of alpha linolenic acid at marginal protein levels in Wistar rats. Reprod Toxicol. 2007 Nov-Dec;24(3-4):333-42. Epub 2007 Jul 28. Yu B, Khan G, Foxworth A, Huang K, Hilakivi-Clarke L. Maternal dietary exposure to fiber during pregnancy and mammary tumorigenesis among rat offspring. Int J Cancer. 2006 Nov 15;119(10):2279-86. Ambrose DJ, Kastelic JP, Corbett R, Pitney PA, Petit HV, Small JA, Zalkovic P. Lower pregnancy losses in lactating dairy cows fed a diet enriched in alpha-linolenic acid. J Dairy Sci. 2006 Aug;89(8):3066-74.
Petit HV, Twagiramungu H. Conception rate and reproductive function of dairy cows fed different fat sources. Theriogenology. 2006 Sep 15;66(5):1316-24. Epub 2006 Jun 2. Farmer C, Giguère A, Lessard M. Dietary supplementation with different forms of flax in late gestation and lactation: Effects on sow and litter performances, endocrinology, and immune response. J Anim Sci. 2010 Jan;88(1):225-37. Epub 2009 Sep 25.
Colazo MG, Hayirli A, Doepel L, Ambrose DJ. Reproductive performance of dairy cows is influenced by prepartum feed restriction and dietary fatty acid source. J Dairy Sci. 2009 Jun;92(6):2562-71. Farmer C, Petit HV. Effects of dietary supplementation with different forms of flax in late-gestation and lactation on fatty acid profiles in sows and their piglets. J Anim Sci. 2009 Aug;87(8):2600-13. Epub 2009 Apr 24. Brazle AE, Johnson BJ, Webel SK, Rathbun TJ, Davis DL. Omega-3 fatty acids in the gravid pig uterus as affected by maternal supplementation with omega-3 fatty acids. J Anim Sci. 2009 Mar;87(3):994-1002. Epub 2008 Nov 7.
Galbreath CW, Scholljegerdes EJ, Lardy GP, Odde KG, Wilson ME, Schroeder JW, Vonnahme KA. Effect of feeding flax or linseed meal on progesterone clearance rate in ovariectomized ewes. Domest Anim Endocrinol. 2008 Aug;35(2):164-9. Epub 2008 Jun 5.
This post comes from Karen Siegel in Houston, Texas. In addition to being a Registered Dietitian, she is also a Licensed Acupuncturist.
Acupuncture in Pregnancy & Childbirth
Pregnancy is an amazing time in a woman's life. Many women report feeling healthier than they have ever felt before; however, the physical growth of the baby and changes in hormone levels can bring about pain, discomfort and a variety of health problems.
Acupuncture and Oriental medicine can provide a safe, effective alternative for many of the health complications that may arise before, during and after pregnancy. A growing number of women are choosing acupuncture to use throughout their pregnancy and as an optional treatment for an overdue or difficult labor.
Planning for a Healthy Baby
Healthy parents produce healthy babies. With acupuncture and Oriental medicine, parents can improve their health to create the most optimal environment for their unborn child. In addition to their ability to strengthen, support, and balance overall health and well-being, acupuncture and Oriental medicine are an effective treatment for regulating menstruation and hormone levels, reducing stress and addressing any pre-existing medical conditions or concerns that a woman may have.
Acupuncture during Pregnancy
Acupuncture and Oriental medicine can play a vital role in the comfort of a pregnant woman. There is strong evidence to support that acupuncture is highly effective at treating some of the most common problems experienced during pregnancy including morning sickness, heartburn, insomnia, water retention and sciatica.
Here is a list of some of the problems that an acupuncturist often treats during pregnancy:
* Nausea and Vomiting * Heartburn * Constipation * Hemorrhoids * Edema and Swelling * Urinary Tract Infection * Pelvic Pain * Neck and Back Pain * Sciatica * Carpal Tunnel Syndrome * Leg Cramps * Fatigue and Exhaustion * Insomnia * Anxiety and Depression
Acupuncture for Childbirth
While there are acupuncture points that can provide natural pain relief during labor, acupuncture is more commonly used to induce labor. There are several points that stimulate contractions and influence cervical ripening. There is also an acupuncture point that has been found to turn a breech baby.
Acupuncture Postpartum
Many women feel depleted after the birth experience. Acupuncture and Oriental medicine can help the transition of those first few months after birth to ensure a quick recovery. Postpartum care focuses on the physical, emotional and psychological recovery of the mother from the effects of pregnancy and labor, as well as encouraging breast feeding.
Here are some of the postpartum disorders that can be treated with acupuncture:
* Fatigue * Postpartum Depression * Mastitis * Insufficient or Excessive Lactation * Post Operative Healing * Night Sweats
If you would like to know more how acupuncture and Oriental medicine ease discomfort and facilitate pregnancy, please call for more information.
