The Hemp Connection:
supplements

I'm all for local eating. But another endeavor I enjoy is helping other cultures find worthwhile products to produce that encourage preservation of the rainforest and farming of products other than coca. So I was excited to see the country of Peru have such a beautiful and informational pavilion at Expo West.

We all know about quinoa and I've written about purple corn…here are some other foods you might be seeing more of that could be fun to try!

Maca Most of us think of maca as a supplement to enhance sexual prowess. It's actually been studied in the laboratory and been found to enhance libido and semen quality. It may also help alleviate sexual dysfunction related to antidepressant use. It may also help reduce enlarged prostate glands.

That being said, Americans have a really bad habit of taking something they think is"good", grinding it up, concentrating it, and using it in larger quantities than would be possible in nature. In this case, there is some thought that excessive maca consumption may negatively affect thyroid function. In addition, there are several varieties of maca, and only the red was found to have significant hormonal effect. Labeling on supplements may not contain this information and you may be wasting your money.

Bottom line, if you see it on a restaurant menu or a fun international market, take it home and cook it like a turnip! Be careful, however, about the supplement version.

Amaranth Gluten-free enthusiasts love this grain, but like quinoa, it's not actually a grain…it's a seed. It can be toasted and eaten like popcorn, or cooked like a grain. Here is more information on how to use amaranth in your kitchen. In other parts of the world, such as Asia and Africa, amaranth leaves and roots are also culinary specialties.

Regular consumption of amaranth seed may help regulate hypertension and cholesterol, and the leaves and roots are very high in vitamins and minerals, including calcium, iron, magnesium, phosphorous, potassium, zinc, copper, and manganese.

Both Bob's Red Mill and Arrowhead Mills sell amaranth flour, but if you can't find it in your store, here are amaranth options on amazon.com.

Aguaymanto This fruit is related to one of my local favorites, the tomatillo (you can see the similar husks in the photo). It is currently being researched for its potential as an antioxidant source, and it has been found to contain melatonin.

Locals like to use it in jams, syrups, and pastries, but it is also seen in fruit salads and salsas.

Lucuma, or eggfruit, if you Google it, will pop up quite frequently as the next big superfood, and ground powders are available online. (As with maca, I am not providing links, as I am not telling you about these foods to encourage a superfood or supplement mentality.) This fruit tree can grow in warmer US climates such as Florida or Arizona. It's a Peruvian favorite, as illustrated by the blog Peru Food. It is described as tasting a little bit like maple syrup ice cream.

It is a favorite of raw food enthusiasts. They promote it as low-glycemic, though I was not able to find the actual scientific reference for it in my search; most references circle back to the same video. If anyone out there can direct me to that, I'm happy to post for everyone.

Nutritionally, lucuma is high in fiber, iron, and as you might guess from its beautiful color, beta carotene.

Sacha Inchi, or the Peruvian peanut, comes from the rainforest. I actually tried this at Expo West; it was prepared like corn nuts and there was also a version coated with fair-trade chocolate (isn't that the best way to get Americans to try anything new and different?) It's pretty high protein, and it contains ALA, the vegan omega-3 fatty acid. (With respect to the omega-3's it's an option to flaxseed.) In Peru, its oil is used for cooking so I imagine some day it will show up in US markets as well.

Again, American marketing reps are trying to capitalize on the superfood craze when selling this food. It's fine to eat, and its nutritional value is nice, but no need to abandon everything else you're doing for it. Try it when you can, enjoy it when you find it, and know it fits well into a hormone-friendly lifestyle.

One of the reasons I put this blog post together is to illustrate why closing out food choices can deny you some food fun, not to mention nutrition! If you're locked into a top ten list of foods, you may miss some great culinary experiences…that can be healthy as well! Sometimes when you're focused on"fixing" a disease it can take the fun out of food. The more enjoyable it is, the more likely it is you'll have a healthy relationship with it. Every culture has its gems, even if they're not salmon, blueberries, and broccoli!

I admit, I had a personal reason for writing this blog post. My Peruvian friend Denise has told me she wants to share her favorite local Peruvian restaurant with me sometime soon. I wanted to be sure I knew what I would be seeing when I looked at the menu. Now that I've done my homework, I'm hungry and looking forward to what the menu has in store.

Gonzales GF, Miranda S, Nieto J, Fernández G, Yucra S, Rubio J, Yi P, and Gasco M. Red maca (Lepidium meyenii) reduced prostate size in rats. Reprod Biol Endocrinol. 2005; 3: 5.

Dording CM. Fisher L. Papakostas G. Farabaugh A. Sonawalla S. Fava M. Mischoulon D. A double-blind, randomized, pilot dose-finding study of maca root (L. meyenii) for the management of SSRI-induced sexual dysfunction.

Czerwiński J, Bartnikowska E, Leontowicz H, et al. Oat (Avena sativa L.) and amaranth (Amaranthus hypochondriacus) meals positively affect plasma lipid profile in rats fed cholesterol-containing diets". J. Nutr. Biochem. 15 (10): 622–9, 2004.

Wu, SJ; Tsai JY, Chang SP, Lin DL, Wang SS, Huang SN, Ng LT (2006). Supercritical carbon dioxide extract exhibits enhanced antioxidant and anti-inflammatory activities of Pysalis peruviana. J Ethnopharmacol 108 (3): 407–13

Kolar J., Malbeck J. Levels of the antioxidant melatonin in fruits of edible berry species. Planta Medica 2009 75:9

If you've been following the blog over the last week, I've been reporting about interesting products and things I learned at the 2011 Natural Products West Expo. It's a huge exposition where food companies hoping to connect with buyers for health food stores have a chance to showcase their products. There were about 2,000 exhibitors there, and in 3 days I didn't get a chance to see and talk to everyone I wanted to. You can imagine, on the exhibitor end, the pressure there is to create a product, packaging concept, and booth display that catches the eye of the people you came to meet!

Unfortunately, not all concepts were on target. I'm sharing one that is a common example of how omega-3 marketing is not always accurate. It's still not regulated well, so there are lots of variations in how facts are presented that can be confusing to the person who knows they want to eat well but doesn't understand all the facts.

Yesterday I pulled a fish oil bottle out of my sample bag and noticed on the label that it was"extra-virgin" fish oil. This is a concept that I'm familiar with when it refers to olive oil, and it means that it is the olive oil from the first press of olives. It's a stronger oil, with a lower smoke point, and more appropriate for recipes where the oil is not heated. But it's not really a concept that has any relevance to fish. (I joked with my Facebook friends about whether or not it really mattered what the fish were doing before we caught them!) This particular product's label was also busy with breakdowns of omega-3's, 5's, 6's, 7's, and 9's, promoting a"perfect complement of 16 omega's". It all sounded very official, but to the average consumer who is still confused about 3's, 6's, and 9's, it only serves to make shopping for fish oil tedious and painful.

