The Hemp Connection [Search results for EPA] 

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

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

From inCYSTER Karen Siegel…contact information for her Houston clinic is listed below.

"Yes. Another reason to keep encouraging the fish oil supplementation."

Public release date: 16-Dec-2009

Contact: Public Affairs Office
public.affairs@apa.org
202-336-5700 202-336-5700
American Psychological Association

New study links DHA type of omega-3 to better nervous-system function
Deficiencies may factor into mental illnesses
WASHINGTON — The omega-3 essential fatty acids commonly found in fatty fish and algae help animals avoid sensory overload, according to research published by the American Psychological Association. The finding connects low omega-3s to the information-processing problems found in people with schizophrenia; bipolar, obsessive-compulsive, and attention-deficit hyperactivity disorders; Huntington's disease; and other afflictions of the nervous system.

The study, reported in the journal Behavioral Neuroscience, provides more evidence that fish is brain food. The key finding was that two omega-3 fatty acids – docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) – appear to be most useful in the nervous system, maybe by maintaining nerve-cell membranes.

"It is an uphill battle now to reverse the message that 'fats are bad,' and to increase omega-3 fats in our diet," said Norman Salem Jr., PhD, who led this study at the Laboratory of Membrane Biochemistry and Biophysics at the National Institute on Alcohol Abuse and Alcoholism.

The body cannot make these essential nutrients from scratch. It gets them by metabolizing their precursor, α-linolenic acid (LNA), or from foods or dietary supplements with DHA and EPA in a readily usable form."Humans can convert less than one percent of the precursor into DHA, making DHA an essential nutrient in the human diet," added Irina Fedorova, PhD, one of the paper's co-authors. EPA is already known for its anti-inflammatory and cardiovascular effects, but DHA makes up more than 90 percent of the omega-3s in the brain (which has no EPA), retina and nervous system in general.

In the study, the researchers fed four different diets with no or varying types and amounts of omega-3s to four groups of pregnant mice and then their offspring. They measured how the offspring, once grown, responded to a classic test of nervous-system function in which healthy animals are exposed to a sudden loud noise. Normally, animals flinch. However, when they hear a softer tone in advance, they flinch much less. It appears that normal nervous systems use that gentle warning to prepare instinctively for future stimuli, an adaptive process called sensorimotor gating.

Only the mice raised on DHA and EPA, but not their precursor of LNA, showed normal, adaptive sensorimotor gating by responding in a significantly calmer way to the loud noises that followed soft tones. The mice in all other groups, when warned, were startled nearly as much by the loud sound. When DHA was deficient, the nervous system most obviously did not downshift. That resulted in an abnormal state that could leave animals perpetually startled and easily overwhelmed by sensory stimuli.

The authors concluded that not enough DHA in the diet may reduce the ability to handle sensory input."It only takes a small decrement in brain DHA to produce losses in brain function," said Salem.

In humans, weak sensorimotor gating is a hallmark of many nervous-system disorders such as schizophrenia or ADHD. Given mounting evidence of the role omega-3s play in the nervous system, there is intense interest in their therapeutic potential, perhaps as a supplement to medicines. For example, people with schizophrenia have lower levels of essential fatty acids, possibly from a genetic variation that results in poor metabolism of these nutrients.

More broadly, the typical American diet is much lower in all types of omega-3 than in omega-6 essential fatty acids, according to Salem. High intake of omega-6, or linoleic acid, reduces the body's ability to incorporate omega-3s. As a result,"we have the double whammy of low omega-3 intake and high omega-6 intake," he said.

###
Article:"Deficit in Prepulse Inhibition in Mice Caused by Dietary n-3 Fatty Acid Deficiency"; Irina Fedorova, PhD, Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health; Anita R. Alvheim, PhD candidate, Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, and National Institute of Nutrition and Seafood Research, Bergen, Norway; and Nahed Hussein, PhD and Norman Salem Jr., PhD, Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health; Behavioral Neuroscience, Vol. 123, No. 6.

(Full text of the article is available from the APA Public Affairs Office)

Norman Salem Jr. can be reached at nsalem@martek.com or at (443) 542-2370 (443) 542-2370. He was with the National Institutes of Health until 2008, when he became the chief scientific officer and vice president of Martek Biosciences Corp. in Columbia, Md., an ingredient supplier of DHA. He states that he and his co-authors conducted this research while with the NIH.

The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States and is the world's largest association of psychologists. APA's membership includes more than 150,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting health, education and human welfare.
--
Karen Siegel, MPH, MS, RD, LD, LAc
Acupuncture & Nutrition Clinic
9660 Hillcroft, Suite 202
Houston, TX 77096
713/721-7755 713/721-7755
www.AcupunctureandNutritionClinic.com
or
www.Karensclinic.com

Quite a bit, it turns out. They're some of the hottest new sources of omega-3 fatty acids available in supplement form.

As the public starts to recognize the importance of omega-3 fatty acids for overall health, the hunt for sustainable sources of this nutrient intensifies. The fact is, there simply is not enough salmon on the planet to nourish every brain on the planet. We're going to have to learn to use other sources for that than relying solely on wild Alaskan salmon.

Here's what we found out about three unique players you're seeing more of: green-lipped mussels, krill, and calamari.

Here's the real reason this shellfish gets its name. As you can see, there is a rim of green pigment on the lip of its shell. This bivalve is a native of New Zealand, and the farming process bringing them to market is sustainable. We love that!

However, there seems to be a bit of hype related to this product. It is related to an anti-inflammatory compound found in these mussels that supposedly helps to relieve arthritis. The studies are sketchy, and seem to concede that the effect is actually due to the omega-3's in these mussels, not any secret special ingredient. The capsules are pretty low dosage wise, about 50 mg EPA and little information about DHA content. Meaning you're going to have to take an awful lot of these capsules to get any effect, and you're going to spend a lot of money in the process. Sixty capsules, in the dose we recommend here, is going to cost you $33. That's more than you need to spend.

This teeny, tiny, shrimp-looking thing is a krill, a creature at the very bottom of the food chain that grows in pretty much all ocean waters. It's an important food source for marine life — 500,000,000 tons are produced each year, and over half of it is consumed by whales, penguins, seals, squid, and fish.

As an omega-3 supplement, it is often touted as the superior source. However, a Norwegian study published in January of this year comparing krill oil to fish oil concluded that the effects of supplementation were comparable. In other words, there was no unique benefit to taking krill that could not be achieved with fish.

The bigger issue is sustainability. Scientists reported an 80% drop in krill supply recently. Given the heavy dependence of much of the rest of the ocean on krill, this is important to note. Whole Foods Market actually stopped selling krill oil over concerns that it was not a sustainable product. One voice countering these arguments is, Dr. Joseph Mercola, the popular natural medicine advocate. It is important to note that Dr. Mercola is personally invested in the krill industry so he has much to lose from consumers heeding the warnings of the National Geographic Society and the well-researched buyers at Whole Foods. He is entitled to his opinion, as you are to yours. All I ask is that you consider the financial influences underlying his opinion before deriving your own.

