I recently blogged about Greek yogurt, and how most major brands contain no vitamin D. Given the realities that many women consider yogurt to be a nutritional equivalent to milk, and vitamin D is increasingly being recognized as a factor in PCOS and other health issues, this is a really important thing to know. I have become increasingly frustrated with the amount of nutritional advice encouraging Greek yogurt consumption without mentioning this.
Last night I noticed that Yoplait has come out with its own Greek yogurt, containing twice the protein of regular yogurt and 20% of the recommended Daily Value for vitamin D. I would strongly recommend going with the plain version and adding fruit to sweeten it, to avoid excessive added sugar, but otherwise, it's probably the best Greek yogurt out there for anyone who is concerned about their vitamin D levels.
If you go to the link above, you can get a coupon you can use when you try it, too!
It's really become important for us to partner with like-minded companies in order to do all the work we aspire to do.
When Pat Hunter, Hillary Wright, and I present in Nashua, NH, we owe that event's existence to St. Joseph Medical Center. Kristen Rioux has been instrumental in developing our flyer, and providing marketing insights that helped to create a great event with potential to reach a lot of women.
In addition, Australis is donating the barramundi we're serving for lunch. If you're not familiar with barramundi, please check out their website. It's a sustainable farm-raised fish with a very high omega-3 content. I love it because its flavor is very mild, which makes it acceptable to many people who just cannot tolerate the distinctive flavor of salmon. The Australis people like to call it"sustainable sea bass" because its flavor is reminiscent of that species.
Stonyfield will be donating samples of their vitamin-D supplemented yogurt for our snack break. If you have read inCYST intern Sarah Jones' blog post about yogurt, you will remember that not many yogurts even have vitamin D. Stonyfield is one brand that does have a variety, and we're looking forward to showcasing it in Nashua.
In the spirit of Mardi Gras week, I thought I'd highlight a kissin' cousin of that Cajun crawfish…shrimp.
Shrimp are one of those foods people love…and they have learned to be afraid of. When I started out in this field, I was taught to teach patients to avoid shrimp because of their high cholesterol content.
Turns out, dietary cholesterol in foods such as eggs and shrimp do not influence our own cholesterol nearly as much as pro-inflammatory fats, saturated fats, and trans fats. Some researchers even suggest that shrimp consumption may IMPROVE cholesterol and triglyceride levels!
In addition shrimp, lucky for a shrimp lovin' woman like myself, is extremely low in fat! A 3.5 oz (deck of card-sized) serving of fish has about 1 gram of fat…whenever I'm questioned about shrimp I always remind the person with the question that shrimp is so low in fat, it almost squeaks from lack of lubrication against your teeth when you bite into it.
Shrimp is also a great source of protein, vitamin B12 (crucial for mental health), tryptophan (needed to make serotonin), and vitamin D (thought to be important in managing PCOS). In addition, shrimp helps omega-3 balance by contributing a moderate amount of DHA. And, when you're replacing red meat with seafood, you're exchanging pro-inflammatory omega-6 fats with healthier fats, which ensures that your omega-3's are not metabolically destroyed before they have a chance to benefit you.
So if you see shrimp cocktail, shrimp fajitas, grilled shrimp on the menu…go ahead! Enjoy! It's contributing to your health while providing a tasty adventure.
I was asked by one of our readers (who happens to also be my dear cousin Susan), if there was anywhere on the Internet, a checklist for vegetarians to follow to be sure their diet is complete. Her pretty exhaustive research found nothing really practical for meal planning.
So in response to that, and knowing that a very high percentage of our own readers are vegetarian, I put something together. Please let us know if it needs refining or detail, so that we can make this as practical as it can possibly be.
There are five main things to attend to. All of them are important, but I ordered them in the way I look at them when planning a vegetarian meal for myself.
1. What is my protein source and how much of it do I need to truly give me enough protein?
Here are your goals based on the number of calories you eat. This will make 30% of your calories protein, which will help to fight insulin resistance.
2. Where is my vitamin D coming from, and have I had enough? You will have to make a very conscious effort to get enough of this vitamin. With regard to whole foods, mushrooms are pretty much the only vitamin D-containing food. With regard to vegan milk alternatives, beware. Most are so low in protein, they are more accurately thought of as juices rather than milks. If you choose to drink them you will need to find other ways to meet criteria nu,ber one above. I blogged about this in detail not too long ago.