One of the reasons for all of this confusion is that fish oil is Mother Nature's patent. Consumers want their foods and supplements to be as unrefined as possible, but the only way to patent and protect a manufactured product, is to alter it. So it is very difficult for fish oil companies to create products that distinguish themselves from other competing products while keeping their customers happy. What is left to distinguish a product is where the fish is caught, what species the fish is, and the total amounts of omega-3 fatty acids. And lots of pretty, irrelevant marketing words.

Even with all my knowledge and training, I can spend hours in the health food store looking at labels on fish oil supplements and keeping up with new and different products. From my perspective, it's the total amount of omega-3's that matters. If you have a hard time with the flavor or the burps, there are several flavored options and packaged forms that can get you around that problem.

Here is my advice to you.

1. First of all, before you spend a lot of money and time, try taking fish oil to see if it works for the problem you're trying to solve. Be sure you take enough of it. For the degree of inflammation seen with PCOS, you're going to need to take the equivalent of 1000 mg DHA. That can be 2 to 3 times the recommended dose on the bottle. Be sure you do your math. It can even be the Costco brand. That is actually my first recommendation to clients. I'm more interested in whether or not adding DHA to the diet is helpful, not where the fish was caught, what the flavor of the fish oil is, yadayadayada. I just want to establish if there is a DHA deficiency.

2. Make a list of the problems that you have that you're looking for relief with that you know are related to omega-3 imbalance: memory, concentration, mood swings, carbohydrate cravings, skin problems, menstrual irregularity. Keep this list in a handy place.

3. If memory problems are on your list, be sure you have a mechanism for remembering to take the fish oil! I swear, this is one of the biggest barriers to PCOS, memory and forgetfulness keeping you from remembering what it is you need to do! If you need to engage your significant other, or set up an alarm on your phone, or a Google calendar reminder…do whatever it takes to be consistent. If you didn't take it, and it didn't work, it didn't work because you didn't take it, not because it's not the issue.

4. Be diligent about reducing your omega-6 intake: soy, safflower, sunflower, sesame, corn, cottonseed. The less of these oils you have in your diet, the better chance omega-3's have of doing the job.

5. Be sure you're reading the dose right on the label. One of my biggest issues I have with one of the most popular brands of fish oil is that their dose is two capsules, not one. Most people never read the fine print, assume a dose is one pill, and end up taking half of what they were thinking they were taking.

6. At the end of your trial period, look at your list and see what improved. Did it work? NOW, and only NOW that you've established whether or not you were DHA deficient, consider if the type of fish oil you take. Would you prefer a flavored, a gel, a capsule, a liquid? All of them are going to give you what you want, you're just deciding which one fits best with your personal taste and texture preference.

Pretty packaging and fancy words are not what are going to help you to feel better. It's what's inside the package, and in what concentration, that you need to focus on!

This article just popped up when I logged in this morning, and I thought you all might find it interesting. I know from my website that skin and appearance issues are among the top concerns of"cysters"…

http://food.yahoo.com/blog/beautyeats/29703/18-foods-that-make-your-skin-glow

What's interesting about this, is that the very same foods that promote fertility, can promote healthy skin.

A short note about fish oil and skin. About 15 years ago I took a vacation to Costa Rica. I used sunscreen…but my German-WASPy skin just didn't tolerate the intensity of the latitude. I ended up with a second degree burn, and scarring on my chest that I had resigned myself to having as a lifelong lesson about sun and skin.

In the last few years I've been changing my own diet based on what I've learned in studying PCOS, and I've begun to do some work for omega-3 companies. Dennis, my friend at Nordic Naturals kept sending me bottles of flavored cod liver oil, which I kept putting in the refrigerator or trying to pass off on my cats.

Finally, I decided to try it. And a few months later, I noticed, the scarring looked a whole lot less worse. It's probably a combination of a better diet and supplements, but it really reinforced with me, being here in Arizona, that my skin deserves the best possible diet and care I can give it.

Every other Sunday morning, I pull out my “old lady pill boxes” and load them up with my current selection of supplements, some of which are for PCOS. At times, I confess, I’ve been known to take as many as 90 pills a day. If that sounds kind of crazy, I’m in full agreement with you. I often incorporate Chinese remedies prescribed by my acupuncturist, and those are typically dosed at three to five capsules, three to four times per day, which can quickly add up. I don’t do that anymore. But I routinely take a hearty little handful of things like fish oil, D-Chiro Inositol, Vitamin C, and alpha lipoic acid. I’m sure many of you do too – or you think you should be, if you’re not.

Some doctors want to know everything you’re on, and some don’t bother to ask beyond the fish oil or the Vitamin D3. I actually keep an Excel spreadsheet listing everything I currently take, both supplements and prescription medications. This is for my own tracking purposes (so I can see if there’s something I’ve tried in the past and deleted because it didn’t do anything for me – no point in trying those again), and for the doctors who want a comprehensive record. It’s too much to track on, and often doesn’t fit on the few lines given on a doctor’s intake form. “See attachment” is my favorite labor-saving phrase!

As I updated my spreadsheet today, I got to thinking about the lure of supplements. Americans spend $20.3 BILLION dollars (NIH, 2004) per year on supplements. That’s a staggering amount of money for something that isn’t guaranteed effective, may be irregularly dosed, and can be just as powerful as prescription medications. And yet, we continue to buy. PCOS patients in particular are prone to chasing the latest and greatest potential cure – or at least, anything that might offer some symptomatic relief. When you’ve got a condition that’s frustrating, complex, inconsistent, and impossible to permanently resolve, you’re vulnerable to the seduction of marketers, Twitter feed, and anecdotal reporting.

At this point, I try to limit my supplementation to things prescribed or recommended by my physician, dietician, and/or acupuncturist to treat the symptoms that most concern me, such as high blood sugars and inflammation. If I hear about something new that holds some promise for my PCOS, I research it independently and then make a decision about whether or not to add it to my repertoire. I’m mindful of the fact that there’s a great deal we don’t know about supplements, just as there’s a great deal we don’t know about prescription medications. My goal is to support my body in becoming as normal as possible.

Periodically, I get disgusted with the whole thing, decide it’s too many pills, too complicated, too much money, and too overwhelming. Then I take a supplement vacation. And in the meantime, I’m continuously researching and contemplating what I can delete, or if perhaps it’s best to eliminate supplements altogether. The supplement vacation usually lasts a couple of weeks, and then I go back into it a little more strategically, and with greater consciousness about my own need to be “fixed,” and how that can lead to bad decision-making.

If you take supplements, I encourage you to think about them consciously, and not just chase the promises. If you don’t, don’t feel bad about it, but consider what might actually be beneficial to your mental as well as physical health (fish oil comes to mind!). Be willing to experiment, monitor, and make adjustments. Be patient with your body and your brain. Seek consultation with experts. Do your own research. Treat yourself with the importance you deserve.

Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She has completed the inCYST training. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.

If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at AskDrHouseMD@gmail.com. You can also follow her on Twitter @askdrhousemd.

Chromium is a commonly used (or at least recommended) supplement in PCOS. What is it, why is it recommended, and should you be taking it?

Chromium is a metal, just like iron and copper. It's not really needed in large amounts to do its job, which in the body, is to help metabolize sugar and fats.

