The Hemp Connection:
time to be

One of the most difficult parts of working with PCOS is how hard it is to help cysters understand the widespread effects of their diagnosis. The tendency is to focus on the symptom causing the most distress in the moment, and to look for relief from that distress, even if it isn't helping the core issue.

So, for example, women who are focused on infertility, tend to be caught up in ways to have a child, and to not think about what it's going to take to keep that pregnancy, how to nurse the child, and how to stay healthy until that child grows up to produce grandchildren.

One very nice woman I worked with who had PCOS was only willing to work with me for one appointment. It seemed, as we worked through my assessment questions, that she was realizing that what was going to result from our time together, was that she would need to address her binge eating behavior in order to reduce her carbohydrate intake and manage her blood glucose. She politely told me that she had decided that she would be better off pursuing in vitro fertilization (IVF), and if she developed gestational diabetes, she would call me to schedule another appointment.

I felt very sad about this, because this woman was not young, and fertility was not something to take for granted. And it seemed to me that the bigger picture here was that if the binge eating was not addressed, she may never get to the point where she was pregnant and in need of my help! But I couldn't tell her that. My job is to accept my clients where they are at and maybe plant a seed or two that encourages seeing things in new and different ways.

Which brings me to my topic for today.

Serum C-reactive protein (CRP) is a blood marker of inflammation, a degenerative process that has been identified in women with PCOS.

In a study of 63 women receiving IVF, it was found that CRP increased in conjunction with this treatment. Even if the women were taking metformin.

There is such a mentality in our country that we are entitled to have access to medical treatments for whatever ails us, and that we should expect that these treatments are risk free. That simply isn't the case. IVF produces many beautiful babies, but that doesn't mean it isn't without its issues.

What isn't even considered here…is the effect of an active inflammatory process on the developing fetus who has no choice but to live in that environment for nine months?

Is it just me…or doesn't it seem that if you want a baby that badly, that this baby deserves the absolute best possible environment in which to live and thrive from day one in utero? Which means taking a serious inventory of all of the nutritional and lifestyle choices we make that interfere with that on behalf of the new life that we want to create? And making some sacrifices in that department?

Just a little something to think about.

Kjøtrød SB, Romundstad P, von Düring V, Sunde A, Carlsen SM. C-reactive protein levels are unaffected by metformin during pretreatment and an IVF cycle in women with polycystic ovary syndrome. Fertil Steril. 2008 Mar;89(3):635-41. Epub 2007 Jun 4.

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.

I just finished reading a list of new research on the hormone melatonin. This is the hormone that helps you feel sleepy at night. It is also one of the most powerful anti-aging compounds in the body. I've got quite a few things to share over the next few posts, hopefully to reinforce the importance of getting enough sleep. When you don't, your body is out of balance and hormones start to act wacky!

Today I'd like to talk about endometriosis, something I've had myself since a teen and something I wouldn't wish on anyone.

Researchers created an artificial state of endometriosis by implanting endometrial tissue on the abdominal walls of a group of rats. After 4 weeks, a portion of these rats were given a daily dose of melatonin. At the end of the study, the volume of the artificially implanted tissue was measured, and the melatonin/no melatonin groups were compared. Tissue volume actually shrunk in the melatonin-treated rats. Anti-oxidant activity also increased in the rats receiving melatonin.

The risk in presenting information like this is that the first thing most people ask when reading studies like this, is how much melatonin they should be taking. That's not my point. If you're struggling with disorders related to melatonin imbalance…the very first thing you should be asking yourself is how much attention you pay to sleep hygiene.

Are you getting enough sleep?

Do you recognize the importance of adequate sleep for overall health, or do you tend to consider the little amount of sleep you get as an indication that you're harder working/better than others?

Do you minimize your alcohol intake? Are you judicious with your caffeine intake?

Do you get physical activity on a regular basis?

If you can answer"yes" to all of these questions, a melatonin supplement is something you may want to consider…used judiciously. If you can't, these are the lifestyle areas you should work on first.

