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The following is a guest blog post from Dawn Marie Black, a woman with PCOS. Dawn is learning to cook in hormone-friendly ways, and has a great blog, Much Madness Is Divinest Sense, in which she records her experiences on this journey. In this post Dawn shares information about coconut flour.

If you'd like to try coconut flour but cannot find it locally, here are some options for online ordering.

What flour is high in fiber, and protein, low in carbohydrates and gluten free? We're talkin' coconut flour here!

I have PCOS, and found that these things are better for me, and having tried this flour I found I really like it.

Coconut flour is fiber from the coconut meat after most of the oil has been extracted to make Virgin Coconut Oil. Each brand of coconut flour will vary in their content of protein and fiber, but the protein and fiber is higher than gluten based flours, and that makes this flour very appealing for keeping my baked goods low carb, and to reduce other gastric issues that gluten can aggravate. Who really likes having IBS issues? I, for one, am not a fan. It is also considered a hypoallergenic food since so few people are allergic to coconut, which makes this easy to offer to many of your friends who may have other allergies. There are three things to remember when using coconut flour: One, always sift. Two, extra liquid is needed. Three, it needs something to bind it all together.

Coconut flour can be used in all recipes calling for flour. Most can be substituted with anywhere between 10% — 30% coconut flour, adding in the equal amount of liquid into the recipe as well. Other recipes may need further adjustments, for binding agents and liquid depending on the amount of fiber in the coconut flour. The easiest recipes to convert to 100% coconut flour are muffins, bars, pancakes, cakes, and quick breads. There are recipes on the internet and in print that can be helpful in building new recipes from. I have tried doing an equal exchange of flour, and without the extra binding agents and liquid the muffins were really dry, enough to toss with one bite. It was awful. If it looks dry, add more liquid.

There are several things to remember when using coconut flour. Always sift before measuring whether the recipe calls for it or not, it is inferred. If you forget to sift, you will be disappointed with your results as it will be dry and crumbly. This flour is very"thirsty", the fiber in the flour soaks up moisture, so more needs to be added to your recipes, it's usually an equal amount. Sticky sweeteners, such as brown rice syrup, can be included in your measurements for liquid, but oil is not included. Then you'll want to remember that since the flour has no internal binder, it requires additional eggs. The ratio is between 4-5 eggs per cup up to 1 egg per ounce of flour, there are other binders that can be utilized as well, egg whites, soaked flax, sticky sweeteners help with binding as well. I have found that those who are cooking vegan know many other binding agents and are good sources to ask regarding other alternatives in your baking. I've compiled a list of alternatives you can find by clicking here. I personally like eggs, they provide protein and are tasty, but I do substitute egg whites for some of the eggs, especially when I know I will be eating them in other forms through out the day.

If your batter is dry your baked goods will be dry, add in more liquids to moisten the flour for a more moist baked item. I forgot this once with a quick bread recipe, the batter was dry, and when the bread came out of the oven it was more lumpy and dry then when I had put it in the oven. Do not be afraid of a more moist batter, the fiber soaks it up. Coconut flour can be used in other common purposes such as breading and as a thickening agent for soups, stews, etc. If you are using it as a breading, make double the sauce to pour over your item in order to allow for the soaking up of the liquids. I made a Coq a Vin for a party, and overnight the breaded chicken soaked up all the sauce that was to be poured over the pieces of chicken. The flavor was there, but it would have been more delicious with the sauce to pour over the meal. Do not be afraid to make adjustments, print out your recipes make notes with your changes, decide how you liked your item and either make more corrections or make a note letting yourself know if you liked it or not. There will be some things that you will love the flavor, but maybe you will want a different texture. I'm still working on gooey brownies, I will be adding apple sauce to increase the moisture in my next batch.

Here are some helpful links to find recipes to begin your journey of cooking with coconut flour, and don't forget these three things when using coconut flour: always sift before measuring, extra liquid is needed, and it needs something to bind it all together.