3. Are my fats healthy? If your definition of vegan is primarily not eating meat, and you are eating a lot of packaged, processed, prepared, or baked food…be extra sure you are not inadvertently letting the pro-inflammatory fats sneak in. Remember, they tend to begin with the letters"s" and" c" — soybean, safflower, sunflower, sesame, corn, cottonseed. (Canola is the exception.). Vegans are often blindsided here with salad dressings, baked goods, cookies, and chops. Read your labels--as much as I love Whole Foods, their entire snack food aisle only has a handful of choices you can bring home if you follow this rule! Good fats include olive and organic canola.
4. Am I getting DHA and EPA (marine omega-3)? Yes, flax, green veggies, and other foods contain omega-3, but the conversion rate is not high. You will need to find a marine algae supplement to be sure your intake of these two essential fatty acids is adequate. InCYSTer Chris Marquette found one that is not genetically modified; look for it next time you shop.
5. Am I getting enough fruits and vegetables? Ideally, these should be the vast majority of what you eat. I am surprised at how many vegans I know who do not like vegetables! You should be aiming for 2-3 1/2 cup servings PER MEAL. Beware of juicing; it is a great way to get in large volumes of fruits and vegetables…BUT…the carbohydrate to protein ratio is not going to help reduce insulin resistance. Make a smoothie out of your juice with your favorite protein powder.
Of course, you can take supplements to make up many of these deficiencies…but if your solution in more than one of these categories is a supplement, I challenge you to consider why you do what you do. The true definition of a vegan is someone WHO MEETS THEIR DAILY NUTRITIONAL NEEDS without using animal-based food to make it happen. If all you have done is remove animals from your diet, you are simply a picky or misinformed eater.
I finished up my nutrition education during the height of cholesterol phobia/low fat mania. The message we were taught to teach about egg yolks dies hard.
Several years ago colleague Susan Kleiner, Ph.D., R.D., shared in a presentation I attended, that there really isn't hard research that shows, without a doubt, that eating egg yolks increases cholesterol. Neither is there really evidence to show that removing egg yolks from your diet reduces cholesterol. Other dietary choices, such as the ones we teach on this blog, are far more effective at normalizing your blood lipid tests.
Eggs are such a cheap, easy source of protein. Scrambling them with vegetables is my favorite way to clean out my vegetable bin.
If you're trying to increase and maintain your vitamin D levels, keep in mind that it is found in egg yolks. And the levels of vitamin D in egg yolks, according to the US Agricultural Research Service, is higher than thought. Each large standard egg contains 41 IU.
If you're still not convinced and questioning, consider that this same analysis showed that the amount of cholesterol in eggs is 14% lower than previously reported, 185 milligrams per egg.
Egg yolks also contain choline, the precursor for acetylcholine, the neurotransmitter involved in memory. It's not easy to find in food…if brain fog and memory are problems your PCOS has brought you, perhaps rethinking your relationship with egg yolks could be helpful.
I'm not sure what the change is, perhaps farmers have been changing the composition of poultry feed in response to the dietary concerns of their customers.
Whatever it is, I'm hoping the new results in a few more egg yolks showing up on diet diaries I review here in the office!
Note: I've received quite a few compliments about this blog post. It was written and published without a single edit by Sarah Jones. Sarah is currently a nutrition student and Arizona State University and has been interning with me over this academic year. The attention to detail you see here is just how Sarah does things. I'm very lucky to have her, and glad she has shared such a timely topic in such a wonderful post. Thanks, Sarah!