We have a difficult time respecting the importance of balance, but it's pretty much a non-negotiable thing. We either work toward achieving it, and improve our health, or we ignore it, and we stay stuck in a place where we just don't feel the absolute best that we can.

Güney M, Oral B, Karahan N, Mungan T. Regression of endometrial explants in a rat model of endometriosis treated with melatonin. Fertil Steril. 2008 Apr;89(4):934-42. Epub 2007 Jun 19.

If you've ever dieted, and you have trouble sleeping…there may be a reason. Keep in mind, this study was done on rainbow trout, but there is still a message in it for humans. Three groups of trout were studied with regard to their melatonin (sleep hormone/antioxidant) levels and cortisol (stress hormone) levels. The three groups were defined as fed fish, fish that were fasted for 7 days, and fish that were fasted for 7 days then refed for 5 days.

Melatonin levels were disrupted in fasted fish. If you were human, this would likely mean if you were on a strict fasting/dieting protocol, you were probably having trouble sleeping as well.

Interestingly, nighttime serotonin levels were higher in these fasted fish. Melatonin is made from serotonin, so I would presume that what the body tries to do when you're not eating well is to keep you alert and thinking about getting some food. It does that by hanging on to serotonin and preventing its conversion into melatonin. That's a survival mechanism.

So if you're dieting and you're awake at night with cravings? That's a normal response. Don't obsess about what's wrong with you, don't surf the Internet looking for what to do about your cravings. In this kind of situation, you're thinking about food because you need it. Get some.

As far as cortisol, dieting reduced levels and they stayed low after refeeding. You could argue that this is a benefit of dieting…except for the fact that if you're cutting yourself short on melatonin, you're aging yourself more quickly than you should. There are plenyy of ways to reduce melatonin levels without dieting that don't cut your life short on the back end.

By the way, since I write so much about sleep I thought I should mention…I love naps. The long afternoon kind where my cats curl up with me, and I wake up with a little bit of drool on my pillow. I don't feel guilty at all. I completely buy into the idea of"beauty sleep"--sooooo much cheaper than all those anti-aging potions on the infomercials!

Ceinos RM, Polakof S, Illamola AR, Soengas JL, Míguez JM. Food deprivation and refeeding effects on pineal indoles metabolism and melatonin synthesis in the rainbow trout Oncorhynchus mykiss. Gen Comp Endocrinol. 2008 Apr;156(2):410-7. Epub 2008 Jan 8.

I am mostly a purist. I like real food from the source. But I am also a realist. And I understand that not everyone can cook, or even likes to cook. And that there are times when you are hungry when there's not a kitchen in sight. So I wanted to share a new product with you that I really like.

I have 3 friends in Seattle, all nutritionists, who partnered with a fourth friend, to create an all-natural, wheat-free, gluten-free, soy-free, low-glycemic energy bar that is just perfect for someone with PCOS. It's got the right kind of fats, and its protein source is whey protein powder, which is great too. Currently available flavors are: chocolate peanut butter, blueberry almond, and oatmeal chocolate chip. I especially like the fact that nutritionists understand that it's much easier to get people to try something healthy if you throw in a little chocolate!

I am really excited about this product, because it's not easy for me to come up with grab-and-go ideas for women with PCOS, and this one fits the bill.

It takes a lot of work and sacrifice to take an idea you have over coffee…"There's nothing out there I can recommend to my clients…hey, why don't I create my own?"…into a reality…and I am really excited that my friends stuck with their idea to the point where I can promote it to people like you. Which is the other reason I'm telling all of you about them. I'd really like them to be rewarded for what it took to go into a business that provides a much-needed service for women like you.

Currently, Zing Bars are primarily available on the West Coast (there is a store locator on the website), but you can order them online by the box. If you like them, be sure you encourage your local stores to stock them.