Bottom line here is, if there are options that are equally as effective that do not create nutritional hardship for such a wide variety of important citizens of the planet, we prefer to use those. Krill is not on our recommended list.

Which brings me to my last, and favorite, of our three profiles. The unassuming squid!

Last fall inCYST intern Sarah Jones and I were at our local Sprouts Market evaluating omega-3 supplements. Sarah noticed a bottle made from calamari. The supplement clerk told us that this is an up and coming concept, designed to bring a sustainable source of EPA and DHA to a market that is starting to feel ecologically strained in trying to meet the consumer demand for fish oil. Calamari is sustainably farmed and has been for a long time. It is only recently that they have been used as a source for the supplement industry.

Since we first saw their capsules, Carlson's has also released a lemon flavored liquid product called CalaOmega. And it is concentrated — one teaspon contains 800 mg DHA and 400 mg EPA. That dose for most of our readers is completely sufficient.

Squid are not exotic. There is nothing mysterious or magical about them. Since omega-3's are omega-3's, whether they come from salmon, mussels, krill, or squid, many marketing schemes use mysterious hype to differentiate their products. It's really not that complicated. Find a good source of DHA or EPA at a reasonable cost per dose, and be sure that in using it you're a responsible planetary citizen. You'll get benefit from all three options here. One is sustainable, but costs a lot of money. One is costly to the overall stability of the marine ecosystem. One is sustainable and economical. We think it sells itself.

Besides, now you have an extra reason to order that really tasty calamari appetizer at your favorite Italian restaurant.

Ulven SM, Kirkhus B, Lamglait A, Basu S, Elind E, Haider T, Berge K, Vik H, Pedersen JI. Metabolic effects of krill oil are essentially similar to those of fish oil but at lower dose of EPA and DHA, in healthy volunteers. Lipids. 2011 Jan;46(1):37-46. Epub 2010 Nov 2.

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.

Many of the women I work with are vegan vegetarians. Which means when it comes to increasing omega-3 intake, they tend to want to go heavy on flax, hoping it will make up for not eating fish. It simply doesn't work this way…in ways that are very important to PCOS.

When different groups of rats are given ALA (the primary omega-3 in flax), EPA and DHA (the primary omega-3's in fish oil), EPA and DHA lowered glucose and insulin levels about 35-38% greater than did ALA. Insulin sensitivy improved by 60% in the fish oil groups compared to the ALA groups.

Bottom line, if you really, really want to get better, and you're not currently eating fish, or using a fish or marine algae supplement, you may want to seriously consider adding one of those to what you're doing. It's pretty non-negotiable, we need DHA and EPA to properly function as human beings.

Andersen G, Harnack K, Erbersdobler HF, Somoza V. Dietary eicosapentaenoic acid and docosahexaenoic acid are more effective than alpha-linolenic acid in improving insulin sensitivity in rats. Ann Nutr Metab. 2008;52(3):250-6. Epub 2008 Jun 19.

As you know, I have a huge allegiance to omega-3 fatty acids and their potential for our readers. So much so that my friends are convinced that under the mask of my smiling face there is a giant fish head. I have done my best to steer clear of allegiance to any particular brand, but I do have a strong allegiance to integrity. I ran across something recently that felt really wrong, and I'd like to bring it to our fans' attention, so that their choices for who to support in the quest for hormone balance are informed choices.

From time to time I've mentioned a line of products I thought were really nice omega-3 options from a company called Barlean's, their Omega Swirl line. Pictured here is their packaging, including their lemon-flavored fish oil and their strawberry-banana flavored flax oil.

Yesterday I ran across a new line of products.

Here's a picture of their lemon fish oil product.

And wow, here's their — whaddaya know — strawberry banana flax oil product.

Same flavor, same concept…they didn't even bother to package in a different bottle.

As for what's inside, the original (Barlean's) contains 365 mg DHA, 365 mg EPA, and 970 mg total omega-3 fatty acids. The other company's product? 360 mg DHA, 360 mg EPA, and just over 1000 mg total omega-3 fatty acids. A little too close to be considered coincidence.

I know there are certain rules by which the US Patent and Trademark Office define how we each can play the intellectual property game. And I know for every rule there are always 2 or 3 or 4 ways around it.

But I also know what integrity looks like. This is not it.

Be good to the Barlean's people. They're the ones who did the hard work and the ones who deserve our support.

**I receive no compensation from Barlean's and never have.

I was asked to clarify some comments I recently made about chia, as they were questioned for their accuracy. I'm all for revisiting and making sure my information is accurate, so here is my response.

First of all, while the information on this blog should be helpful to anyone regardless of whether or not they have PCOS, it IS targeted toward women who have this hormone imbalance. So some of the information I provide is more geared toward their specific nutritional needs and not the apparently healthy population. This should always be kept in mind when reading what I write.

One of the questions about my post was that I stated that taurine is an essential amino acid. There is actually some debate about this. Some experts say no, we can synthesize it. Others call it a conditional amino acid, meaning in some situations it may be essential.

Women with PCOS seem to have something going on in their brain and nervous systems that interferes with everything from mood and appetite regulation to speech and language function. (Simply read the responses to my question last week about the symptoms I listed and you will see what I mean.) Much of the dietary protocol we have developed is actually derived from epilepsy research at Johns Hopkins University, with the premise that calming nervous system excitability makes it easier for the brain and nervous system to function as they should when not under duress. Taurine is an amino acid showing promise as an anti-seizure compound, which makes me wonder whether or not a hyperexcitable brain blows through available taurine much more quickly than a brain that does not have to live under these conditions.

That being said, I am more comfortable with the premise that for the population for whom this blog is written, as well as anyone living with any kind of condition that places stress on the brain (migraines, epilepsy, OCD, anxiety disorder, bipolar disorder, PTSD, schizophrenia, etc.), taurine may actually be an essential amino acid. Research to support my claim still needs to be done, but I am more comfortable being conservative on this one, especially given the responses to last week's questionnaire and the severity of some of the diagnoses I just listed. Better to be safe than sorry.

Secondly, even if the amino acid profile of chia is complete, the total protein content of chia is relatively low. So if we're advocating for a 30% protein diet in a woman who is being advised to consume 1500 calories a day, she is going to need to consume about 113 grams of protein. That translates into your needing, at this protein level, to consume 700 grams of chia per day, just to get your protein needs. That is also 3,430 calories' worth of chia, more than twice your daily calorie needs. And while its amino acid profile is nearly complete, its nutritional profile is not. It contains no vitamin A, vitamin C, vitamin D, vitamin K, thiamine, riboflavin, niacin, vitamin B6, folate, or iron, to name a few.