You may have noticed that vitamin D has been a hot topic in the media lately and, at this point, it is likely that we as consumers are becoming overwhelmed by all the media hype. Recent studies have suggested that in prehistoric times, in addition to normal skeletal development, humans probably used vitamin D as a natural form of sunscreen. Before majoring in Dietetics, my basic knowledge of the role vitamin D played in the body is that it somehow worked with calcium to promote healthy bones. As it turns out, I had no idea how complex the relationship actually was between vitamin D and the human body! Let’s take a further look at vitamin D. Most of us may know vitamin D as the “sunshine vitamin.” We get it from the sun, right? Sure, but how? When ultraviolet light from the sun shines on a cholesterol compound in our skin, it is transformed into a vitamin D “precursor” (compounds that can be converted into active vitamins that the body can use) and is absorbed directly into the blood. The liver and kidneys finish converting the precursor to the active form of vitamin D. There are two major forms of vitamin D; these are vitamin D2 (ergocalciferol), which is present in plants, and vitamin D3 (cholecalciferol), which is present in the skin of animals. Vitamin D was discovered in 1920 and was originally classified as a vitamin. However, it has since been revealed that vitamin D is actually a hormone (steroid) since it can be synthesized by the body when exposed to sunlight. Essentially, the major biologic function of vitamin D is to maintain normal blood levels of calcium and phosphorus in our bodies, which aids in the absorption of calcium and helps to form and maintain strong bones. Vitamin D3 is the most active form of the vitamin, which is what you will see in most supplements. Obtaining vitamin D from sunlight presents no risk of vitamin D toxicity because the body is able to regulate the vitamin D precursor – see what I mean about complex! But, as we know, getting too much sun puts us at risk for skin cancer. Since moving to Arizona, I have started wearing sunscreen everyday to decrease my risk of skin cancer, but sunscreen can reduce or prevent the synthesis of vitamin D. And, because vitamin D is one of the most toxic of all the vitamins, taking supplements can put us at risk for toxicity. Now you may be thinking, I wear sunscreen, I am concerned about supplementing without first consulting my doctor, and I live in an area that does not get much sunlight during this time of year, what foods can I eat that have vitamin D in them? As far as foods are concerned, dietary vitamin D is provided primarily by foods of animal origin, especially liver, beef and eggs (mainly the yolk). You can also find vitamin D in dairy products such as milk, cheese and butter. Lastly, vitamin D is in some saltwater fish, including tuna, salmon, herring and sardines. Because few foods naturally have substantial vitamin D content, i n the United States there are pre-selected foods, such as milk, cheese, margarine and yogurt as well as some orange juice, bread, and cereals that have been fortified with vitamin D. If you are a vegetarian, you likely will not be obtaining vitamin D by eating liver, beef or fish, but you may still be eating eggs and dairy products. I mentioned yogurt as a source of vitamin D, but after a trip to the grocery store and looking at no less than ten brands of yogurt, I was stumped! I was hard pressed to find yogurts that have been fortified with vitamin D. However, it was not a complete loss, as I eventually spotted one (which also happens to be one of my favorite brands). Stonyfield Organic Yogurt has fortified most of their yogurt products with vitamin D3. Here is a list from their labels of the “percent of daily values based on a 2,000 calorie diet”: Organic Fat Free Smooth and Creamy 6 oz (all flavors): 20% of D3 Organic Fat Free Fruit on the Bottom 6 oz (all flavors): 15% of D3 Organic Low Fat Smooth and Creamy 6 oz (all flavors): 20% of D3 Organic Low Fat Fruit on the Bottom 6 oz (all flavors): 15% of D3 Their soy and Greek yogurt’s do not have vitamin D, but they also make six and ten ounce organic smoothies that contain vitamin D. Additionally, they have two other products that are worth mentioning: “B-Healthy and B-Well.” B-Healthy includes omega-3 fatty acids, as well as three of the B vitamins ( B3 or Niacin, B5 or Panthothenic Acid and B12). B-Well contains vitamin B6, probiotic cultures and vitamin D. According to their website, if you live in the Phoenix area, Stonyfield Organic Yogurt can be found at: Bashas’, AJ’s Fine Foods and Sprouts Farmers Market.
References
1. K.M. Dixon, S.S. Deo, G. Wong, M. Slater, A.W. Norman and J.E. Bishop et al., Skin cancer prevention: a possible role of 1,25dihydroxyvitamin D3 and its analogs, Journal of Steroid Biochemistry & Molecular Biology 97 (2005), pp. 137–143. 2. Linus Pauling Institute Micronutrient Research for Optimum Health Website. Available at: http://lpi.oregonstate.edu/infocenter/vitamins/vitaminD/. Accessed June 18, 2011. 3. Mahan, LK, Escott-Stump S. Krauses’s Food & Nutrition Therapy. 12th ed. St. Louis, MO: Saunders/Elsevier; 2008.