Some researchers have suggested that chromium supplementation in PCOS can help insulin function. There are two articles in the National Library of Medicine database looking specifically at the use of chromium supplementation in PCOS. One study, using a dose of 200 mcg per day, resulted in improved glucose tolerance but not fertility. The second study bumped the dose up to 1000 micrograms per day, resulting in a 38% better ability to remove glucose from the blood.

BEFORE YOU RUSH OUT AND BUY A YEAR'S SUPPLY…

There are more than a few articles in the very same database connecting chromium picolinate to DNA damage. The earliest one, for someone writing so much about infertility, really caught my eye, as it was entitled, "Chromium(III) picolinate produces chromosome damage in Chinese hamster ovary cells." Another study reported that offspring of pregnant mice who were given chromium picolinate had an increased incidence of skeletal defects.

In the United States, dietary chromium recommendations have actually been LOWERED.

Because this is such a popular supplement recommendation and I'm sure at least some readers will question this, I've put all the references I found at the bottom of this post.

What I did notice was that over time, articles started to appear that countered this finding. I'm not sure if that means that earlier studies were wrong, if study design was manipulated to generate a different outcome, or if nutrition scientists are still trying to figure out how chromium works in the body.

What I know is, there were enough reports of potential toxicity to cause concern, and I do my best not to make recommendations that future research might force me to backpedal on. The entire model of PCOS intervention promoted by inCYST is about preventing oxidative stress and its associated damage. Chromium picolinate was referred to as an oxidative stress agent in more than one of the cited references, so to encourage readers to supplement with it seemed counterproductive.

WHAT TO DO?

First of all, understand what it is that chromium does. The clue lies in the fourth sentence of this post, in which I mentioned that chromium is needed to metabolize sugar and fats. If you're eating less sugar and fat, you need less chromium! So…perhaps one very important thing you can do is create less of a need for chromium by working to reduce your sugar and fat intake. We've talked a lot about strategies for reducing sugar cravings and binge eating, which could be two of your most important chromium-balance strategies.

Know your dietary sources. What you CAN do about the deficiency that previous dietary choices may have created, is to be savvy about what foods naturally contain trace amounts of chromium. These include brewer's yeast, whole grains, liver, bran cereals, potatoes, romaine lettuce, onions, and tomatoes.

Skip the refined foods Part of the reason we may have so much trouble getting chromium in the diet is our love of processed foods. It's especially problematic when we eat a food (such as bread) that is eventually going to require chromium to be metabolized, that has had the chromium processed right out of it.

It's kind of like if your car is running inefficiently. It's blowing through gasoline at a rapid rate. You can keep the car running by putting more and more gasoline in it, or you can get a tuneup to increase your fuel efficiency. Both will work, but one is more likely to cause long term problems.

Lucidi RS, Thyer AC, Easton CA, Holden AE, Schenken RS, Brzyski RG. Effect of chromium supplementation on insulin resistance and ovarian and menstrual cyclicity in women with polycystic ovary syndrome. Fertil Steril. 2005 Dec;84(6):1755-7.

Stearns DM, Wise JP Sr, Patierno SR, Wetterhahn KE. Chromium(III) picolinate produces chromosome damage in Chinese hamster ovary cells. FASEB J. 1995 Dec;9(15):1643-8.

Stearns DM, Belbruno JJ, Wetterhahn KE. A prediction of chromium(III) accumulation in humans from chromium dietary supplements. FASEB J. 1995 Dec;9(15):1650-7. Review.

Bagchi D, Bagchi M, Balmoori J, Ye X, Stohs SJ. Comparative induction of oxidative stress in cultured J774A.1 macrophage cells by chromium picolinate and chromium nicotinate. Eur J Epidemiol. 1998 Sep;14(6):621-6.

Kato I, Vogelman JH, Dilman V, Karkoszka J, Frenkel K, Durr NP, Orentreich N, Toniolo P. Effect of supplementation with chromium picolinate on antibody titers to 5-hydroxymethyl uracil. Chem Res Toxicol. 1999 Jun;12(6):483-7.

Speetjens JK, Collins RA, Vincent JB, Woski SA. The nutritional supplement chromium(III) tris(picolinate) cleaves DNA. Mol Cell Biochem. 2001 Jun;222(1-2):149-58.

Bagchi D, Bagchi M, Stohs SJ. Chromium (VI)-induced oxidative stress, apoptotic cell death and modulation of p53 tumor suppressor gene. Mutat Res. 2002 Jan 15;513(1-2):135-42.

Vincent JB. The potential value and toxicity of chromium picolinate as a nutritional supplement, weight loss agent and muscle development agent. Sports Med. 2003;33(3):213-30.

Bailey MM, Boohaker JG, Sawyer RD, Behling JE, Rasco JF, Jernigan JJ, Hood RD, Vincent JB. Exposure of pregnant mice to chromium picolinate results in skeletal defects in their offspring. Birth Defects Res B Dev Reprod Toxicol. 2006 Jun;77(3):244-9.

Stallings DM, Hepburn DD, Hannah M, Vincent JB, O'Donnell J. Nutritional supplement chromium picolinate generates chromosomal aberrations and impedes progeny development in Drosophila melanogaster. Mutat Res. 2006 Nov 7;610(1-2):101-13.
Kim M, Lim JH, Ahn CS, Park K, Kim GT, Kim WT, Pai HS. Mitochondria-associated hexokinases play a role in the control of programmed cell death in Nicotiana benthamiana. Plant Cell. 2006 Sep;18(9):2341-55.

Andersson MA, Petersson Grawé KV, Karlsson OM, Abramsson-Zetterberg LA, Hellman BE.
Evaluation of the potential genotoxicity of chromium picolinate in mammalian cells in vivo and in vitro. Food Chem Toxicol. 2007 Jul;45(7):1097-106.

Hininger I, Benaraba R, Osman M, Faure H, Marie Roussel A, Anderson RA. Safety of trivalent chromium complexes: no evidence for DNA damage in human HaCaT keratinocytes. Free Radic Biol Med. 2007 Jun 15;42(12):1759-65.

Bailey MM, Sturdivant J, Jernigan PL, Townsend MB, Bushman J, Ankareddi I, Rasco JF, Hood RD, Vincent JB. Comparison of the potential for developmental toxicity of prenatal exposure to two dietary chromium supplements, chromium picolinate and [Cr3O(O2CCH2CH3)(6(H2O)3]+, in mice. Birth Defects Res B Dev Reprod Toxicol. 2008 Feb;83(1):27-31.
Komorowski JR, Greenberg D, Juturu V. Chromium picolinate does not produce chromosome damage. Toxicol In Vitro. 2008 Apr;22(3):819-26.

Komorowski JR, Greenberg D, Juturu V. Chromium picolinate does not produce chromosome damage. Toxicol In Vitro. 2008 Apr;22(3):819-26.

Tan GY, Zheng SS, Zhang MH, Feng JH, Xie P, Bi JM. Study of oxidative damage in growing-finishing pigs with continuous excess dietary chromium picolinate intake. Biol Trace Elem Res. 2008 Winter;126(1-3):129-40.