From an omega-3 standpoint, I did invert the numbers. There is no consistent order by which omega-6 and omega-3 ratios are reported, and though I usually check to be sure I did not flip them, I did not this time. I do apologize for that.

According to http://www.nutritiondata.com/, chia seed contains an omega-6 to omega-3 ratio of 3.03, which is actually quite good.

The caveat is that the omega-3 this food contains is alpha-linolenic acid (ALA), not EPA or DHA. Most omega-3 experts will contend that in the most perfect of conditions conversion of ALA to DHA is at best 5%. Again, the women this blog serves seem to need a much higher level of DHA than average for a variety of reasons. We find that they seem to do best on 1000 mg DHA daily, the level recommended by Dr. Artemis Simopolous for treating depression. Calculated out, if you are depending on chia seed to get all of your omega-3 fatty acids, from ALA through EPA and DHA, you're going to need to consume about 115 grams of chia seeds per day. Just be forewarned.

Bottom line, I actually think chia is a healthy food--as part of a varied diet. I especially think that for vegans reading this blog it can be a great addition to your diet. However, I do not believe in superfoods. There seems to be a trend toward wanting to find one perfect food that has it all. I have yet to find it. It's understandable when we're surrounded by a lot of confusing information and we live in a culture where over 10,000 new products hit the grocery shelves each year (I saw half of them in Anaheim last month and it was overwhelming!) that we'd want to have just a few foods and a small nutritional comfort zone. Unfortunately that is not really how human nutrition works.

This is an especially important philosophy to stick to on this blog, given the fact that we're learning that a very high percentage of the women we're helping have some kind of history of"veganism gone wrong"…in other words, overzealous veganism with a focus on eliminating foods rather than on learning how to eat to be nutritionally complete with no animal products on the menu. We discourage fanaticism and encourage food curiosity and variety!

We were designed to be omnivores and to eat a variety of foods from a variety of sources. I encourage you, rather than arguing for why you should narrow your choices down to feel more comfortable around food, to learn to negotiate a wider variety of foods you are willing to include in your diet.

Gaby AR. Natural approaches to epilepsy. Altern Med Rev. 2007 Mar;12(1):9-24.

Last night I settled in to watch the evening news, in time to see an ad for Country Crock's Omega 3 Plus brand margarine. With my reputation as somewhat of an"omega 3 queen," I figured I'd better pay attention. And by the time the ad was over, I knew I had today's post.

This label is a perfect example of why consumers are confused, and why they can have a hard time achieving the benefits of good nutritional choices.

First, the good news.

The margarine has no trans fats, because it contains no hydrogenated or partially hydrogenated oils. For fertility, this is a huge plus--with as little as 2% of your total calories per day coming from trans fats (about 2/3 tsp for the average woman), fertility can drop by as much as 73%.

Secondly, one serving provides 500 mg of omega-3's in the form of ALA.

Now for the confusing and potentially detrimental news.

When the professionals on this blog talk about what we're doing to enhance fertility and reduce inflammation, and we refer to omega-3's, we are primarily referring to EPA and DHA, the omega-3's that, except for omega-3 eggs and foods supplemented with algal DHA, contain either fish or fish oil. (Menhaden oil, which is what is found in Smart Balance Omega 3 Margarine, is a type of fish oil.)

Any other type of omega-3 is likely to be ALA. This type of omega-3 is found in canola oil, and flaxseed oil, among other things. In this margarine, the ALA source is canola oil.

But there is no fish oil or marine algae to provide a similar nutritional feature.

There are some things that flax and canola can do, and there are some that flax and canola simply cannot do.

Many people, nutritionists included, operate on the assumption that since the omega-3 found in canola and flax can be converted into EPA and DHA, that you can get enough of the latter two without having to eat fish. Most respected omega-3 chemists will tell you this is highly unlikely.

On a good day, when your diet is as perfect as it can possibly be (which, even in the case of the person writing this post is never), only about 2-3% of your flax and canola can be converted into the other omega-3's.

Bottom line, it's pretty non-negotiable, you are highly unlikely to get the amount of omega-3's your body needs, especially if you are trying to conceive, if you are assuming you can do it without fish.

Secondly, the primary oil in the margarine appears to be liquid soybean oil. Remember the rule about"S" and"C" oils? Soybean is one of those"S" oils with a tendency to be pro-inflammatory. It was impossible to tell from the label what the ratio of soybean to canola oil was, and I would suspect that it was higher than you're going to want if you're trying to choose fertility-friendly foods.

I immediately became suspicious about this Country Crock product when I went to the website and nowhere, I mean absolutely nowhere, could I find a plainly stated ingredient list. Sure, there's a label to look at, but it's strategically posted in a way that all the nutritional information is there except for the ingredients. Hmmmm…

…so I went to the FAQ section. Couldn't find it there either. I found a lot of long-winded explanations of trans-fat labeling, and that was my second red flag.

Since I had to go to the grocery store anyway, I stopped in and looked at the label. Here, for the benefit of the rest of the people on the Internet, is the list of ingredients from the side of the container of this product:

Vegetable oil blend (liquid soybean oil, canola oil, palm oil, palm kernel oil, water, whey, salt, vegetable mono and diglycerides, soy lecithin (potassium sorbate, calcium disodium EDTA), citric acid, artificial flavor, vitamin A (palmitate), and beta carotene.

For more information on healthy fats, go to http://www.zingbars.com/science-of-zing.html, where my Zing Bar friends describe why they did--and didn't--include certain fats in their new product.

Any fat that is going to be solid at room temperature is going to have to have some saturated fat in its formula. Otherwise, it would melt. So even though the total saturated fat content is low, the type of fat being used to provide the solid quality is not one you want to get much of in your diet.

I'm not really a butter or margarine person so giving those up was not an issue for me. But I did start my career in the Chicago area, and I remember how people used to look at me like I was purple-polka-dotted if I even hinted that dairy intake might need to be adjusted. So I know it's an issue for some of you.

Bottom line--if you choose to use the product, do so only once in awhile and sparingly. I'd rather see people use olive oil-based dipping sauces for breads and cook with either canola or olive oil.

If you're interested in learning more, the authors of the study below also wrote a recently released book in plain English entitled, The Fertility Diet. I'd check it out.

Chavarro JE, Rich-Edwards JW, Rosner BA, Willett WC. Diet and lifestyle in the prevention of ovulatory disorder infertility. Obstet Gynecol. 2007 Nov;110(5):1050-8.

So you've been told you need to clean up your nutrition act, and you've stopped eating the Fritos. You've decided to stop being the reason the stock price of your local fast food restaurant has weathered the Wall Street willies. Your salad dressing shelf in your refrigerator is now half of what's in your refrigerator.

Still no luck.

Hey, isn't eating better supposed to be the answer?

Depends on how you define eating better.

