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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.

My post a few days ago about the effects of PCOS on the brain seems to have created some discomfort. We lost a few Facebook fans, and those who did respond, said that learning that PCOS was taking its toll on brain tissue and function was somewhat depressing to take. Theories of behavioral change state that until you know a problem exists, you will not act to change. So while the news can be uncomfortable to live with, the good news is, now you know why you need to make changes. You can't talk yourself out of those changes by convincing yourself that you're at peace with your body type, or that maybe you can live without having a baby. You're fighting for your cognitive life, and only you can make the changes that can make a difference. Here is a list of things you can do to help preserve brain and nervous system function. 1. Get sleep. You may think it's a badge of honor to cut yourself short in the sleep department. But it takes its toll. It is when you sleep, that your brain cleans out all the crud from the day before…spit shining neurons, so to speak. If you go too long without sleep, it's like you're letting rust accumulate all throughout your brain. Make it a habit to get to bed at an hour that allows you to get at least 7 hours of sleep a night. 2. Reduce stress. Every little thought, behavior, chemical reaction, that gets you through a day, requires a series of neurons to coordinate that activity. Every time a neuron is asked to work, it uses glucose to do so. Every time a neuron burns a molecule of glucose, it uses oxygen to do so. More neurons = more glucose = more oxidation. Make it a priority to give up the small stuff…and if you can't completely give it up…learn how not to sweat it so much. 3. Manage mental health issues. Most mental health diagnoses affecting PCOS (anxiety, bipolar disorder, PTSD, OCD, ADHD), involve processes that overwork the brain and nervous system. People with these disorders are fairly high energy, and that means they are using more neurons, more often, with far more intensity, than people who don't have to live with these conditions. Get counseling. If you need medication, take it. Health means MENTAL as well as PHYSICAL conditioning. Take it seriously. Do what you need to do. Slow down those neurons in any (legal) way available to you. 4. Exercise. Research is showing that regular physical activity slows down the development of brain diseases like Alzheimer's and helps to maintain brain tissue. How many times have you struggled with a problem at your desk, put it down, walked over to the post office, and had an inspiration while moving your body? Muscles and neurons are best friends. Be sure to give them plenty of play dates.

5. Eat less carbohydrate. Because your brain uses glucose, and because it's going to want more glucose when it is stressed, you're going to want to eat more carbs when under pressure. Remember what I said in number 2. The more carbs you eat, the more oxidative stress you impose on your brain. The more easily your brain rusts out and breaks down. I want you to think of this picture every time from this point forward you see a donut, order of french fries, or bottle of soda. Look less appetizing? Good. That was my point. 6. Eat antioxidants Antioxidants, those chemicals with the funny names nutrition experts love to impress people with in their blogs…hate oxidation. Eat them. Don't worry if you can pronounce their names, just know if the food in your hand (1) doesn't have an ingredient label, (2) has color, (3) and rots if left too long in your fridge, it's good for you. Put it on your plate and into your body. 7. Use fish oil. Fifteen percent of the dry weight of a healthy human brain is DHA, one of the primary omega-3's found in fish oil. It has to be fish, it can't be nuts, or flax, or greens. Eat the fish or take the capsules. I don't care if they come up a little bit. You have a choice…burps or brains. Just do it. 8. Reduce omega-6's. All those oils beginning with the letters"s" and"c"…break down brain tissue. Read labels. Get them out of your diet. Two exceptions. Organic canola is fine and coconut oil is fine, provided you're not eating it by the tablespoonful. 9. Yoga. Yoga tones the nervous system. It chills you out. It improves circulation in your spinal column. It improves your flexibility. It helps to manage mental health issues. It pretty much takes items 1 through 8 and makes them work even more effectively for you. It's worth the time. 10. Cut the high-fructose corn syrup. Recent research suggests that HFCS affects memory. Get it out of your diet!

I've been writing this blog long enough to know that as soon as I recommend a supplement, the post is circulated, reposted, retweeted, ad nauseum. If I talk about changing food choices, it sits there like a bump on a log.

I posted the information about myoinositol supplementation because I knew that many of you are having such a hard time with the side effects of metformin, that it might be helpful to try this compound as an adjunct.

In the process of researching the topic, however, I came to understand that part of the reason many of you have a problem with your myoinositol levels in the first place…is that your dietary choices may have backed you into a corner.

Myoinositol isn't new news, really. Back in 1980 a physician and a dietitian wrote a very nice review article and developed some recommendations for increasing dietary inositol that I'm going to summarize here. In a nutshell, it's a dietary intermediate that is found in high quantities in nerve cells. If your nerves are working harder than they were designed to, as is the case when you don't manage your stress, don't attend to good sleep hygiene, overexercise, and eat a poorly varied diet, there is a really good chance you're going to deplete your myoinositol levels more quickly than you can replete them. That is a consequence for ANYONE not taking good care of themselves, it's not a unique feature of PCOS.