Tan GY, Bi JM, Zhang MH, Feng JH, Xie P, Zheng SS. Effects of chromium picolinate on oxidative damage in primary piglet hepatocytes. Biol Trace Elem Res. 2008 Dec;126 Suppl 1:S69-79.

I've always wanted to take this topic on but everytime I started, and I looked at the list of supplements needing to be covered, I've been overwhelmed.

Thank heavens for a network of professionals with different interests and talents! Christine Marquette, RD, LD, HFS, CLT, has recently released an e-book on this very topic. If you order it be sure to use the coupon code she's created for inCYST fans, INCYST10, for a 10% discount.

I've actually talked her into doing a webinar for us as part of the 2011 PCOS training. To name a few, Chris is covering: cinnamon, turmeric, American Ginseng, Saw Palmetto, D-Chiro-inositol, L-Arginine, Alpha-Lipoic Acid, the B vitamins, vitamins C, D, and a few minerals (calcium and magnesium).

Click here if you'd like to buy Chris' e-book on PCOS supplements.

If you'd like to test drive our professional training with this session, you can register for this topic alone ($40) at this link. If it turns out you like what you hear…you can apply the money you invest into our complete training ($425) if you do so on or before December 31, 2011.

This week we’ll talk about bargaining, from the perspective of how bargaining plays out in relationship to our PCOS, and the sadness and grief that are often parts of PCOS. Bargaining is part of the DABDA (denial, anger, bargaining, depression, and acceptance) model that is typically applied to chronic/terminal illness. In the dying process, bargaining looks quite similar to what it looks like in PCOS, although it tends towards making deals with god, or trying to manipulate doctors. In PCOS, it looks more like this:

• Making a deal with god to be more attentive to him/her, if only the PCOS will go away
• Trying to negotiate with doctors – “Okay, so I’ll take the metformin like you said, but I’m still going to keep eating fast food, and it should all balance out, right?”
• Negotiating with your dietician, personal trainer, etc. – “I’ll do the cardio, but then I don’t have to do weights today.” Or, “I’ll come in three times a week, but only if you cut your fee in half.” Or, “Look, I know that dark green leafy vegetables are really good for me, but they give me gas, so can’t I just have a (pre-sweetened, sugar-laden, actually junk food) yogurt instead?” (HUH?! As you can see, we get very creative with our attempts to avoid what we don’t want, and get what we do want instead.)
• Over-exercising in order to compensate for eating badly – we develop a strange, twisted, internal logic that allows us to, essentially, do whatever we want. We convince ourselves that there are no consequences.
• Eating badly but taking lots of medication or supplements – this is another favorite form of a secret internal balancing plan that absolutely has no scientific or logical merit. It doesn’t just apply to food.
• Figuring, I’m young, I can do what I want until ___ age, then I’ll behave – the damage is occurring now, the bad habits are just getting more cemented as daily behavior, etc.

And here’s the thing about these games that we play with ourselves, our partners, and the professionals who try to help us – who’s it hurting? Really? You know the answer to this one. It’s only hurting you. I know reality is uncomfortable, but you’re spending so much energy on this bogus bargaining practice. What if you applied all of that energy to grounding yourself in reality, and taking small, manageable steps towards getting your self-care practices in line with what you know (or at least believe) to be true?

Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She has completed the inCYST training. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.

If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at AskDrHouseMD@gmail.com. You can also follow her on Twitter @askdrhousemd.

Hello everyone,

Just a reminder that this coming Sunday I will be at the Venice Whole Foods for an inCYST Fertility Friendly Food Tour. We'll be talking about basic concepts of eating to improve your fertiliity, and we will be roaming through the store discussing foods and supplements that can be part of your program.

If you want to attend and guarantee your space, please call Whole Foods and RSVP. 310.566.9480. I am not in charge of reservations, you need to call the store.

We had a lot of fun with this event in Scottsdale and I'm excited to be able to bring it to Southern California…

Hope to see you there!

Monika

At Expo West, I am always as interested in the beauty care section as I am foods. I have come home with lots of great information that I've shared with all of you about how to have the healthiest skin you can. However, Expo West has also taught me that the hype in the beauty industry is as bad, if not worse than, what I work with daily in the food industry.

We are an appearance-based culture, and as a culture we fear aging. That gives the beauty industry a lot of ammunition to work with. A simple promise of younger skin, a suggestion, and magical thinking takes over.

The booths for these products are all beautiful, and the claims sound reasonable. It is only when you get home, away from the lights and the pictures of someone else's flawless skin, that logical questions start to have a chance.

For example, I was very taken by the beautiful orange and white booth of a company called Sibu Beauty. They were selling a product line based on the ingredient"sea buckthorn". This is a berry native to Tibet, with a high anti-oxidant content that helps it to survive the harsh mountain climate.

The big claim of this product line, though, is its high contents of all of the omegas — 3, 6, 9, and 7. Not real fond of omega-6…as you know, it's pro-inflammatory.

Omega-7? Yes, 7. Never heard of it, so I took as much information as I could so I could come home and research more.

Went to the company's website, clicked on the"science" link, found no links to studies specifically supporting their claims, no clinical studies, no before-after pictures.

I did see a photo of a beautiful young woman who likely had yet to see a mark of aging hit her flawless skin and who very likely couldn't point out Tibet on a map if you asked her to.

Here's what bothers me about these companies selling anti-aging programs using ingredients from exotic places like Tibet and the Amazon. If you Google Image pictures of women from these countries, you see beautiful faces like the one to the left, with the history of the elements carved into their expressions. Why do these companies who sell these supplements from these exotic places like Tibet and the Amazon, never show the faces of real people who live there. Shouldn't they be the real testimonials for how these products work?

The site proudly shared that it had been promoted on Dr. Oz. Do you know what it takes to get your product on Dr. Oz? A good PR agent, mostly.

Out of fairness to the man, however, I did watch one of the videos from his sea buckthorn segment. He didn't really talk much about skin, but rather focused on two rats, both who had eaten a high fat diet, one of which managed to stay thin because it had also been given sea buckthorn. So my takeaway here was that Dr. Oz was promoting the concept that you can eat crap as long as you can get your hands on some exotic foreign berry extract. (C'mon, Mehmet, really? I could give you a laundry list of exciting nutritional angles for your show…teaching people who to eat junk and stay thin is not one of them.) I digress. The truth is, Dr. Oz spoke about sea buckthorn in general, not the brand promoting the fact that Dr. Oz promoted the product.

Went to my favorite resource, PubMed, and looked up sea buckthorn. I did see some studies with regard to wound healing, a lot about anti-inflammatory action, and even more about it being therapeutic for ulcers. But no rave reviews for the product as an anti-aging agent. And I even found one study suggesting that skin fatty acid content did NOT respond to sea buckthorn supplementation.