I'm noticing with my inCYST classes that a disproportionate percentage of women coming for information have adopted vegetarian practices. And I'm beginning to wonder if it isn't part of the problem.

No, the problem isn't that you're vegetarian. It's how you're defining vegetarian, and it's how you go about being one that matters. Here are my simple rules for being the healthiest (potentially fertile) vegetarian you can be.

1. Define your vegetarianism by what you DO eat.

Most people I know who become vegetarian after eating meat, define that practice in terms of what they DON'T eat. They DON'T do red meat. They DON'T do dairy. They DON'T do fish. DON'T, DON'T, DON'T.

Therein lies the problem.

A most important rule of nutrition is, when you eliminate an entire category of food, for whatever reason, be it meat or wheat, you are also eliminating crucial nutrients that this category contains.

My definition of vegetarian is someone who meets all of their complete nutritional needs without using animal products.

Do you know what fertility-related nutrients you're likely short on if all you've done is cut out meat? If not, read on!

2. Zap yourself with zinc!

Zinc is needed for oodles of reactions that keep your body running, from your brain to your ovaries. Are you eating whole grains? Beans? Pumpkin and sunflower seeds? Nuts? Oops…go get your shopping list, right now, and put them down!

3. Forgetting folate can be fatal

You likely know about this nutrient since there has been so much publicity about its role in pregnancy. Put spinach on your sandwich instead of lettuce…make sure your morning cereal is fortified…eat more beans and split peas…and become savvy with sunflower seeds!

4. Cultivate a copper attitude

It's not as famous as folate, but it still is important to remember. Outside of red meat, its vegan sources are rather random: molasses, green olives, cocoa, nuts, avocadoes, black pepper, sunflower seeds…hopefully at least one of these sounds tasty!

5. Try to remember tryptophan

Tryptophan is a building block for serotonin, one of the major neurotransmitters regulating the brain's hormone center. For vegetarians, there are still a lot of options even if you're not using dairy products or eating turkey. Does your pantry have…cocoa, mangoes, sesame seeds, pumpkin seeds, oats, dates, chickpeas, peanuts, bananas, and sunflower seeds? It needs to.

6. Allow for algae

If you're vegan, chances are you're not getting enough DHA and EPA, the omega-3 fatty acids primarily found in fish. Become friendly with an ingredient known as Life's DHA, a marine algae source of DHA (unfortunately not EPA), that is being added to vegan-friendly foods. The link I'm providing gets you to the most recent list of foods containing this ingredient that you may want to become proficient at finding.

7. Not all vegan products are created equally healthy. Be sure if you've gone vegan, that you are aware of oils that can interfere with healthy balance. These oils are all vegan, but tend to be pro-inflammatory: safflower, sunflower, soybean, corn, cottonseed, sesame. (Remember my"S and C" rule from previous posts. If you're eating absolutely no meat at all, but you're eating a salad doused with soybean oil-based dressing…that could be a problem. Become familiar with brands that are made with olive or canola oils, or learn to make vinaigrettes. (Canola is the"C" oil exception, by the way.

8. Be happy without hydrogenated.

Hydrogenated = trans fat. Enough said.

9. Forget the fructose…high fructose corn syrup, that is.

It's been connected to insulin resistance in more than one study. And despite what marketers would really like you to believe, more than one nutrition expert does not endorse its use.

10. Be pro-protein

This is the most obvious one…know your complementary proteins and be sure your diet includes them. One caveat…soy may be hard on your thyroid function and is not a good choice if you have a family history of breast cancer. Be sure you are reading labels, as soy is a filler in many, many foods.

I like to look for patterns that make nutrition recommendations easy to recommend. In this post, it didn't work out that way. A lot of these foods are random. If I'm not giving you ideas that seem easy to work into your food plan…think of consulting with one of our experts! That's what we excel at, and that's what we're waiting to help you with.

After all, you became vegan to be healthy, let's work together to do it correctly.

I just received an email from a client who noticed that every time she added flaxseed oil to her diet, she started to wheeze. We checked online, and sure enough, some people can be allergic to flaxseed. Here are some of the common symptoms of flaxseed allergy.

For anyone who is trying to increase their omega-3's, this can pose a challenge, since the vast majority of foods in the grocery store labeled as omega-3 supplemented contain flaxseed as the omega-3 source. If it turns out you are a flax-allergic person, be extra sure you read those labels!

ALA, the primary omega-3 in flaxseed oil, is not a substitute for fish oil; it has completely different and essential functions. A good way to think of it is that EPA and DHA from fish oil provide the"meat" of the structure of your brain and nerve cells, while ALA acts kind of like"rustproofing", keeping all that DHA and EPA in place that you worked so hard to get in the diet. They both need each other present in order for maximum effectiveness.

Here are some ideas for getting more omega-3's in the diet.

1. Other foods containing ALA include

Broccoli
Brussels sprouts
Cabbage
Canola oil
Edamame
Kale
Parsley
Pecans
Pumpkin seeds
Spinach
Spring greens
Tempeh
Tofu

One reason I have not included walnuts, which are typically the first vegetarian food recommended to increase omega-3 intake, is that the omega-6 content is so high that it is mathematically impossible to improve an omega-6 to omega-3 ratio when using them. I love walnuts and think they have some great nutritional benefits for PCOS, but in the rare and special case of a flaxseed allergy, it may not be a food that you would want to eat in large quantities. (I'm working on a pro-walnut post for a later date for you curious types!)
Here are some practical ways to incorporate the foods above into your diet.

1. Know your nuts!
The nuts with (a) the best omega-3 levels and (2) the best overall ratios of healthy to unhealthy fats include: macadamia, hazelnut, pecan, pine, and pistachio. Those are the nuts you should be using with the most frequency in your snacking and cooking. If you like nut-encrusted fish and pesto sauce…you're in luck! You can also throw nuts in your coffee grinder to make nut powders, which can be added to waffles, pancakes, baked goods, smoothies, and salad dressings. They'll give your creations a little bit of a gourmet twist!

2. Use shredded cabbage in your tacos instead of shredded lettuce. That's how they do it in Mexico…and it's the perfect topping for a fish taco!

3. Get in the habit of throwing a handful of dark greens--kale, spinach, parsley--into your smoothies. You won't even taste them.

4. Pumpkin seeds, like nuts, are easily added to trail mix, thrown on salads, soups, and hot cereals, and ground to include in your encrustings.

5. Cook with canola oil.

6. I've included the three types of soybean that are not tough on thyroid--edamame, tofu, and tempeh. Edamame is a fun snack when popped out of the shell, tofu and tempeh can be the basis for a meatless meal.

7. If you like pesto, you may want to try chimichurri, another parsley-based sauce that I call"South American pesto". It is wonderful on grilled meats and easy to make! I've seen ready made varieties in the grocery store.