I was looking for something comfort-foody to make the other night. I ran across a potato soup recipe that looked yummy…until I saw that it called for heavy cream.
I tried substituting Greek yogurt for the cream and it turned out great! It is not as luscious-creamy as a traditional cream soup, but it's still wonderful nonetheless.
Here is the recipe. I actually added the salsa because the recipe originally called for poblano peppers and my store was out of them. Loved the extra kick!
If you were to use the Monterey Mushrooms, which are organic and high in vitamin D, you'd be creating an especially hormone-friendly meal for yourself!
It is an adaptation of the Potato Poblano Soup recipe found in the lastest Costco Cookbook,"Smart Cooking the Costco Way."
Spicy Creamy Potato Soup
2 tsp canola oil 1 white onion, cut into 1/4 inch dice 8 ounces mushrooms, sliced 1 garlic clove, minced 1 serrano pepper, minced 1 cup fresh salsa 3 small to medium potatos, cut into 1/2 inch dice 5 cups 1/2 strength chicken broth 1 cup Greek yogurt salt and black pepper
In a large saucepan, heat oil over medium-high heat. Add onions and aute for 2-3 minutes.
Add mushrooms and saute for 2-3 minutes.
Add garlic, peppers, and salsa; saute for another minute.
Add potatoes and chicken broth. Reduce heat, cover and simmer for 15 minutes, or until the potatoes are tender. Add Greek yogurt.
With a slotted spoon, scoop out about 1 1/2 cups of the soup vegetables and puree in a blender. Return the puree to the soup and stir well.
Reheat the soup to a simmer, season to taste with salt and pepper, and serve. Makes 6 servings.
Greek yogurt is all the rage these days. Are you missing something by not eating it?
Yes…and no.
This dairy treat is popular with consumers because it's thicker and creamier than regular yogurt. Nutrition experts like it because it is higher in protein. That, for PCOS is something to look for in foods.
Before you jump on the bandwagon, however, consider a couple of things.
Greek yogurt is made by straining out the water to make it thicker. In the process of straining, calcium leaches out into the water that is strained and discarded. This means that its calcium content tends to be lower.
Greek yogurt also doesn't contain vitamin D, a vitamin that is increasingly being found to be deficient in women with PCOS. I personally checked all major brand labels (Fage, Oikos, Chobani, and several other lesser known options) in the store to verify this, and unfortunately, not a single one is fortified with vitamin D.
So if you're using Greek yogurt as your dairy choice for the day, and you're assuming it's a good source of calcium and vitamin D, you're selling yourself short.
Fortunately, if you love Greek yogurt and you have a few minutes of time, the problem can easily be solved. It turns out, it's fairly easy to make Greek-style yogurt from regular, vitamin-D fortified yogurt! All you need to do is strain the regular yogurt with a cheesecloth. Here are the directions, with pictures.
Here is a list of yogurts that DO contain vitamin D. My recommendation is to stick with plain in order to keep the sugar content low. Also, to consider a low-fat rather than a non-fat version. Researchers have found that if only one of your dairy choices a day contains fat, you tend to increase your fertility.
If you want to, you can even save the liquid you've drained off and include it in smoothies--thus recapturing the calcium and the whey protein that's been drained off in the straining process.
Bottom line--don't assume that because yogurt is a dairy product that it is the exact nutritional equivalent of milk. And don't get caught up in the hype, and assume that Greek yogurt is automatically your superior choice.
A new client and I found this recipe online during her consultation. If you use Yoplait Greek yogurt, you can use this to increase both your protein and vitamin D intake.
I don't know about you, but mushrooms just aren't my top priority when I'm writing my grocery list. They're fungus, right? They just can't have much to offer with regards to nutrition, with that neutral color and different texture!
Was I ever wrong! Last week I learned that mushrooms contain two nutrients with healing potential for women with PCOS. They contain chromium, a metal that can be helpful with cravings. You may have read earlier on this blog, chromium in large doses may damage DNA. So the wiser choice may be to include foods in your diet that provide this metal in a dose that Mother Nature has provided.