Finally, contacted a good friend in the beauty industry, who has a background in library science and who deconstructs cosmetics labels like I deconstruct food labels. She'd heard of the product, even tried it herself, wasn't impressed.
So here we have a product with proven therapeutic benefit that is not being promoted, being promoted for something completely wacky by a celebrity who knows when he talks miracle weight loss his ratings stay where the advertisers want them, being sold to do something completely unrelated to either by its manufacturer and unproven in clinical studies.
If your head is spinning, it should be. This is an awful lot of smoke and mirrors. If it gets to be this confusing, your hype and fraud radars should be going crazy.

Save your money.

Yang B, Kalimo KO, Tahvonen RL, Mattila LM, Katajisto JK, Kallio HP. Effect of dietary supplementation with sea buckthorn (Hippophaë rhamnoides) seed and pulp oils on the fatty acid composition of skin glycerophospholipids of patients with atopic dermatitis. J Nutr Biochem. 2000 Jun;11(6):338-40.

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

I recently mentioned that I was embarking on a mini-series of blog posts about the grief process, and how it relates to PCOS. I talked about a handy summary term known as DABDA, which stands for denial, anger, bargaining, depression, and acceptance. Denial is present in our lives in many ways, and it’s actually a very helpful defense – sometimes our minds go into denial, because unconsciously, they know that we’re not quite ready to handle a crisis, trauma, or issue yet. For example, the woman who sees signs of cheating in her marriage, yet overlooks the hints, bypasses opportunities to question her husband, and insists that her neighbor can’t be right – yet she KNOWS in her heart that it’s true. That’s denial.

In death, denial is often quite literally a failure to recognize or believe that a person is dead, that they died a certain way (i.e., suicide), that the death was unavoidable, or that they are not at fault in the death. While one is in the process of dying, the denial may simply be a belief that it is not possible to be dying from THIS – not me, not now.

Specific to PCOS, denial looks:
• “I don’t have PCOS – it’s something else – they just haven’t come up with the right diagnosis for me.”
• “PCOS is no big deal – I mean, I had to have an IVF and all, but whatever – I got my baby, and now I can ignore it.” J
• “PCOS isn’t like a terminal disease or anything, so why do I have to deal with it?”
• “Having a baby will fix it. That’s 10 years away, but in any case, I don’t have to deal with it now.”
• “Those medications don’t really work (so I’m not going to take them).”
• “If I just can find the right combination of supplements, this will all be okay.”
• “If I go gluten-free, I’ll be cured – but that’s so impossible, I won’t even try.”
• “I’m pretty sure that dark chocolate is a health food, so I’m going to have this entire 3.4 ounce bar.”
• “Exercise is overrated – I’ll just gain weight if I gain muscle mass, right?”

Denial’s great when it really is needed and protects you, like the child who is being molested and denies it until she’s an adult, when it’s actually safe for her to tell someone. Or when you just got a cancer diagnosis, and you don’t quite get that your particular cancer has a 75% mortality rate – and maybe if you realized that before you got a chance to explore treatment, you’d consider suicide to be a good option. Sometimes it’s protective.

Yet, as adults, most of the time, denial is working against us. It prevents us from seeing the real picture of what’s happening with our bodies, our lives, and our relationships. It prevents us from grieving. It keeps us from making decisions that will improve or protect our future. It stops us from eating better, or exercising more, or getting enough sleep (another favorite form of denial that I hear all the time is “I don’t know how I do it, but I can totally get along on five hours of sleep” – to which I say, BALONEY!). It stops us from spending money on the help we really need. It allows us to continue engaging in damaging behaviors, poor self-care, and unhealthy relationships.

If reading this gives you a little stinging sensation of recognition, there’s good news. You can start to acknowledge reality. Talking to someone who cares about you, sharing your fears and the thoughts you’ve been hiding, is a good start. If you can’t do that, put it in writing – it’s amazing how seeing it in black and white can help to bring clarity to your random thoughts.

Next week, I’ll address anger, and the insidious impacts that it has on your health.

Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She has completed the inCYST training. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.

If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at AskDrHouseMD@gmail.com. You can also follow her on Twitter @askdrhousemd.

I am currently swimming in Expo West samples, which makes me happy because it gives me fodder for blog posts and Examiner articles. This show is the place where anyone wanting to do business with Whole Foods, Mother's Markets, Central Market…any natural kind of market, parks themselves and their goods for 3 days in Anaheim, California, in an exhibition hall the size of six football fields. All of the products are natural. Not so many are healthy. You'll see all kinds of body building types (you know, the kind who are so overdeveloped they have to walk around looking as if they are carrying invisible suitcases), yoga types, Bob Marley types, chain smokers, heavy drinkers, and a gazillion flavors of kale chips, kefir, gluten free pizza, and nutrition bars.

I have come to hate nutrition bars for the most part, because there are so many, because I like real food, and because most of them should have a"really a glorified candy bar" disclaimer on the label.

But, it is great people watching, great for identifying trends, and we do have some really great inCYST supporters in our yard that we have met at Expo West.

My all time favorite laugh this year came from a product I didn't even pick up, it fell out of my trick-or-treat…er…sample bag, as I was organizing myself on returning home.

Called Blu2Go, it is a blueberry supplement with the tagline,"The Fusion of Blueberries and Science". As you can see on the front label, there are three medical claims with asterisks:

(1) Focus and Energy Melt. Ummmmm…can someone please tell me what an energy melt is? If you had asked me, I'd say that is when I return home after working out on a midsummer Phoenix day and collapse from the heat.

(2) Sustained energy boost. My understanding is that the benefit achieved from eating blueberries comes from consuming them regularly over an extended period of time. It's not like you put them on your oatmeal and take off on your run like you've got a Jetsons jet pack on your back.

(3) Supports focus and mental clarity. Well yeah, each one of those tablets is almost the equivalent of an ounce of espresso!

I went to the website and found a lot of really long and official sounding words…but what do you know? Nothing at all about why caffeine was added to the supplement and why you need to have caffeine with your blueberries. And even though the website goes into great scientific detail, even providing references about DNA, aging, etc…there is nothing, absolutely nothing, about the focus, mental clarity, yadayadayada hyped on the label.

I don't argue, there are healthy things, lots of healthy things, about eating blueberries. So why not let them do their job instead of adulterating them so that you can distract your customer from the fact that the buzz your product induces has nothing to do with the ingredient you are hyping?

Because you won't buy the product for its long term effects, you'll be on to the next, newest goodie in the Expo West bag by then. Add the addictive substance, hope the customer connects it with the other ingredient, and make as much money as you can while riding the wave.

Next hype, please?

Here

A recent inCYST post on grief really resonated with me. Perhaps it’s because I’m a Certified Bereavement Facilitator, so a lot of the work I do is directly related to grief, particularly “out of order” deaths such as suicide, homicide, and miscarriage loss. Or perhaps it’s because there’s so much sadness and loss surrounding chronic illness that, for me, the issue of PCOS cannot be addressed without looking at the issues of loss. In any case, I want to introduce a commonly used model for grieving, since I’ll be talking in more detail about it over the next few weeks, and relating the elements back to PCOS.