8. Be extra careful about omega-6 fatty acids. The less of those in your diet, the less omega-3 you will need to counter their inflammatory influence. For review, except for canola, which is ok, minimize your use of oils beginning with the letters"s" and"c"…safflower, sunflower, soybean, corn, cottonseed. (The reason soy as a food is ok while soybean oil is not, is because the ratio of omega-6 jumps up when you extract and use only the fat and do not buffer it with the meat of the soybean.)

Here are a couple of recipes for you, one for chimicurri sauce, and one for a tasty squash/kale/whole wheat lasagna I tested out this week.

It just takes a little creative thinking to find ways around a flaxseed allergy. Hopefully some of the suggesstions I'm providing turn out to be favorites in your home!

Spinach Kale Whole Wheat Lasagna (from Sunset Magazine, February 2008)

Note: I couldn't find whole wheat lasagna noodles in my store so I bought whole wheat egg noodles and layered them with the other ingredients to make a casserole. It was great!
Prep and Cook Time: about 2 hours. Notes: You can assemble and chill the lasagna a day ahead, but add 10 to 15 minutes to the baking time. You can also freeze the lasagna, wrapped well in plastic wrap, for up to 1 month and bake it frozen (add 1 1/4 hours to the oven time).

Yield
Makes 8 servings

Ingredients
4 tablespoons olive oil, divided
1 medium red onion, peeled and sliced
3 peeled garlic cloves (1 minced, 2 left whole)
2 cans (14 oz. each) crushed tomatoes
1 teaspoon dried oregano
About 1 tsp. each salt and freshly ground black pepper, divided
6 cups (about 2 lbs.) butternut squash, peeled and cut into 1/2-in. cubes
1/2 tsp. dried thyme
1 pound Lacinato kale (often sold as dinosaur or Tuscan kale)
9 whole-wheat lasagna noodles (about 8 oz.) (Often, whole wheat pastas are made with flax…be sure to read your labels!)1 container (15 oz.) part-skim-milk ricotta cheese
1/8 teaspoon ground nutmeg
2 cups shredded mozzarella cheese, divided

Preparation
1. Preheat oven to 400°. Heat 2 tbsp. olive oil in a 2- to 3-qt. pot over medium heat. Add onion and minced garlic; cook, stirring occasionally, until onion is soft and translucent, 5 minutes. Add tomatoes, oregano, and 1/2 tsp. each salt and pepper. Reduce heat and simmer until thick and flavors are combined, about 30 minutes. Set aside.

2. While sauce is cooking, in a 12- by 15-in. baking pan, sprinkle squash with thyme, remaining olive oil, and salt and pepper to taste. Add garlic cloves and toss squash mixture to coat with oil. Bake until soft, 10 to 15 minutes. Meanwhile, bring 3 qts. salted water to a boil in a large pot.

3. Reduce oven temperature to 350°. Transfer squash and garlic to a food processor and purée until smooth.

4. Tear kale leaves from center ribs and discard ribs. Boil leaves until soft, 5 to 8 minutes. Drain; let cool. Squeeze out as much water as possible and chop finely.

5. In the same pot, bring another 3 qts. salted water to a boil. Add noodles and cook until tender to the bite, about 10 minutes. Drain; rinse with cold water.

6. In a bowl, mix ricotta, nutmeg, 1 cup mozzarella, and remaining 1/2 tsp. each salt and pepper.

7. Coat the bottom of a 9- by 13-in. pan with 1/3 of tomato sauce (about 1 1/2 cups). Lay 3 noodles in a single layer over sauce. Top noodles with squash, spreading evenly. Sprinkle 1/2 of kale evenly over squash. Arrange 3 more noodles on kale and top with ricotta, spreading evenly. Top with remaining kale and noodles. Cover noodles with remaining tomato sauce and sprinkle with remaining 1 cup mozzarella.

8. Bake lasagna until juices are bubbling and cheese is melted, about 30 minutes. Let stand 10 minutes before slicing.

Grilled Halibut with Chimichurri Sauce from Epicurious.com

1/3 cup extra-virgin olive oil
1/4 cup fresh lemon juice
1 tablespoon water
1 tablespoon minced garlic
1 tablespoon minced shallot
3/4 teaaspoon hot red-pepper flakes
3/4 cup chopped flat-leaf parsley
4 (6- to 8-ounce) halibut steaks (3/4 to 1 inch thick)
1 tablespoon vegetable oil
print a shopping list for this recipe

Preparation

Whisk together olive oil, lemon juice, water, garlic, shallot, red-pepper flakes, and 1/2 tsp each of salt and pepper until salt has dissolved. Stir in parsley. Let chimichurri stand 20 minutes.

Meanwhile, prepare grill for direct-heat cooking over medium-hot charcoal (medium heat for gas).

Pat fish dry, then brush with vegetable oil and sprinkle with 1/2 tsp salt and 1/4 tsp pepper (total).

Oil grill rack, then grill fish, covered only if using a gas grill, turning once, until just cooked through, 8 to 10 minutes total.

Serve fish drizzled with some of chimichurri; serve remainder on the side.

Cooks' notes:
·Halibut can be cooked in a hot oiled large (2-burner) ridged grill pan over medium heat.
·Chimichurri can be made 1 hour ahead and kept, covered, at room temperature.

We get many questions about hemp, and its value as a protein and omega-3 source. Time to learn some more.

Here are the basic nutrition facts about hemp, calculated for a 1 tbsp serving.

Calories: 80
Fat: 5 grams
Carbohydrate: 3.5 grams
Protein 5.5 grams

POSITIVE: To put that into perspective, a tablespoon of hemp seed has about the same amount of fat as a teaspoon of butter or oil, plus slightly less protein than an ounce of meat. So as far as fat choices, it's going to give you more nutritional bang for your buck than a pure fat source. That protein is also a complete protein, too!

WARNING: Beware of those calories, though! Someone who commented on the Livestrong.com website where I got this information shared that he puts 3 tablespoons of hemp seeds on his cereal every morning. That is 240 calories, which if not removed from elsewhere in the diet, is the equivalent, over a year, of 25 pounds' worth of calories. If you ADD hemp to your diet, be sure you've accounted for it by REMOVING less calorically dense/nutritious food choices.

POSITIVE: With respect to fatty acid profile, the omega-6 to omega-3 ratio of hemp averages 3:1. This is favorable, as it is lower than the recommended total dietary ratio of 4:1.

WARNING: As hemp is a vegetarian source of omega-3, it provides ALA. It does not contain EPA or DHA, which are primarily found in seafood. Some of the ALA found in hemp will be converted into EPA and DHA, but not in the quantities we have found to be of therapeutic value for PCOS. If you want to use hemp in your diet, it is certainly beneficial, but it does not replace the need for the other omega-3's.