For anyone struggling with medical issues related to hyperexcitable brains, including migraines, epilepsy, anxiety disorder, OCD, PTSD, bipolar disorder, etc., it's highly possible that your daily myoinositol needs are simply higher than average. Everything you see us write about on this blog, from omega-3's to antioxidants, is designed to reduce that hyperexcitability and make it easier for your brain to function as it should. It certainly is not going to hurt to take a supplement, and if you've been asking your brain to run on nutritional empty for a long time, or if you've been working hard to turn your PCOS around with good habits and just don't seem to be getting over the hump with it, supplementing may be a great tool to add to your already good habits.

There is some thought that people with insulin function problems may have alterations in myoinositol function, which could also increase the daily needed dose.

I must iterate, however, that a myoinositol supplement is NOT a substitute for a healthy diet. There is no such thing as a donut for breakfast, a Snickers for lunch, and a binge for dinner…cancelled out by a few pills in a bottle. So my guess is that those of you who are making good changes diet and stress management-wise in conjunction with the supplement are the most likely to achieve the benefit of the supplement. That is just how biochemistry works!

The study I recently quoted (focusing on neuropathy, not ovulation) used a myoinositol dose of 4 grams. The study I quote today found an effective response from a highest dose of 1,500 mg. It doesn't mean that these are the doses recommended for each particular diagnosis, or type of inositol, pill or food…it simply means those are the doses the reseachers decided to study.

However, since that is the dose reported in the ovulation study, and more of you reading this are interested in conception than nerve pain, I'll post the values of the highest myoinositol containing foods and let you figure out what your best food/supplement combination is to achieve that dose (4000 mg or 4 g daily).

I'm going to tell you, what I was thinking as I compiled this list was that if you're only concentrating on carb/protein/fat content, you're cutting out all your myoinositol sources. It looks like Mother Nature makes sure that when we eat carbohydrate as it appears in nature, that it comes packaged with a nutrient important for metabolizing it. It's when we refine that sugar and eat it out of context, as with sodas, candy, baked goods, etc…that we dig a hole for our nervous systems.

We just can't outsmart her, can we?

The complete list can be found at this link.

Myoinositol Containing Foods with more than 100 mg/serving
1/2 cup grapefruit juice 456 1/2 cup canned great northern beans 440 1/4 fresh cantelope 355 1 fresh orange 307 1 slice stone ground wheat bread 288 1/2 cup rutabaga 252 1/2 cup kidney beans 249 1/2 cup orange juice 245 1/2 cup canned oranges 240 1/2 cup canned peas 235 1/2 fresh grapefruit 199 1 fresh lime 194 1/2 cup canned blackberries 173 1/2 cup mandarin oranges 149 1/2 cup canned lima beans 146 1/2 cup kiwi fruit 136 1 cup split peas 128 2 T. creamy peanut butter 122 1 fresh nectarine 118 1/2 cup canned black-eyed peas 117 1/2 cup grapefruit sections, canned 117
Rex S. Clements, Jr., M.D. and Betty Darnell, M.S., RD. Myo-inositol content of common foods:
development of a high-myo-inositol diet. Am J Clin Nutr September 1980 vol. 33 no. 9, 1954-1967.

I've mentioned before that receiving any kind of medical diagnosis that can leave you backed into a corner, with no place to go, is one of life's most extreme stresses. If you're someone who is used to being in control, losing that control can throw you into a complete tailspin. That is when you are most likely to be susceptible to something called"magical thinking". This type of behavior is something you engage in to allow yourself to feel as if you you have more control over a situation than you actually have. Some examples in recent months that I've personally experienced:

-- A gentleman I really wanted to do business with because I liked his product, started to panic because sales of that product were not matching his projections. I started receiving e-mails from him about all kinds of interesting"effects" he was personally noticing that he attributed to the special powers of his product. I mentioned to him once that if his observations were true, science would validate them. He told me he didn't have time to wait for science. Can you hear the desperation and wishful thinking that was interfering with his overall long-term success? I felt sad, because his product was good, but he was gradually burning business bridges before he could get the sales he wanted and should have had.

--A young woman who had failed one IVF and was scheduled for another, afraid she'd lose that success too, wrote me asking to help her with a detox/cleanse, less than a week before her procedure. She wanted to rid her body of any negative influences that might work against her. We decided against the detox, and simply set up a very balanced eating/exercise/relaxation plan focusing on nurturing instead. (She's pregnant, BTW). I don't think she really wanted to detox, she really needed something constructive to do as an anxiety outlet, and to give her hope she wasn't going to fail again.