Elizabeth Kubler Ross was a physician who worked with terminally ill patients. The model was first described in relationship to terminal illness, and the process that patients go through as they struggle to reach acceptance of their situation. It has come to be applied extensively to grief therapy work. The model is known as DABDA, which stands for denial, anger, bargaining, depression, and acceptance. I’ll be devoting a post to each of these five items.

The first thing to know about grieving is that grieving is a non-linear process, with unpredictable timelines and variables, and that no two people grieve the same way. It’s estimated that most people grieve adequately and appropriately on their own, but about 30% would benefit from the assistance of a professional grief counselor. All of those phases of grieving – denial, anger, bargaining, depression, and acceptance – may occur in order, out of order, simultaneously, repeatedly, in an overlapping fashion, or perhaps not at all before you finally reach a state of peaceful resolution around the loss.

Also, the “normal” grieving process may go awry if you have multiple losses, too many losses occur in a short period of time, or you’re not permitted to grieve openly. For example, your mother dies, and then three months later your sister and brother-in-law are killed in a car crash. Or you’re close to 40, and end up having five IVF cycles in the space of eight months, and five miscarriages. Then you have something called “complicated bereavement.” Complicated bereavement typically needs some outside help to work through.

Grieving doesn’t just take place in the context of death or a diagnosis of terminal illness. Grieving can occur in relationship to chronic illness, loss of finances, sexuality, spouse, freedom of movement, employment, and even in response to seemingly positive situations, such as the birth of a child, which also means leaving something else behind. There may be grief associated with graduating from school, leaving a job or a neighborhood, or a myriad of other situations.

In reference to PCOS, losses may include loss of femininity, loss of reproductive capacity (infertility, miscarriage), loss of health or the illusion of health, loss of freedom (all of the things you can’t or shouldn’t do if you want to be healthy), finances (the money spent on non-covered health practitioners, supplements, special dietary items, personal trainers, etc.), sexuality, relationships, and many other things. There is often a great deal to be grieved, which contributes to the chronic low-level sadness that accompanies many PCOS patients. You may not have labeled what your feeling as grief, but that may in fact be precisely what you’re feeling and doing.

Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She has completed the inCYST training. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.

If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at AskDrHouseMD@gmail.com. You can also follow her on Twitter @askdrhousemd.

Today, my post is devoted to a special project promoting registered dietitians. I am cohosting, with dietitian Renata Mangrum, the first-ever Registered Dietitian blogfest, aimed at showcasing to the Internet-surfing public the many things dietitians do and can do to help you with your quest for help. Listed below my entry is a list of links to other blogs written by other dietitians that you can visit to see the many things my friends and colleagues do within this profession.

inCYST was created precisely because I realized there was so much misinformation about polycystic ovary syndrome. Not only was it not HELPING women with PCOS to get better, some of the information seemed to have potential to actually HURT those women.

So I started this network as a means of putting together a team of professionals whose mission and knowledge was evidence-based and cohesive.

What has developed out of that has been far more than I ever could have envisioned when I sat down to do this. Several of our network members have PCOS themselves. Several others have gone through their own issues with infertility. Others have family members with mental health diagnoses, whose treatments for those diagnoses have affected their hormone function.

So as we grow, we are becoming a network of practitioners who happen to be people first, and practitioners second. I love that, because it means we've been there, we know how it can feel to have PCOS and its many associated problems, and we're committed to helping provide accurate information wrapped in a compassionate package.

I can't think of anything better I could be devoting my work and my career to. I hope you enjoy our blog…and I hope you enjoy getting to know some of the many colleagues participating in our blogfest today!

Warmest regards,

Monika M. Woolsey, MS, RD
Founder, inCYST Network for Women with PCOS

Beyond Prenatals — Food vs. Supplements and Real Advice vs. Fake Advice
Annette Colby — No More Diets! A Registered Dietitian Shares 9 Secrets to Real and Lasting Weight Loss
Ashley Colpaart — Dietitians working in food policy, a new frontier
Diana Dyer — There and Back Again: Celebration of National Dietitian Day 2009
Marjorie Geiser — RD Showcase for National Registered Dietitian Day — What we do
Cheryl Harris — Me, a Gluten Free RD!
Marilyn Jess — National Registered Dietitian Day--RD Blogfest
Julie Lanford — Antioxidants for Cancer Prevention
Renata Mangrum — What I'm doing as I grow up…
Liz Marr — Fruits and Veggies for Registered Dietian Day: Two Poems
Meal Makeover Moms' Kitchen — Family Nutrition … It's our"Beat"
Jill Nussinow — The Registered Dietitian Lens I Look Through
Wendy Jo Petersen — March 11 is our day to shine!
Diane Preves — Registered Dietitians and the White House Forum on Health Reform
Andy Sarjahani — Dr. Seuss Tribute continued: Green Eggs and Ham and a Sustainable Food System
Rebecca Scritchfield — Big Tips from a"Big Loser"
Anthony Sepe — RD Showcase: Registered Dietitian Day, March 11, 2009
Kathy Shattler — RD Showcase for Nutri-Care Consultation
UNL-Extension, Douglas/Sarpy County — Nutrition Know How — Making Your Life Easier
Jane Zingaro — My life as a Registered Dietitian
http://workinggreenmom.blogspot.com/2009/03/my-life-as-registered-dietitian.html

6:30 a.m., Miami International Airport, feeling jet-lagged and just about destroyed from over 24 hours of travel, I looked through my stupor at the people who have come to reside in my head as “The Airport Couple,” a poignant lesson in what happens when you don’t take care of yourself. I love to people-watch at the airport, but this was not my usual people-watching.

They both have canes, are morbidly obese, and have extra-large sodas and pound bags of candy – plain M&Ms for her, peanut for him. The breakfast of champions, especially if it’s Diet Coke. They are struggling to breathe, to move, to walk, and even to eat the candy, yet they persevere. They both have an unhealthy pallor that comes more from poor health than bad airport lighting. Neither one makes eye contact with anyone else, not even their spouse. Their isolation, even in the midst of dozens of people, is profound.

Their misery and shame is palpable, and I feel like I should avert my eyes from their pain, and the practice of their addiction to food/sugar. It hurts to watch them, but I am unable to stop glancing sideways at them, in the way that children do when they notice a grotesquely fat or deformed person and simply cannot keep themselves from staring. I am wondering how they are going to make it onto the plane, and if they’ll even survive the flight, let alone whatever comes next. Selfishly, I hope I won’t have to spend the next six hours stuck sitting next to one or both of them. I feel intense sadness for the way that they’re trapped in their bodies, in their diseases, and their disconnection. I wonder which diseases they have, and how many. I make assumptions about diabetes, thyroid disorders, cholesterol problems, and heart disease. As time passes, and my flight is delayed, I add gout, emphysema, and of course depression to the list.

She is probably 52, but looks closer to 70. Walking is laborious, studied, and painful. Her thighs are so fat that her ability to walk a straight line is distorted. Yet she proceeds to the nearest shop to purchase more snacks for him; clearly, this is a form of care-giving. I think he is older, although it is hard to tell. He is almost immobilized, stuck in the confines of the narrow, hard-railed bench/chairs that are uncomfortable even for people of average size. I look for an oxygen tank, certain that must be part of their apparatus. He is wearing extra thickly cushioned diabetic shoes. I wonder about toe amputations. I think long and hard about this human catastrophe, and how preventable almost all of it is.