POSITIVE: Hemp contains gamma-linoleic acid (GLA), which can be helpful for some skin conditions, including atopic dermatitis.

WARNING: GLA tends to work best when it is not overwhelmed with omega-6 fatty acids. In other words, if you have a skin condition, and you want to try GLA as a remedy, you are most likely to achieve good results if you cut back on your total omega-6 fatty acid intake (safflower, sunflower, soybean, sesame, corn, and cottonseed oil).

You could say the bottom line with hemp, as with any other food, is that if it is used judiciously and respectfully and not layered onto an unhealthy diet that needs some tuning up, it can be a tool toward better hormone balance.

But it is not a miracle food that will allow you to continue with unhealthy dietary indiscretions without consequence.

For those who are concerned about the THC content of hemp: in order to ingest enough industrial hemp to get 'a buzz', you would have to consume the the equivalent of 2-3 doses of a high-fiber laxative. Thanks to the North American Industrial Hemp Council for that little tidbit!

For starters, here is a recipe for hemp pancakes. As you can see, the oil has been removed and replaced with hemp seed. That is the way hemp should be used; as a fat alternative, not as an additional fat. It could probably be used in many recipes where you are using ground flax seed, with similar results.

Here are some sample hemp food products available at amazon.com

For more information about the history, politics, and nutritional analysis of hemp, beyond the direct pertinence of hemp to PCOS, try this article on Dr. Bronner's website.

I was recently asked by a colleague, what I thought about various popular cooking oils…in particular, grapeseed, flaxseed, canola, and pumpkin seed oil. Here is a summary.

First of all, all of these oils are oils, and their caloric content is roughly similar, about 50 calories per teaspoon. You will not save calories by choosing a particular oil, and there is no oil you can eat limitless quantities of without the caloric content eventually catching up with you.

Secondly, as far as omega-3 content, any vegetable oil containing omega-3 fatty acids contains ALA, NOT the EPA and DHA found in seafood. Even though some ALA can be converted to DHA, it does not occur in quantities needed to therapeutically treat PCOS, or to maintain the integrity of brain structure in the general population. The reason ALA is important, is that it helps to protect the body from inflammation and when it is consumed in adequate quantities, it allows DHA to do its job. In other words, if all you are doing is taking a few fish oil capsules but not changing your diet, you are not very likely to benefit from the fish oil.

That being said, when you choose oils to cook with, you want to remember that your overall dietary omega 6 to omega 3 ratio should be 10:1 or less, in order to reduce the possibility of insulin resistance. How do these four oils measure up?

I boldfaced the ones I prefer.

Grapeseed oil 696 to 1
Yikes!

Flaxseed oil 0.238 to 1
Now you know why we love flaxseed so much around here. Here is some information on some flaxseed oils you can cook with that you might find interesting.

Canola oil 2 to 1
Whether or not you want to include canola oil in your diet is part of your own food religion. If it fits for you, know its ratio is excellent. If it does not, you may want to investigate the flaxseed oil option listed above.

Pumpkin seed oil 3 to 1
Not bad!

Lard 10 to 1
This surprised me. It also made me feel better about my love of tamales.: )

Butter 8.6 to 1
Even better than lard!

Margarine, stick 11.4 to 1
Don't go there.

Margarine, tub 4.8 to 1
The only problem here is that in order to make a liquid oil solid…it has to be turned into trans fat. Wrong kind of omega-6 oil.

This question comes up from time to time, and since inCYST is so big on flaxseed, it's a good idea to have information at your fingertips.

Around the Internet, caution regarding the use of flax while pregnant is easy to find. The rationale for this caution is that mothers and fetuses are especially sensitive to hormones.

The Internet is also full of advice from flaxseed manufacturers promoting its use, because it can be converted to DHA, which as this blog consistently discusses, is crucial for conception, pregnancy, and development of a healthy baby.

Neither of those assertions is totally correct.

I dove into Pub Med last night and looked for any research to support the advice against flax during pregnancy. I couldn't find it. What I DID find was a whole host of animal studies, primarily done on pigs and cows, with mostly positive findings. It's always important to remember that animal studies do not always extrapolate completely to humans, but they do give us an idea of what's going on.

Effects of flaxseed consumption during pregnancy (again, in pigs and cows) included:
--healthier immune systems in babies
--better growth in babies
--after having one baby, a shorter time to ovulation (restored fertility)
--breast milk with a higher omega-3 fatty acid content and a lower omega-6 to omega-3 fatty acid ratio
--higher brain omega-3 content in babies
--increased levels of EPA, another omega-3 important for prostaglandin function and healthy blood clotting
--higher pregnancy rates
--larger follicle size
--higher conception rates
--lower miscarriage rates
--higher progesterone levels

IMPORTANT DISCLAIMERS
While I'm always excited to report positive links between nutrition and fertility, you all should know when I look through the research I am actually searching hard for the BAD news. This is such a high-risk specialty! The very last thing I would want to do is encourage our readers to make choices leading to frustration, disappointment, heartache, and loss of our own credibility. So I want to make it clear, the benefits of flax can be achieved only if it's used with respect.

Flax cannot replace fish oil. Some flax supplement manufacturers promote its use because it is converted into DHA and therefore can be used as a supplement for flax. Not true! The studies I perused found different effects for both, meaning you need both in your diet.

If your diet is imbalanced, flax won't make up for it. One study I found showed that when protein intake was low, flax supplementation was not beneficial. This would be a scenario not uncommon with our vegetarian readers, if their definition of vegetarian eating focuses more on what to eliminate rather than what to include, or is the remnant of an eating disorder. As always, supplements work best in a well-nourished environment; they cannot replace balanced, nourished eating.

Finally, if you choose to use flax…IT MUST BE GROUND. In other words, the flaxseed tortilla chips at Trader Joe's were not what made these studies work.: )

I've heavily referenced this post to save the skeptics the work.

I hope you find this helpful!

Rao SS, Kale AA, Joshi SR, Mahadik SP. Sensitivity of fetus and pups to excess levels of maternal intakes of alpha linolenic acid at marginal protein levels in Wistar rats. Reprod Toxicol. 2007 Nov-Dec;24(3-4):333-42. Epub 2007 Jul 28.
Yu B, Khan G, Foxworth A, Huang K, Hilakivi-Clarke L. Maternal dietary exposure to fiber during pregnancy and mammary tumorigenesis among rat offspring. Int J Cancer. 2006 Nov 15;119(10):2279-86.
Ambrose DJ, Kastelic JP, Corbett R, Pitney PA, Petit HV, Small JA, Zalkovic P. Lower pregnancy losses in lactating dairy cows fed a diet enriched in alpha-linolenic acid. J Dairy Sci. 2006 Aug;89(8):3066-74.