Supplements are the place where magical thinking really takes control. I watch women with PCOS throw the entire kitchen sink at a problem, without knowing exactly what kind of effect they're looking for, what dose, what brand, what kind of interactions their multiple supplements may have with each other…which ones duplicate the effects of others…all it seems to take is for one person out there to mention one supplement and the"wave" rolls across the PCOS blogs and Facebook pages. Because no one ever really took the time to figure out how to use the supplement in a scientific fashion, it doesn't work, women give up on it before it might have a chance to work, and they're off on a search for the next magical supplement.

We're starting to understand here at inCYST that there is more than one kind of PCOS. So if anyone is recommending any particular supplement, and it's a one-size-fits-all recommendation, they're either telling you what worked for them (which may not work for you), or they are throwing together a little bit of something from every study they could find, which makes their answer extremely expensive because half of what is in it, most women don't even need.

Just because you can buy supplements yourself over the counter, and dose them yourself, does not mean they're safe. If your physician is anti-supplement and you're not telling him/her about the supplements you're taking because you know s/he is against them, you could be negating the effects of both your medications and your supplements. There are ways to use both, but it's only going to work if whoever you are asking for help, is amenable to combining both approaches.

The supplement that currently seems to be the rage right now seems to be n-acetyl-cysteine, or NAC. I'm not sure where this wave got started. I'm not going into the nuts and bolts of the chemistry, you can find that elsewhere. But here are some things to consider.

1. NAC has also been shown to reduce the symptoms of bipolar disorder and schizophrenia. I'm guessing that the subpopulation of women with PCOS who also have one of these diagnoses (and that's a pretty significant percentage of the PCOS population BTW), are the ones most likely to benefit from NAC. But since mood regulating medications are powerful, it's super important, if this is you, to let the prescribing physician of any mood stabilizers know so that you don't experience a dangerous adverse reaction between medication and supplement. And by all means, DO NOT stop taking medication for schizophrenia or bipolar disorder because you read what I just wrote!!!

2. NAC is also being considered as a treatment for obsessive-compulsive disorder, something I know is also very common with PCOS. If you're going to use a supplement, I'm more comfortable with your using myoinositol for this purpose, which has also been shown to help improve fertility rates. Again, please let your caregiver know what you're doing. One of our fans recently shared that she took a blog post regarding inositol to her physician, who now recommends it to his PCOS patients. In talking to your doctors, you have to potential to teach them important things. (That's why I reference posts, so your doctors can read the research themselves and know my thoughts are evidence-based.)

2. There is some evidence that large doses of NAC can increase the risk of pulmonary hypertension, a very dangerous condition. I can't stop you from taking this supplement, but I can encourage you, if you decide you want to use it, to do so in conjunction with a knowledgeable health professional who can help you to properly dose it.

3. In the most recent study I found regarding NAC compared to metformin/clomiphene, metformin/clomiphene was found to be superior. But if you remember, I wrote pretty extensively not too long ago about the peer-reviewed finding that metformin increased ovulation and pregnancy rates but not live births (thus increasing the miscarriage rate). Perhaps you should think a little bit about whether or not this is the path you wish to embark on, using a supplement that has not been proven to be as"effective" as a medication that hasn't even been proven to be effective.

4. One reason NAC is thought to be useful is that it protects against"glucose toxicity". Here's a thought — why not eat less glucose? Even if you choose myoinositol over NAC based on what you're reading, consider that your own inositol stores may have found themselves depleted in the first place from imbalanced eating. No way around it, supplements do not replace healthy choices. If you're going to experience the greatest benefit from a supplement, it needs to complement, not replace, better eating.

You're all grown women and you can make your own choices. I hate seeing you struggle with PCOS. But worse than that, I hate seeing you jump around from supplement to supplement without any kind of plan of action for how you're going to use it, how you're going to know if it's working, and how you're going to know if you need to not use it.

The people who benefit the most from magical thinking…are the ones who play on your anxiety and frustration and take your money, offering"solutions". Be a wise consumer. And remember, something you ALWAYS have control over…is healthier food choices, activity schedules, and stress management.

Berk M, Dean O, Cotton SM, Gama CS, Kapczinski F, Fernandes BS, Kohlmann K, Jeavons S, Hewitt K, Allwang C, Cobb H, Bush AI, Schapkaitz I, Dodd S, Malhi GS. The efficacy of N-acetylcysteine as an adjunctive treatment in bipolar depression: An open label trial. J Affect Disord. 2011 Jun 28. [Epub ahead of print]

Camfield DA, Sarris J, Berk M. Nutraceuticals in the treatment of obsessive compulsive disorder (OCD): a review of mechanistic and clinical evidence. Prog Neuropsychopharmacol Biol Psychiatry. 2011 Jun 1;35(4):887-95. Epub 2011 Feb 23.
Abu Hashim H, Anwar K, El-Fatah RA. N-acetyl cysteine plus clomiphene citrate versus metformin and clomiphene citrate in treatment of clomiphene-resistant polycystic ovary syndrome: a randomized controlled trial. J Womens Health (Larchmt). 2010 Nov;19(11):2043-8. Epub 2010 Oct 12.