Mushrooms, surprisingly, also contain vitamin D! It's one of the few non-animal sources of this vitamin, so vegetarians take notice! Your pizza is a great place to sneak in some 'shrooms. You may have read that some mushroom producers are experimenting with a technology to increase the vitamin D content of mushrooms using light exposure. Even if you get the regular button mushrooms at the store that have not been processed in this fashion, they'll still contain vitamin D.
I spent last night looking at how different mushrooms vary in nutritional value. Regardless of what the type…portabella, shiitake, button…there was something valuable about each and every one of them.
So put them in your omelets, add them to your salads, toss them into your pasta sauce! Mushrooms, for PCOS, can be pretty marvelous!
If you'd like more specific help planning menus including mushrooms, our new inCYSTem menu planning/coaching program features mushrooms this coming week. If you sign up before October 23 and help us beta test this program, you pay half price ($7.50 for a month of ongoing menus and can continue to subscribe at that price for the following 5 months). Contact me directly at marika@google.com for more information.
This past Wednesday, Sasha Ottey of PCOS Challenge interviewed Walter Futterweit, MD, a longtime PCOS researcher and advocate. He provided a great summary of the laboratory tests you should be getting and why. I'm providing that summary here.
If you'd like to listen to the interview with Dr. Futterweit in its entirety, please visit Sasha's Blog Talk Radio page.
Adrenal hormones--these test rule out an adrenal problem, necessary to do to be sure it's actually PCOS
17 hydroxy progesterone (drawn between 5 and 9 of a menstrual cycle)--rules out the diagnosis of nonclassic congenital adrenal hyperplasia.
(Normal levels are 15-70 ng/dl prior to ovulation, and 35-290 ng/dl during the luteal phase. )
DHEAS (dehydroepiandrosterone sulfate)
Typical normal ranges, according to NIH, for females, are:
Prolactin levels, which rule out a prolactin producing tumor, as well as the effects of some medications such as Risperdal, which can elevate prolactin levels
•Non-pregnant females: 2 — 29 ng/mL
•Pregnant women: 10 — 209 ng/mL
Tests to monitor thyroid function
T4
A typical normal range is 4.5 to 11.2 micrograms per deciliter (mcg/dL).
TSH
Normal values are 0.4 — 4.0 mIU/L.
SHBG (sex hormone binding globulin) — helps to evaluate how much of your testosterone is bound/inactive and how much is free and available to cause androgen-related symptoms.
Normal values:
Follicular phase of menstrual cycle 24 — 200 nmol/L Luteal phase of menstrual cycle 48 — 185 nmol/L Contraceptive use 89 — 379 nmol/L Postmenopausal 46 — 200 nmol/L
Insulin function
Fasting insulin level Normal values: less than 13 mIU/ml
2 h glucose tolerance test Depends on the laboratory's protocol. Typical values can be found at the link directly above.
***************************************************************************** Dr. Futterweit did not mention vitamin D testing but since low vitamin D levels are commonly found in women with PCOS, I'd recommend that as well.
They're all tasty ways to include mushrooms in your diet.
Earlier this week, Christine Marquette mentioned high vitamin-D mushrooms in her radio interview. I wanted to give you more information if you're vegan and looking for a way to increase your dietary vitamin D intake.
Check out the Monterey Mushroom website for nutrition information, recipes, and where to buy them.
As I mentioned when talking to Christine, I wasn't a big mushroom fan for a long time. Then I realized they had a lot of nutritional benefit. They're so easy to add to a lot of your already favorite foods.
It is so much easier to eat well when it tastes good!
Thank you to Christine Marquette and Michael Keele for such an informative program this morning!
If you're interested in hearing our discussions about vegetarian eating, home design for better health, and farmer's markets, please visit our show archives. It is the second show on the list. (I'm still learning how to work the software and didn't properly title it.)
Since vitamin D deficiency has been identified with a long list of health issues, including PCOS, I've been hearing readers, clients, colleagues, and friends talk about loading up on this nutrient with supplements. They're going about it in a not-so-scientific fashion, and I've wondered if that wasn't going to introduce a whole new spectrum of health issues.
A friend and colleague recently mentioned that she had just had a cholesterol test taken, and the LDL (bad cholesterol) reading had increased since her previous test. One of the changes she could identify was between the two tests, she had started to supplement with vitamin D.