Petit HV, Twagiramungu H. Conception rate and reproductive function of dairy cows fed different fat sources. Theriogenology. 2006 Sep 15;66(5):1316-24. Epub 2006 Jun 2.
Farmer C, Giguère A, Lessard M. Dietary supplementation with different forms of flax in late gestation and lactation: Effects on sow and litter performances, endocrinology, and immune response. J Anim Sci. 2010 Jan;88(1):225-37. Epub 2009 Sep 25.

Colazo MG, Hayirli A, Doepel L, Ambrose DJ. Reproductive performance of dairy cows is influenced by prepartum feed restriction and dietary fatty acid source. J Dairy Sci. 2009 Jun;92(6):2562-71.
Farmer C, Petit HV. Effects of dietary supplementation with different forms of flax in late-gestation and lactation on fatty acid profiles in sows and their piglets. J Anim Sci. 2009 Aug;87(8):2600-13. Epub 2009 Apr 24.
Brazle AE, Johnson BJ, Webel SK, Rathbun TJ, Davis DL. Omega-3 fatty acids in the gravid pig uterus as affected by maternal supplementation with omega-3 fatty acids. J Anim Sci. 2009 Mar;87(3):994-1002. Epub 2008 Nov 7.

Galbreath CW, Scholljegerdes EJ, Lardy GP, Odde KG, Wilson ME, Schroeder JW, Vonnahme KA. Effect of feeding flax or linseed meal on progesterone clearance rate in ovariectomized ewes.
Domest Anim Endocrinol. 2008 Aug;35(2):164-9. Epub 2008 Jun 5.

While shopping at Trader Joes the other day, I stumbled upon an amazing product!
Trader Joes Five Seed Almond Bars
They are made with flax, poppy, sunflower, sesame and pumpkin seeds and combined with almonds, cinnamon, vanilla, brown sugar and honey to create these soft, chewy and delicious cookie bars
They taste amazing, but what is so wonderful is that each 110 calorie bar has 53mg EPA and DHA. The omega 3 sources seem to be from the flax as well as Omega-3 refined menhaden fish oil (with tocoperols)
If you live by a Trader Joes you just have to try it!

Secondary infertility is the inability to conceive or carry a pregnancy to term after successfully and naturally conceiving one or more children.

Secondary infertility also appears to often be a condition with a significant nutritional cause…and a fairly easy solution.

A developing fetus has no way of obtaining the important omega-3 fatty acids, EPA and DHA, that it needs for adequate brain and nervous system development, except from its mother.

And what do we do to pregnant moms? We tell them to not eat the main source of these fatty acids, fish.

Even though the FDA warning limits their advised restrictions to four fish (shark, tilefish, king mackerel, and swordfish), studies have shown that women tend to limit ALL fish consumption while pregnant.

So as their firstborn develops, mom's omega-3 stores gradually dwindle. It's highly likely, given the stressful demands of new motherhood and the continued concern that fish may not be safe while nursing, that omega-3 intake continues to be inadequate.

And since fertility is dependent on adequate omega-3's as well, it makes sense that what it required to conceive and carry the first baby to term, may be exactly what's keeping baby #2 from happening.

We've been pretty successful at inCYST with this type of infertility. It's about getting over the fear of eating fish when you're pregnant.

At this point, pretty much every reputable fish oil on the market is molecularly distilled, meaning it's clean. Random tests of bottles of fish oil pulled off of pharmacy shelves rarely find mercury. Believe me, if they did, with the popularity of fish oil, it would be all over the news.

You can't just take fish oil and expect your problems to be solved. It is important to combine this with a healthy diet free of trans fats, low in inflammatory fats (safflower, sunflower, soybean, corn, cottonseed), and rich in antioxidants.

When you DO dose the fish oil, you'll need to take more than the recommended dose on the bottle; about 1000 mg DHA. You will need to calculate the number of capsules your favorite brand provides.

This issue is actually one of the things that inspired me to create the inCYST Network. When I saw what the fish fear was potentially doing to mother, child, and unborn children, I decided it was time to step up and speak out.

I hope you find this information helpful!

A significant percentage of the women I counsel, whether their issues are officially related to PCOS or not, are vegetarian. They get in trouble with their vegan lifestyle because it eliminates the essential nutrients DHA and EPA.

Not any more!

Marine algae is an up and comer in the omega-3 world. It's been increasingly incorporated into foods, which I've written about before. Now, the people who developed this ingredient are reporting that this algal DHA is as effective as salmon in increasing the body's DHA levels.

You can either take it as a supplement, or you can find it in popular foods. The best place to go in order to get the list of foods you can use is the Martek website. I'm also including the"Life's DHA" logo here, because it's on the packaging for these products for easy identification.

No more excuses, all you vegans! You can make choices that help you to be healthier while honoring your culinary code of ethics.: )

Arterburn LM, Oken HA, Bailey Hall E, Hamersley J, Kuratko CN, Hoffman JP. Algal-oil capsules and cooked salmon: nutritionally equivalent sources of docosahexaenoic Acid. J Am Diet Assoc. 2008 Jul;108(7):1204-9.

Way back when I first started studying omega-3 chemistry, I put together a list of DHA contents of a variety of seafoods. I was recently asked for a copy of that list, and since the list was not complete the first time I did it, I decided to update it.

I noticed when looking at the latest list that there were two significant changes: Over half of the seafood given the"green light" are farmed. Meaning we need to be more open to eating farmed fish and better manage our ocean farming habits. Secondly, as a consumer it is also important to know what fishing method was used. Some are sustainable, some are not.

The list below is based off of the Monterey Bay Aquarium Seafood Watch list, most recently updated January 11. As much as I advocate for all of you to eat more fish, I want to be sure that I do my part to encourage responsible use of the ocean's resources. So the only options included on this list are the"green light", or most sustainable options. If you don't see it there, it didn't get a green light. The (F) in front of an item denotes"farmed".

I'll update this from time to time so you all can keep current. I used the national list, but you can also find more specific regional lists at the same website. The downloadable wallet cards or iPhone application are great to keep with you so that you can always make better choices when you're grocery shopping or eating out.

Bottom line, any seafood has omega-3's. Even if they're not as high as what is found in salmon, every time you eat fish, you're not eating a meat higher in saturated fat. There's a"double whammy" benefit over and above that simple DHA.

Hope this inspires you to think when buying or ordering your seafood!

Milligrams of EPA/DHA/total omega-3 per 100 gram (3.5 cooked ounces)

(F) artic char 600/500/1100
(F) US barramundi 900/600/1500
(F) US catfish 200/200/400
(F) clams 100/100/200
(F) US cobia 383/418/801
(F) Pacific cod, bottom longline fished 100/100/200
Dungeness/stone crab 100/200/300
Pacific US halibut 300/100/400
Pacific US spiny lobster 100/100/200
(F) mussels 300/200/500
(F) oysters 200/400/600
Alaska sablefish/black cod 100/100/200
Alaskan salmon 575/500/1075
(F) off-bottom scallops 100/100/200
Pink shrimp 100/200/300
(F) striped bass 600/200/800
*striped bass 200/600/800
(F) US tilapia 130/50/180
(F) US rainbow trout 400/100/500
US/British Columbia albacore tuna (canned white) 100/300/400
Skipjack tuna (canned light) 300/100/400

I'm hearing more and more that many of you are switching to raw eating, and you're asking me if it's good for PCOS. It's not something that has been formally researched, so my answer is pulled together using what I do know about nutrition.