For more information, visit www.zingbars.com

First of all…it's great to be back! I was traveling, and while it's kind of fun to say I saw both the Atlantic and Pacific oceans in the period of a week, I do like my base camp and I really missed reading research. I'm looking forward to getting back into my daily groove.

Last week, I read an article in the New York Times about insurance companies, and how they are starting to ask consumers to absorb the cost of medications by asking that these medications be paid for not by flat copayment, but proportionate to the cost of the medication.

Nice. First we're convinced that we absolutely need all these drugs, and that we can get them for cheap, then once we're dependent on them…we're thrown under the financial bus.

Right now, the medications that are being sold under this new proportionate plan are not any of the medications that I focus on with this blog. However…since several of the medications you readers are on, are some of the most popular medications out there, I suspect it won't be long before these insurance companies start to see dollar signs in terms of the quantity of people they can expect to help finance this venture. Categories of medications like antidepressants…and insulin sensitizers and statins, which are commonly prescribed when the antidepressants start to mess with hormone balance.

That's the bad news.

The GOOD news is, I finally felt vindicated for having sat through this scenario for the last 25 years, wishing people would see what I have always seen…that when you take responsibility for your own health, and don't depend on people who make money off of you to help you, you have a good chance of getting better results. Think about it. Why would a drug company spend millions and millions of dollars to develop a product that you eventually wouldn't need once you started using it?

My goal, ever since I started what I do, is to put myself out of business. I started learning to play golf last year and it has been very frustrating to have to put it aside to attend to the demands of my growing business. I have a children's story I'd like to publish. And there are a couple of screenplays roaming around in my head that I'd love to get into theaters.

But the drug and insurance industries don't have that goal. Their goal, as is the goal of most corporations, is to increase market share and return on investment. Which means you can (1) increase the dosages of medications you sell to already existing customers, (2) find new customers for your medications by either creating new diagnoses or finding off-label uses for your already developed products, and/or (3) increase the price you charge for the product. Hmmmmm…nowhere in there do I see"helping the patient feel better".

Of course, I'm not naive. I know some medications are entirely necessary and even life-saving. But I also see so many conditions that could drastically improve with a few judicious lifestyle choices.

Last week I listened to the husband of a friend tell me what it was like to go through an in-vitro fertilization (IVF) procedure with his wife. He was near tears as he spoke about the trauma, the callousness of the providers, the emotional stress…the expense, and the feeling of failure as a human being when the entire investment of time, emotions and money did not produce the desired result.

He drove me to the bus stop, and I headed to the airport. As I was standing in line to board my plane, a colleague phoned me. She'd gone through my professional training and had been using my protocol on women with infertility. And she told me, that with just a few nutritional tweaks, these women were getting pregnant! Not only that, their depression was responding with equal profundity. Even the women who'd failed with the same IVF procedure as my other friend and who had given up on ever having children, were seeing results.

There's something very wrong with a system that promotes a $20,000 emotional and financial (mis)adventure over a $12 bottle of Coscto fish oil…but we as consumers need to shift our expectations for help from those who stand to make money off of our misfortunes and invest in choices, behaviors, and financial purchases that are empowering and affirming. You'll never get a company making money off of you to change how they do things if it means less money. But we can certainly get their attention if, collectively, we start to say"no" to some of their answers to our problems and"yes" to options that make more sense.

You bet the power of where you pull out your wallet is tremendous. And when groups of thousands of wallets get together…well, that's the vision I have that will finally get these screenplays out of my head!

Eating well. Physical activity. Adequate sleep. Less stress. It's that simple. It's incredible what prioritizing these four areas can do to your overall health. Not to mention your budget.

http://www.nytimes.com/2008/04/15/opinion/15tues1.html?hp

Fatty liver is a common problem in women with PCOS. In this study, EPA, an omega-3 fatty acid and a fish oil, was shown to improve the symptoms of nonalcoholic steatohepatitis (fatty liver). EPA is the fish oil that you cannot get when you rely on vegan sources of omega-3's--it's not in flax, and it's not in marine algae. Some research shows that when you've eaten enough marine algae to completely saturate your tissues, what's left can be used to make EPA, but it's not the way of getting it that the body prefers.