We struggle, day in and day out, to manage our PCOS, and whatever other diagnoses come with it. We get tired of eating right, limiting sugar and other carbs, avoiding alcohol and grain-fed meat, getting up at 5:30 a.m. to make it to the gym, taking supplements, and going to the doctor quarterly for check-ups. We complain that it isn’t fair that we’re stuck with this condition. We deal with, or don’t deal with, our depression, our anxiety, our obsessions and compulsions, or the thoughts that we might be bipolar. We adhere to diets and violate the diets. We struggle, and wonder why. I’ll tell you why – you don’t want to be The Airport Couple.

Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She has completed the inCYST training. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.

If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at AskDrHouseMD@gmail.com. You can also follow her on Twitter @askdrhousemd.

I spent Friday and Saturday in the popular sports medicine workshop hosted by Nancy Clark, MS, RD, and William Evers, PhD. Both are well respected in their fields, and their even has been attended for years by hundreds of sports professionals.

Dr. Evers brought up chromium and I asked him what he thought of its use to curb carbohydrate cravings. Turns out, he has actually studied it firsthand in his lab…and has far as he could actually measure, the vast majority of it is not even absorbed by the body. Like 99.99 percent!

So what explains the commonly reported effect that it helps to reduce cravings? Placebo. Meaning if you believe something can happen, you can often give it the mental power to do so.

Food…or should I say…supplement…for thought?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Here are the numbers from our calculations for your reference.

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

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

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

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

It keeps happening. I keep getting inquiries that are pretty clearly indicative of how little attention is focused on a huge issue, PCOS, and how much ground inCYST has gained in the progress of trying to change that.

--Several months ago, a noted researcher with an interest in PCOS wrote and told me he was interested in being considered to join my"board". I had to tell him I didn't have one!

--A reporter recently asked me for a photo of our"institute". I had to tell her that right now we're just virtual.

--Twice in the last week, I've been asked where someone might donate money to support PCOS research.

The second inquiry, yesterday, was my inspirational moment. It came through one of our network members, who had inspired one of her support group members enough to start exercising. This woman decided she wanted to run her first 5K race to celebrate her commitment to wellness. And she wanted to use her race running as a means to raise money to donate to PCOS research.

Only everywhere she turned and tried to give money…she was turned away. Someone actually told her the cause wasn't"sexy enough" to be worth raising money for.

I was appalled. I've spent years at this point listening to women with PCOS share their stories, their frustration, their heartache, their desire to just know what they need to do. I've seen, time after time, the benefits of simple lifestyle changes. And I've also personally witnessed the battle these women have to fight to be taken seriously. They deserve better than to be told their illness is not sexy enough for researchers to care about.

My emotional response was probably fueled by the story WVEC reporter Lucy Bustamante recently put together, in which a physician treating PCOS admitted that women don't often get the right diagnosis because the tests it would take to do so"are just too expensive."

Over the summer, someone in the reproductive medicine department of Bristol Myers Squibb spent about 7 hours of time reading 378 pages of inCYST content. I remembered that during my conversation yesterday, and thought two things.
--Apparently these women are sexy enough to keep making medications for and taking their money for.
Even though these women are too expensive to thoughtfully treat, given the fact that they comprise 10%
of the female population, they are a great revenue source to target in research projects.
--If we got that much attention from the people doing the"real" research, it seems to me that on our own
inCYST has what it takes to be a rockin' research institute.: )

I decided, the moment I heard the words"not sexy enough", that it was time to stop turning all these inquiries away and start pulling together all of those resources to do something different.

So, thanks to the small but profound and genuine gesture of the exact kind of person inCYST was created for, a woman who simply wants answers, I'm going to start the procedure for pulling together a not-for-profit arm of inCYST, devoted to research. Only our research will be different in nature. We want to encourage the kind of research that has a hard time getting funded, because it does not involve drug research. We want to balance the message that is out there and add credibility to the message we want you all to hear. And we want to be sure the supplements you all spend money on…are actually worth spending money on.

I have a lot of work to do, but I'm willing to do it if you're willing to help make it happen. My first step is the paperwork, and because that involves an attorney's work, it will cost money. I do not have an avenue for collecting donations right now, but I am posting this announcement so that anyone who might be interested in making a donation in the future might be able to write me and let me know where to find them when we're ready to take the plunge. It's not really all that much to get started, about $1000, so I think it's entirely doable.

If you are interested, please send me an email at marika@google.com.

Remember, it was a small gesture that prompted me to act. A lot of small gestures, pooled together, can make a huge difference.

Let's get this research party started!

Most of you know that your PCOS is an inflammatory disorder. But if someone asked you what that meant, would you be able to explain it? I've found that it's a pretty meaningless and misleading term to most people. So I like to use a visual. This visual has had such a profound impact on some of my clients that they've printed it out and they hang it on their computers or other prominent place to graphically remind them of the importance of making proactive choices.

Inflammation is a misleading term because most people, when they hear it, tend to think of swelling, as you might experience if you sprain your ankle. In the case of inflammatory disease, it's really more oxidation that we're talking about. (Hence the focus on antioxidants by the supplement industry).

But even then…what is oxidation? It is the metabolic effect of oxygen being broken down. Outside of your body, the easiest illustration I've come up with is rust. When metal reacts with oxygen, and an oxidative process occurs, rust is the result.

It's no different in your body. An inflammatory, or oxidative process, is essentially the rusting out and deterioration of your tissues. It happens when the balance between processes that oxidize outweigh those that do repair work.

One of the most important places where this oxidation has effect is in your brain and nervous system. Oxidative processes are known to destroy neurons! For example, depression, another inflammatory disorder and one which commonly co-exists with PCOS, is known to destroy neurons in the hippocampus, the brain's memory center. And as many of you know, loss of memory, concentration…brain fog…are common side effects of PCOS.

Take a look at this photo. If the balance in your own body is tipped toward inflammation, it's literally like your brain and nervous system are rusting out. Yes, this is your brain on inflammation.

Your job is to reverse that process.

And it can be reversed! Studies also show that the hippocampus rebuilds those lost neurons as an indication of resolving depression.

What to do?

1. Remember that the substance that the brain needs in order to rebuild neurons is DHA. It's not sugar, it's not flax, it's not a vitamin or mineral. It's DHA, the fish oil that is found in fish and marine algae. Dr. Artemis Simopolous, omega-3 expert, has written that treating depression with DHA requires a dose of about 1000 mg per day. That is about 4 times what is recommended on the bottles of most supplements, and eating fish a few times a week is far below that. If you really want to experience the benefits of omega-3's, you likely need to up your dose.

2. You need to remember to take your fish oil! I know, it sounds funny, that in order to improve your memory you need to remember to use the thing that improves your memory…but that's one of the biggest barriers I've seen to PCOS success…consistency. If you cannot put your fish oil next to your milk in the refrigerator, or remember to take it when brushing your teeth, program your computer or smart phone to remind you to do so. I cannot reinforce the importance of consistency.