"Raw" refers to whether or not a food's temperature has exceeded a certain temperature during preparation. I actually tried to write a blog post about this several years ago and at the time could not find a specified temperature defining"raw" for a long time. I finally found something that suggested if it stayed below 124 degrees it would be considered raw. Then, last year, I ate lunch at the Whole Foods Venice, and decided to try a raw lunch for myself. The name of the restaurant that prepared my food was"118 Degrees," referring to the threshold raw temperature. This week, when researching it again, found everything from 104 to 118 degrees listed, without any scientific references for any of those values. It's one reason the diet can't be studied easily — those who follow it have yet to consistently define it.

One of the issues I have with any of those temperatures is that some of the foods popular in the raw community, by virtue of the fact that they grow in tropical climates, are regularly exposed to temperatures exceeding even the highest threshold. The mesquite trees growing in my backyard, yesterday alone, were exposed to an ambient temperature of 118 degrees the entire afternoon. The mesquite beans are dark, meaning they absorb heat and get even hotter. The flour made from them would not technically be raw, though mesquite flour is valued by the raw community. Coconuts, rice…both grow in tropical climates and therefore cannot be guaranteed to be"raw" if the benchmark is the definition above.

I'm assuming for the average person, for whom food is sustenance and not a religion,"raw" more likely means food that was not formally heated during preparation, and for the rest of this article that is the definition I will use.

Though raw eating has not been studied with regards to PCOS, it has been studied. It has been found to have both risks and benefits. The very first study of a raw food diet, published in 1985, found that after 7 months, subjects following this diet dropped their blood pressure, lost weight, and tended to spontaneously give up smoking and drinking.

One study found that raw foodists have lower cholesterol and triglyceride concentrations. However, a couple of other cardiovascular risk factors, serum homocysteine and HDL, were elevated, likely because a raw diet tends to be low in vitamin B12. It would be wise to take a multi-vitamin just to be safe.

Another study reported more dental caries in raw foodists. I'm assuming this is related to the increased carbohydrate and simple sugar content of the diet. So don't forget to brush and floss!

Here's what all you readers really need to pay attention to. One study specifically looked at menstrual function and raw food. It found that about 30% of women studied who were under 45 years of age had partial to complete amenorrhea, with subjects eating high amounts of raw food (>90%) being more affected than moderate raw food dieters. Ouch, ouch, OUCH.

A raw diet is also low in DHA and EPA, the omega-3 fatty acids primarily found in fish. If you're a raw foodist and also vegan, consider taking an omega-3 supplement derived from marine algae.

One benefit to a raw diet is that most people who consume it eat far more fruits and dark green leafy vegetables than they used to. Yay for antioxidants! Interestingly, however, one study found that though raw foodists had higher beta-carotene levels than average, their serum lycopene levels were low. Since lycopene is found in easily found fresh fruits and vegetables like tomatoes and watermelon, this suggests that even when eating raw, it's important to make conscious choices and not limit yourself to a few favorites. It can't just be about carrot juice!

The flip side of all those fruits and vegetables, however, is that protein is a difficult nutrient to get with this diet without soaking and sprouting legumes, in adequate quantities to balance out all of that carbohydrate. It may aggravate your insulin resistance. Be sure to add some protein powder to your cooking to prevent that from happening. Growing Naturals organic brown rice protein isolate powder has designed its product to be raw-compatible; be sure to check them out!

Another natural consequence of cutting out so much protein is that the fat content of the diet naturally increases. And even if it's raw fat, and good fat, it still has calories. I would recommend working out some menus on paper or running them through http://www.fitday.com/ just to be sure the diet doesn't push you in the wrong direction.

How your diet affects your health appears to be more determined by the proportions of carbohydrate, protein, fat, vitamins, minerals, and antioxidants that your diet contains. If you want to do that with raw foods, just be sure you do it right.

Douglass JM, Rasgon IM, Fleiss PM, Schmidt RD, Peters SN, Abelmann EA. Effects of a raw food diet on hypertension and obesity. South Med J. 1985 Jul;78(7):841-4.

Koebnick C, Garcia AL, Dagnelie PC, Strassner C, Lindemans J, Katz N, Leitzmann C, Hoffmann I. Long-term consumption of a raw food diet is associated with favorable serum LDL cholesterol and triglycerides but also with elevated plasma homocysteine and low serum HDL cholesterol in humans. J Nutr. 2005 Oct;135(10):2372-8.

Ganss C, Schlechtriemen M, Klimek J. Dental erosions in subjects living on a raw food diet. Caries Res. 1999;33(1):74-80.

Koebnick C, Strassner C, Hoffmann I, Leitzmann C. Consequences of a long-term raw food diet on body weight and menstruation: results of a questionnaire survey. Ann Nutr Metab. 1999;43(2):69-79.

Garcia AL, Koebnick C, Dagnelie PC, Strassner C, Elmadfa I, Katz N, Leitzmann C, Hoffmann I. Long-term strict raw food diet is associated with favourable plasma beta-carotene and low plasma lycopene concentrations in Germans. Br J Nutr. 2008 Jun;99(6):1293-300. Epub 2007 Nov 21.

Women with PCOS tend to have higher risk pregancies. A risk that is pretty well acknowledged is gestational diabetes. However, the rate of pre-eclampsia is also higher in cysters. Did you know diet can help you reduce your risk?

Researchers analyzed the diets of women with pre-eclampsia and gestational hypertension to see if any specific nutrients were correlated with these problems. The specific nutrients they looked at were: calcium, omega-3 and omega-6-6 fatty acids, trans fatty acids, magnesium, folate, and vitamins C, D, and E. There was a slight reduction in risk of pre-eclampsia in women with a higher intake of omega-3 fatty acids.

Omega-3 fatty acids, especially DHA and EPA, are two essential items you should include in your"Healthy Pre-pregnancy, Pregnancy, and Nursing Toolbox".

Boomsma CM, Eijkemans MJ, Hughes EG, Visser GH, Fauser BC, Macklon NS. A meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome. Hum Reprod Update. 2006 Nov-Dec;12(6):673-83.

Oken E, Ning Y, Rifas Shiman SL, Rich Edwards JW, Olsen SF, Gillman MW. Diet during pregnancy and risk of preeclampsia or gestational hypertension. Ann Epidemiol 2007 Sep;17(9):663-8.