This is important to understand, because the vast majority of foods that are labeled as supplemented with omega-3 fatty acids either contain ALA (primarily in the form of flax) or DHA (primarily from marine algae).

The other advantage to eating fish is, that if you've put a fillet on your plate, you've likely removed another (fattier) kind of protein. That's the positive double whammy you get in seafood choices.

In my training I was always encouraged to develop good negotiation skills. In other words, if a client didn't like a certain food, to have a few other options up my sleeve that would provide equivalent nutritional value. Only when I got into omega-3 chemistry, inflammation, and PCOS, did I realize that in this one crucial area, I would have to dig my heels in and advocate that this essential nutrient was simply non-negotiable: if you don't eat fish, you miss out on total health.

Over the weekend I had an animated discussion with another dietitian who was adamant that her clients (mainly with eating disorders) simply were not going to accept this. I told her they simply would not achieve total health…and possibly total recovery. I got some resistance, but hopefully at some point this colleague will come to understand that we're here to guide our clients where they have the potential to go. We're not here to tell them what they want to hear, with the hopes that somehow health will just magically appear.

Tanaka N, Sano K, Horiuchi A, Tanaka E, Kiyosawa K, Aoyama T. Highly Purified Eicosapentaenoic Acid Treatment Improves Nonalcoholic Steatohepatitis. J Clin Gastroenterol. 2008 Apr;42(4):413-418.

Happy Monday to all of you!

Sorry for the silence, I was in Boston for a sports nutrition conference, promoting the Nordic Naturals line of fish oils. I've been sidelined from my half marathon training with a cranky knee, and it was so nice to get off of the elliptical trainer, get outside, and walk along the Charles River to and from my hotel and the conference!

Something I was very happy to see, throughout the conference, was the emphasis on nuts in general as a healthy food. I've been frustrated for a long, long time that the walnut people seemed to be the only nut commodity board with media contacts. Not that I don't like walnuts, but there's nothing wrong with other nuts as well.

I did an analysis for an article a few years ago, in which I compared the ratios of beneficial fats (omega-3's and monounsaturated) to potentially detrimental fats (omega-6's and polyunsaturated). And when they were all lined up in terms of most beneficial to least beneficial…walnuts actually turned up at the bottom of the list. Macadamias came out on top!

I use that analysis in my trainings, and dietitians will always immediately say,"But macadamias are so high in fat." Precisely. But it's the kind of fat that keeps us healthy. Lucky for me…my very favorite way to have nuts is macadamia nuts roasted in coffee, the way they fix them in Hawaii.

Anyway…(I tend to get distracted in this blog, don't I?)…

…one of the presentations showed data for macadamias, pecans, and pistachios, suggesting that they, too, are good foods to include in an anti-inflammatory (aka anti-PCOS and pro-fertility) diet. Nuts, in addition to good fats, have a variety of antioxidants that can delay and prevent aging and help fight stress. I even learned that the green part of pistachios contains lutein, which makes them good for eye health. Who knew a food so fun to eat would also be so helpful to my health?

Of course, there's a limit to how many nuts can be healthy, and fat has calories, no matter where it comes from. But if you're reaching for a handful of pistachios instead of a bag of Fritos, it's nice to know you're also reaching for better health.

So this week…go nuts!

I'm supposed to be getting all of you excited about food…how in the world does cabbage fit into that idea?

I think cabbage is one of those overlooked foods that is easy to include in your diet. And I like it because as a vegetable, it's pretty inexpensive.

Plus, cabbage belongs to the Brassicaceae family, which you may know as the cruciferous vegetables. These include: broccoli, cauliflower, brussels sprouts, kohlrabi, bok choy, mustard, radish, horseradish, and watercress. These vegetables are superstar cancer fighters. In fact, they have even been shown to stop tumor cell growth in breast and endometrial tissue, especially important for women with PCOS.