3. Slow down the rusting out process. Anything that raises metabolism, speeds up the rusting out process. That means extra stress. Sleep deprivation. Diet excesses. Dietary deficiencies. Too much exercise.

4. Eat a variety of foods from a variety of food groups. There are so many antioxidants available to you, none of them is the be-all-end-all…you need to mix it up so you get the most opportunity to benefit from the entire palette.

My hope is that now that you've seen what inflammation is, you will understand why it is so important to take action and do the repair work, then rust-proof yourself against further damage.

Last week I posted this graphic describing the grief process on our Facebook page. It got enough comments that I thought it might be worthwhile to expand on it in a blog post.
If you haven’t miscarried, or lost a family member, or been through a tough breakup, perhaps you don’t think this pertains to you. But there are many, many things you can grieve. --Being told you can’t have children. --Not getting into grad school and having to change your career plans as a result. --Foreclosing on a home. --Getting older. --Being diagnosed with a chronic, non-lifethreatening illness, like PCOS or infertility. --Accepting that your body likely is never going to be sculpted or dieted into that of Gwyneth Paltrow.
Diets? Something to grieve?
Absolutely.
In most cases I listed, it’s easy to understand how grieving is the result. Let’s talk for a minute about why dieting and self-medicating are often signs you’re in a grief process.
Grieving, you see, is about change. Any time you have to move out of your comfort zone and adjust to life in a different world, your potential for entering a grief process is high. If the change involves a promotion and a substantial increase in income, it’s a whole lot easier to adjust and accept than one that involves having to accept news you’d rather not hear.
In the case of PCOS, the news, in general, is that choices you have been making in your lifestyle have been counterproductive to your health. And that if you want to regain your health, you’ll need to make different choices.
You’ll need to go to bed earlier.
You’ll need to delegate more.
You’ll need to get to the gym.
You’ll need to eat more vegetables and fewer corn chips.
Looking at the long list of things your husband, your caregiver, your health coach, and your dietitian are asking… and expecting you to do… can seem insurmountable.
I receive, on average, about 5 emails a week from women with PCOS, asking if some supplement (Dr. Oz’ recent show on supplements raised that average), or diet (think HCG), is going to work. I have come to think of those emails as indicators that the person who wrote them is cycling through grief. They just want the PCOS to go away. It won’t go away on its own, the necessary changes that are not user-friendly, and anything that seems like the easy answer seems like it’s worth a try.
It’s when your grief process and my expertise collide that we often butt heads. It is my job, as unpleasant as it may feel on the receiving end, to not allow you to succumb to magical thinking and detours that ultimately keep you grieving. It doesn’t feel good when I give you honest answers to your questions. I’m making you aware of something you’ve been working really hard to avoid, that you’re really needing to move out of your established behavioral comfort zone.
Am I a sadist? Not at all! I just know that the shortest way out of grief is to walk right through it. It is only when you confront the pain, maybe even get really, really angry about it… that you’ll consider a path that may actually work.
I spent an hour on the phone a couple of months ago, with a client who finally “blew” over the fact that her body doesn’t respond to diets, and that when she pushes the diet/exercise/binge/purge thing a bit too far, her body fights back and responds by giving her a weight she doesn’t like. All of the “maybe if I exercise an extra hour today… ” she’s been doing has no logic or science to support it. She’s been bargaining with her body, hoping it will finally give her the answer she wants, that you can use unhealthy means to force your body into being healthy.
The reason the conversation lasted so long is because I sensed she really, really wanted me to just tell her that her way of doing things would eventually be right, and she could avoid the reality of living with PCOS if she could get me to say that. Of course, I couldn’t do that. And she became angry. Really, really angry. And we stayed on the phone as long as she needed to vent.
Dr. Gretchen has written about anger before, and the importance of not ignoring it in order to move into health. If you don’t allow yourself to get angry… you are highly likely to stay stuck in your grief, bouncing back and forth between overdoing the healthy behaviors and overdoing the unhealthy ones and even worse, exhausting yourself into doing absolutely nothing at all.
And because the health-related behaviors you’ve tried have let you down, when you do reach out for help, you’re skeptical of what we at inCYST have to offer you that might be helpful. In addition to the questions I get about supplements, diets, etc., each week, I have at any given time, two or three email threads with women who kind of sort of reach out, but who have already decided that if I don’t give them promises of what they want to hear, that they’re not going to give us a try.
If you’re one of those women, and you’ve felt frustrated, perhaps that my response was curt or not compassionate, I hope this blog post helps you to understand. It’s not that at all. I just know, from over 30 years of doing this work, that if someone comes and they’re still doing a lot of bargaining with themselves, their health, and their bodies, that what they’re asking for is not what I can provide. If I become involved too early in the grief process, I stand to become part of the problem, not the guide to the solution.
I could actually prolong your grief by keeping you stuck thinking there is an easy way out.
I haven’t had PCOS or infertility. But I had a serious athletic injury that took my active life from me for almost two years. My business has hit some really hard times over the years. I’ve lost more than one person in my life, who meant the world to me. I’ve been through all of the emotions and stages in this cycle, more than once, sometimes managing several grief processes and their different stages, simultaneously! Every single time I felt like I couldn’t get up to face the day, or that what I was needing to do to get through that day, was inconceivable and insurmountable, and I challenged myself to get out of bed anyway and do exactly what I didn’t feel like doing… I felt myself move a little further along in the grief. In each case, it’s made me a better person for accepting the challenge.
I wouldn’t be the person I am with the experience, perspective, tolerance, compassion, and motivation that I have, if I had not been challenged to face some really horrible situations. If anyone had come along who tried to remove any of the life events I encountered while dealing with my own grief, I don’t think I would have gotten over it. They would have kept me stuck, as well-intended as they might have been.
My job, the job of all of us here at inCYST, is to understand what it is that you are grieving, to be aware of where you are in the process of grieving it, and to respect that process. Sometimes we have concrete solutions, and sometimes it’s best to step back while you do some things on your own.
It’s called respecting the dignity of the struggle.
I do promise you, there is a light at the end of the tunnel if you accept the challenge. But you’ll probably need to struggle.
One of my friends who knew the most detail of how much I had on my plate and how hard I was fighting to keep that plate from tipping over and crashing to the ground, used to always tell me the best way to eat an elephant was one bit at a time.
I have a special love for elephants now that I have conquered most of the circumstances that had me overwhelmed. Sometimes I think we should include one in our logo design!
I guess the point I want to make here, is that really, a very small part of what we can do for you is prescribe a diet or exercise plan. The biggest part of it, is actually more in Dr. Gretchen’s domain. I think most of you know what you need to do. Understanding why you aren’t doing it, may have a lot to do with grieving.
If you look at that graphic and feel like you’re going around in circles, perhaps spending sometime with Dr. Gretchen, or someone else who can help you step outside of yourself and understand the process without self-judgment, is the next most important investment you can make in your PCOS care and your overall health.