Kaneto, H. Kajimoto, Y. Miyagawa, J. Matsuoka, T. Fujitani, Y. Umayahara, Y. Hanafusa, T. Matsuzawa, Y. et al. (1999). Beneficial effects of antioxidants in diabetes: possible protection of pancreatic beta-cells against glucose toxicity. Diabetes 48 (12): 2398–406.

Hello readers!

I am in contact with an author who is looking to interview women with the following. Each is s eparate condition, you don't have to have them all. If you are interested in sharing your experience, please contact Marianne Russo, sunrise959@aol.com

Have been diagnosed with an anxiety, OCD or depressive disorder along with PCOS
Had early symptoms of PCOS (Before age 12)
Have had intermittent bouts of rage or aggression as a child
Have co-existing Cushing's Syndrome
Were born to mothers who experienced SEVERE pre-natal stress.
Have had their emotional issues abate or resolve with Metformin or Yaz

OK. Today's the day. There was finally a quiet morning to read the research about d-chiro inositol. Ever since I posted a link to Sasha Ottey's interview on the topic on her PCOS Challenge radio show, traffic linking to us with that keyword has been very high. I've known we needed a blog post, but I just wanted to be sure it was scientifically accurate and presented information in a way that was beneficial, not hurtful.

What is inositol? It is a chemical that is necessary for several body functions, including: cell structure, insulin function, nerve function, fat breakdown, and maintenance of healthy cholesterol levels.

Inositol comes in nine different forms. Two of those types of inositol, myo-inositol and d-chiro-inositol, have been found to have therapeutic value. Myo-inositol supplementation has been found to alleviate symptoms of bulimia, panic disorder, obsessive-compulsive disorder, agoraphobia, depression, and bipolar disorder. d-chiro-inositol supplementation has been found to be useful for symptoms associated with insulin, high androgen levels, and menstrual irregularity. It is also reported that myoinositol can help prevent hair loss.

Both categories of symptoms are common in PCOS, so it appears that inositol levels and metabolism may be problematic with a high percentage of readers of this blog.

One thing you can do to help improve your levels of both myo- and d-chiro-inositol is to know their dietary sources. Myo-inositol is found in brewer's yeast, liver, milk, whole grains, brown rice, oats, nuts, citrus fruits, molasses, legumes, raisins, and bananas. The best sources of d-chiro-inositol are buckwheat and garbanzo beans (hummous, anyone?)

The theory is, that women with PCOS have trouble converting myo-inositol into d-chiro-inositol. So they need to bypass that metabolic bottleneck with a supplement.

I haven't had the opportunity to use d-chiro-inositol with my clients yet. I haven't wanted to recommend anything unless I'd researched it. But I had a client once, with severe OCD, who responded well to myo-inositol in a way medication and behavioral therapy never achieved. The only issue she had with the supplement was the large dose she needed to take (10 grams per day) in order to see benefit.

Fast forward to today, I've been wondering for awhile if maybe the symptoms attributed to myoinositol deficiency weren't actually myoinositol issues at all, but d-chiro-inositol issues, and the large dose needed was because the conversion in this population is so low.

So here's the best way I would think it would work to determine if d-chiro-inositol deficiency is your problem.

1. Be sure to include all the foods I mentioned above in your diet on a regular basis.

2. Try d-chiro-inositol. Give it three months of regular use to see if it helps.
--If it helps with your insulin levels, androgen levels, and menstrual cycles, then by all means continue using it!
--If it helps with the above, but doesn't help with binge eating, mood, or obsessive thinking, then consider adding some myoinositol to the mix.

3. And please, check back with us. I'm really curious to know what happens. If d-chiro-inositol also helps with mood, etc., that's very important information.

Recommended doses of each: myo-inositol 12-30 grams per day
d-chiro-inositol 100 mg, twice per day

I know, I know, if you're obsessive, you're going to want to take the higher dose of myo-inositol, or even double the dose I've listed.: ) I strongly encourage you to resist the temptation and start low and titrate up as you need to.

I spent quite a bit of time in the supplement department at Whole Foods, to get an idea of what readers would find if they went to buy inositol. As you can see at this link, the options on amazon.com, as they are in most health food stores, are primarily myoinositol.

If you'd like to purchase d-chiro-inositol, the most popular source for women with PCOS appears to be www.chiralbalance.com.