So now that I hopefully have your attention, what the heck are you going to do with cabbage?

First of all, don't overcook it. All cruciferous vegetables tend to get a strong flavor if overdone, which may be why many people think they don't like them. They never had a chance to try them at their best. I made cabbage rolls this week, which requires you to steam the leaves until they're soft enough to roll. It was a great make-ahead meal for a busy work week.

Think slow cooker! I love mine, and I use it to make soups and casseroles. It's easy to add some chopped cabbage just a few minutes before serving.

Stir-frying is another way to use cabbage.

In other words, keep a head in the fridge and add it to some of your many favorite meals.

If you've got German blood, like me, you may want to think of sauerkraut. If that's a little bit extreme, try this red cabbage and apple recipe. Even the world's most notorius veggie hater might think cabbage is (at least an occasional) possibility with this treat. Be sure to use canola oil for the best omega-3 source.

http://www.foodnetwork.com/food/recipes/recipe/0,1977,FOOD_9936_13395,00.html

I got my start in this specialty in a nontraditional fashion. Even though I did a lot of work in endocrinology initially, I gravitated into sports nutrition, and from there, eating disorders. I initially started my business thinking that it would be a resource center for eating disorders. But PCOS followed me. I kept getting phone calls from women looking for help with their eating disorder who mentioned they'd recently been diagnosed with PCOS. Thinking there must be some relationship, I started mentioning the symptoms of the syndrome at local mental health networking meetings. I started getting counseling referrals from eating disorder specialists--and they tended to be women who had initially been diagnosed with bulimia, put into traditional eating disorder treatment, and then a few years later,"relapsed". It was with this"relapse" that the PCOS was diagnosed.

I put that word into quotes, because you can only relapse from a disease you've been treated for…if the treatment you received is for the problem you have. The word blames the person for the diagnosis with the problem.

I have come to believe the problem may lie, in large part, with the caregivers. Eating disorder symptoms are primarily behavioral. There isn't a blood test you can administer, or an x-ray you can examine. And therefore, if you fit a certain criteria, you must have the disorder.

Just as diabetes won't respond to psychotherapy, PCOS, which in many cases is PREdiabetes, won't either.

The problem with PCOS is, the hormonal imbalances it renders can induce the very same behaviors that we use to diagnose eating disorders. Carbohydrate cravings are extreme. Hormones are so out of whack that the only thing that manages them, it seems, is extremes in diet and in activity. And God forbid, if no doctor caught on to your hormone problem and you decided to take things in your own hands…then you have control issues and you have an eating disorder.

What can make it especially challenging to diagnose PCOS, if it has progressed this far, is that the extremes in exercise and diet may, at least temporarily, suppress abnormal labs. It takes a skilled clinician to even see what's going on. I think back to my 3 1/2 years in an inpatient treatment center, and how many young women came to me complaining that as they started to refeed, they were craving carbohydrates. And because it was the treatment center's philosophy, I smiled back and told them all foods could fit.

A lot of eating disorder treatment is about the battle between the clinician, who wants his/her clients to believe that they can get back to eating everything in moderation, and the client wanting to tell the clinician that just isn't so, but playing the game as long as she needs to in order to graduate to the next level move toward discharge.

Last year I wrote to several hundred mental health practitioners who specialized in PCOS, introducing my company and the work I do with PCOS. I described the symptoms and explained to them what I just explained above. I received who knows how many polite responses, thanking me for my interest, but they worked with eating disorders, not PCOS, and there wasn't really a need for my information. I wondered how many thousands of women were sitting in therapy, being told if they just addressed their"issues"…they could beat the problem.

Don't get me wrong, I know there are plenty of issues in PCOS that psychotherapy can benefit. But there's a difference between anxiety over the prom and anxiety driven by excess cortisol levels resulting from a poorly balanced nervous system.