I did a pretty thorough search both on the Internet and Pub Med to see if this was a common problem and didn't find anything. I then went to a listserve of about 1,000 nutrition colleagues to see if they'd seen it. Turns out, a few of them had also seen their cholesterols increase with vitamin D supplementation.
There is a tendency with nutrition, to adopt an"if a little is good, a whole lot is better" attitude. Unfortunately, imbalance in either direction, be it deficiency or excess, can be problematic.
The old recommendations for vitamin D were 200 IU per day. All of a sudden, a website popped up recommending 5000 IU per day. I couldn't find any research to support this magnificent dosage leap. I would have thought, given that magnitude, that some kind of dosing study that had ruled out that 500, 1500, 2000 IU were not sufficient. But no, the recommendations simply jumped without explanation.
And every time I tried to find out what the basis for this jump was, I kept being referred back to the website making the recommendation.
My points are:
1. Know your vitamin D and your cholesterol levels. 2. Start out with 200 IU or even 400 IU per day and see how that affects both your vitamin D levels and your cholesterol levels. 3. Consider that the reason vitamin D levels may be deficient is more complex than the simple fact that dietary vitamin D is low…did you know that many of the same health issues associated with vitamin D deficiency are also related to omega 3 fatty deficiency as well as omega 6 fatty acid excess? Most nutritional problems, if they are related to imbalance, cannot be corrected with a supplement. The overall balance of the diet needs to be considered in the plan of correction.
A lot has been talked about when it comes to skin cancer and its cause. Ninety percent of non-melanoma skin cancer is caused by sun exposure. Oddly enough one way we generate a very important vitamin (vitamin D) is from sun exposure! What to do? Expose skin to sun and risk cancer or become housebound avoiding all light from the sun and risk vitamin d deficiency?
Fact: Vitamin D is very good for you.
Fact: Sun is not.
First understand that I think the body is genius in the way it can take sun applied to the skin and start a biochemical process that makes us into little Vitamin D machines. It is photosynthesis like the plants! Without sun the machine does not work.
Without Vitamin D we experience a myriad of negative consequences. Vitamin D is necessary for healthy bones, good immunity and possibly in protecting us from diseases from fibromyalgia to multiple sclerosis, and cancers from prostate to colon. The NIH (National Institue of Health) has reviewed research on Vitamin D and found it to be very complicated. It is not just black and white (or in this case tan and white!). A lot of research is happening, just trying to figure out how much vitamin D we actually need for optimum health is an enormous undertaking (If you like data there is a good scientific review in the Journal of the American Academy of Dermatology, Feb 2006). Believe it or not we are still not sure how much Vitamin D is the correct amount.
We can all agree that we need at least some Vitamin D and we have three ways to get it; sun, food and supplements. Start with food; not a great source unless you eat a lot of fish (tuna, salmon, mackerel and fish liver). Beef liver, cheese and egg yolks have small amounts, but think for the cholesterol! Milk and bread are fortified which is helpful but many Americans still seem to be lacking.
So, supplement or sun? The reality is that if you have light skin and don’t live in a submarine you get about 15 minutes of sun on your hands and face just from living every day. The human body maxes out its Vitamin D producing capacity in 5 minutes (sunny day, hands and face unprotected). Anything more is not helping Vitamin D but is helping skin cancer. Shut-ins and dark skinned people are another story. Rolling grandma out to the sun porch everyday is an option but supplements are more practical. With very dark skin more sun time is needed to penetrate the natural advantage in sun protective color but how much time depends (I know, I hate that answer, too).
Bottom line, sun causes cancer; supplements are available to supply vitamin D, so why risk it? Until we know exactly what we need for perfect Vitamin D health perhaps we should go for the sunscreen and a pill. How much? 200 IU a day, 400 IU for over 50’s and 600 IU for over 70’s.
Note from Monika: One of the aspects of inCYST that I absolutely love is how because of our interdisciplinary team we can look at health issues in new and different ways. Dr. Van Dyke has been teaching me so much about skin issues and how the relate to PCOS. She has been very active this month on Twitter for melanoma month. It seemed like the perfect time to have her write about vitamin D from her specialty's perspective. Thank you so much for taking the time!
For more information on Dr. Van Dyke's practice please visit http://www.vandykelaser.com/. She can be found on Twitter at @drvandyke.