Sometimes I wonder if it's not the same diagnosis, being given a different name depending on the office in which it first shows up?

I sure hope at least some of those women have found my website on the Internet and have benefitted from the information I've learned and posted there since that tenure.

I was a little uninspired for this weekly feature until I made breakfast. Oatmeal is such a staple for me, it hadn't even occurred to me that I could talk about it here. It's not fancy, it's not expensive, it's not glamorous…it's just oatmeal. But it's filling, and it can be dressed up in so many different ways that, at least for me, it never feels like the same breakfast twice.

I like to put nuts, raisins, and dried fruit on my oatmeal. I also add my Omega 3 Brain Booster powder as a way to boost the nutritional content. I bought a bunch of glass canisters at IKEA, and I use them to store/display my oatmeal and all my different fixins'. They look so pretty and healthy it makes me want to use them, which is exactly the point!

Oatmeal has a great glycemic index, meaning it won't wreak havoc on your blood sugar. And that means you're less likely to be hungry in the morning because your blood sugar dropped at a time when lunch was still a ways away and there were donuts sitting in the break room.

A special oatmeal note for you frequent flyers. The international terminal at JFK airport (New York) has a wonderful oatmeal bar! You can fix it with just about anything you would want. I was so thrilled to find this, since much airport food can't even really be thought of as food. Check it out and enjoy!

One of the things I love about doing demos at Whole Foods is that they always have great food to sample! This past weekend I learned about baby kiwis. (I am always surprised at how, just about the time I think, at my age, and with my profession, I've encountered every kind of fruit and vegetable there is to eat…that something new pops up in the produce section!)

If you like kiwi fruit, these are the mini version. They're about the size of grapes, but they taste like kiwi fruit. They are very high in vitamin C, and they have a bit of calcium, vitamin A, and iron as well.

They'd be a great snack food to have in the refrigerator--be sure to store them at eye level instead of in the produce bin so you don't forget you have them!

Photo courtesy of melissas.com

Scientists have reported that myo-inositol can be a safe supplement to use to promote ovulation and fertility.

I have known about inositol for years, as it is also a supplement that can be helpful in the treatment of anxiety, obsessive-compulsive disorder, and panic disorder.

Since 80% of the women with PCOS coming to my website are reporting some kind of anxiety, depression, and/or mood swings, it seems that using inositol as part of your overall health and fertility program may not be a bad idea. Even if you don't have a DIAGNOSIS of anxiety, it's so easy to feel stressed out when all you want is to conceive!

The supplement can be a bit expensive…but it's far cheaper than in vitro fertilization. And it's simply a form of a water-soluble B vitamin. If it can't hurt, and it might help, at least one issue you are looking for help with…why not give it a shot?

Papaleo E, Unfer V, et al. A novel method for ovulation induction," Gynecol Endocrinol, 2007; 23(12): 700-3.

Harvey BH, Brink CB, Seedat S, Stein DJ. Defining the neuromolecular action of myo-inositol: application to obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2002 Jan;26(1):21-32.

Palatnik A, Frolov K, Fux M, Benjamin J. Double-blind, controlled, crossover trial of inositol versus fluvoxamine for the treatment of panic disorder. J Clin Psychopharmacol. 2001 Jun;21(3):335-9.

Do you live in Phoenix or LA? Consider coming to my inCYST classes! April's topic is eating better…it's a great place to get into the rotation. Cost of attending is $15, and each session is 2 hours. I have designed this program to be as budget-conscious as a medical copayment, but you get twice the time!

In both cities, classes are held in a local restaurant, so we can also learn restaurant eating while we chat.

I do ask for an in-advance, nonrefundable payment to hold your place (and since I have to travel to LA, that helps me with my own travel planning).

More information on dates and topics can be found on my website, www.afterthediet.com/inCYST.htm.

Last Saturday I was doing a demo for a client at a local Whole Foods store. I love doing demos because I get to do something away from the computer and call it work! Another reason I love demos is because of the fun and creative people I get to meet. Most people who do demos are small business people who had an idea for how to make something tastier, healthier, and/or easier to cook. Which is one reason why, if you're reading this post and you're a Whole Foods patron, you might want to spend more time talking to these people next time you go shopping.

But I digress.

What I started to say was that last Saturday I was positioned across the aisle from a chef who has started a salsa company. And I immediately thought of my blog. Salsa! One of my very favorite foods! How could I be from Arizona and have this"Food of the Week" feature as long as I have and not have even thought about salsa?

Why do I love salsa? Because it's versatile. You can put it on barbecued meat. You can put it on a sandwich instead of ketchup. You can stir a little bit into just about any other kind of sauce to spice it up. You can put it on eggs in the morning. It's just one of those foods that once you learn how to use it, you can't live without it. (I actually start to crave it if I'm traveling in a place where food tends to be a little blander…)

Nutritionally, salsa can be a great way to get those veggies in that otherwise just don't seem to get onto your plate. If you're looking for a way to clean out your vegetable bin, you can make your own salsa. Pretty much anything goes together in some way.

If you're feeling adventurous, try mango or pineapple salsas. Mango salsa goes great with salmon!

One thing you do need to watch with commercially prepared salsas is that they can be high in sodium. The particular brand my new friend was selling happens to be low in sodium because he himself has a blood pressure issue. So read the label--there may be something healthy in your area.

Now I'm hungry. I think I'd better see what's in my own kitchen that I can spice up tonight with some salsa!

Here's a study about lean women with PCOS--the women who I like to call"the forgotten cysters". I have lost track over the years of the number of women who have written me to share that they went to their physician asking for help with a list of PCOS symptoms they had…only to be told they couldn't possibly have PCOS because they were not overweight. Up to 70% of women who have this disorder are not overweight!!!

My belief is that many women who have adopted extreme eating and exercise behaviors to manage their weight, quite possibly many women who have been diagnosed with and who are being treated for eating disorders, actually have undiagnosed PCOS.

We need to get over this belief that thin equals healthy, and that a person cannot have PCOS if her BMI and weight are within normal limits. If you have to adopt extreme measures to stay within your recommended weight range, that is a serious problem and your physician needs to listen to you.

Now for this study to illustrate. Eight lean women who actually had been diagnosed with PCOS ("cysters") were compared to 7 lean women without PCOS. The cysters had higher testosterone, and prolactin levels. They also had lower sex hormone binding globulin levels (this protein binds and inactivates testosterone).

There you have it. You can be thin AND out of balance. Sisters…and cysters…it is your right to be heard and to not be told that nothing is wrong with you when you know there is. That is where my program name, inCYST, came from. You have the right to inCYST on the appropriate treatment for the appropriate problem and not to be told you do not need treatment just because you may not fit the common profile for PCOS, or for any disorder.

Grimmichová T, Vrbíková J, Matucha P, Vondra K, Veldhuis PP, Johnson ML. Fasting insulin pulsatile secretion in lean women with polycystic ovary syndrome. Physiol Res. 2008 Feb 13 [Epub ahead of print]

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

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

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

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

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.

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

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

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

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

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

The more I read about melatonin the more I think I should have majored in sleep instead of nutrition. Just ran across a research abstract reviewing the many effects melatonin, our sleep hormone, has on hair health.

In addition to being a potent antioxidant, which means it destroys compounds that promote the many symptoms of PCOS, melatonin reduces apoptosis, a process which kills cells in the body.

It's really important to value your sleep. Not getting it is not a sign of drive…or superiority…or success…or a glamorous lifestyle…losing sleep is something you do that accelerates aging and promotes all the nasty things you've come to hate about PCOS. Those of you who are losing hair to your PCOS…should take this very seriously!!!

Fischer TW, Slominski A, Tobin DJ, Paus R. Melatonin and the hair follicle. J Pineal Res. 2008 Jan;44(1):1-15.