http://www.freecoconutrecipes.com/gluten_free_coconut_flour_recipes.htm

http://www.kokonutpacific.com.au/OilSales/OilIndex.html?Health/CoconutFlour.php

http://www.simplycoconut.com/coconut_flour.htm

http://www.tiana-coconut.com/coconut_flour_recipes.htm

Reading the entry about the patient with an Flax allergy brought to mind a similar situation with a patient who had multiple allergies, including sesame and soy. I had recently suggested to her that she should take daily supplements of fish oil and vitamin D3. At our next appointment she reported that"there was no way that she could take any of these pills." Apparently she had tried several different brands and found that"most made her psoriasis worse. and several made her joints ache or gave her gastrointestinal distress." She said that additionally, she had tried a couple of fortified foods since the pills were bothersome and had reactions to several of the products. I asked her to email me the brands that she had tried so that I could do a bit of sleuthing. And what I found was quite interesting…
It was neither the fish oil (per se) or the VItamin D3 that was causing her distress but fillers in the pills, contents of the enteric coating of some of the pills and ingredients in some of the foods. Specifically several of the pills contained soybean oil and one contained sesame lignans. Sesame was also listed in the ingredients of some of the bars that she tried. At least 2 of the fortified products also included sulfites and sorbitol. Interestingly, most people know of the eight common allergens discussed here in the US (milk, fish, seafood, peanuts, tree nuts, eggs, soy and wheat.) But most are not aware that Canada recognizes nine common allergens with sesame included in this list. The point that I made to her and what I hope to emphasize here is the need to carefully examine the listing of the ingredients in these supplements — get out that magnifying glass if need be. Try to choose products without unnecessary fillers or ingredients! Check Consumerlab.com for the ingredients in their approved products. If you suspect that you are reacting to an ingredient in the product you can also check the manufacturer's web site or call the company to find out what you are really taking.
Hope all is well, Shelly

Shelly Sherman practices nutrition in Westport, Connecticut. If you would like to contact her for your own appointment, she can be found at smartnutrition@optonline.net.

I hope I got your attention! Because, yes, algae can be a very important part of a diet for PCOS.

It's becoming increasingly clear, as our baby counter ticks up and up and up, that omega-3 fatty acids ARE the answer for a lot of women out there who may not have found fertility success.

But I also know, from being in this business for over two decades, that there are some people, no matter how much you tell them that fish is good for you, simply aren't going to eat it. Whether it's because of taste, allergies, or vegetarian practices.

That's where algae comes in. The innovative people at Martek Biosciences have been culturing a species of algae, Crypthecodinium cohnii, that is naturally high in DHA, one of the omega-3 fatty acids. Don't worry, I stink at Latin, too. Just remember,"omega-3 algae" and you have all you need to know.

Martek has figured out how to take this algae, extract the DHA, and put it into a form that can be incorporated into foods that you and I actually eat. The examples I found today on Martek's website include (in alphabetical order):

Beech-Nut® Stage 2® DHA plus+™ Jars — a product of Beech-Nut
Beech-Nut® Stage 2® DHA plus+™ Cereals — a product of Beech-Nut
Bellybar™ Nutrition bars — for pregnant and nursing women from NutraBella Challenge Dairy Spreadable Butter — a product of Challenge Dairy
DHA plus+™ Yogurt Blends with Juice — a product of Beech-Nut
Crisco® Puritan Canola Oil with Omega-3 DHA — a product of the J.M Smucker Company
Fujisan Sushi — a product of Fuji Foods Products, Inc.
Glucoburst™ Diabetic Drink — a product of PBM Nutritionals Gold Circle Farms® Eggs — a product of Hidden Villa
Horizon Organic® Milk — a product of WhiteWave Foods
Kids-Pro Nutrition Drink — a product of British Biologicals
Little Einstein's Disney Milk — a product of Stremick's Heritage Foods
Minute Maid® Enhanced Pomegranate Blueberry Juice — a product of the Coca-Cola Company
NuGo Organic Nutrition Bar — a product of NuGo Nutrition
Odwalla's Soy Smart™
Oh Mama!™ Nutrition bars — for pregnant and nursing women from Vincent Foods, LLC Oroweat Whole Grain 9 Grain Bread — a product of Bimbo Bakeries USA, Inc.
ProSource NutriPure Supreme — a product of ProSource
Rachel's® brand, Rachel's® Wickedly Delicious Yogurt — a product of WhiteWave Foods
Rico's® Cheese Sauce — a product of Ricos Products Company
Silk® Soymilk — a product of Whitewave
So Good™ Omega DHA Milk — a product of Soyaworld
Stremicks Heritage Foods™ Organic Milk — a product of Stremicks Heritage Foods
Vitasoy® Soymilk — a product of National Foods
Yoplait Kids™ — a product of General Mills
ZenSoy Soy on the Go™ — a product of ZenSoy
Yo on the Go® — a product of Whitney's Foods, Inc.

Bottom line, if you can't or don't do fish, you can still do omega-3's.

One note, it's still important to have a diet that overall, is balanced in fat, carbohydrate, and protein. So if you're loading up on one option here that is sweetened, you may not get the optimal effect of the DHA. It might be worth downloading this list and showing it to your dietitian so the two of you can work out a game plan that incorporates these foods with the best chance of benefitting from them.

We know that about 10% of women have PCOS (recently, some sources say 20% of women). About 20% of women also have irritable bowel syndrome (IBS), which is characterized by abdominal pain or cramping; a bloated feeling; gas (flatulence – aka, farting); diarrhea or constipation — sometimes even alternating bouts of constipation and diarrhea; and mucus in the stool. But a recent study indicates that about 42% of women with PCOS also have IBS – more than twice as many of the women who don’t have PCOS. As if that’s not enough, gastrointestinal irregularities can be caused by:

• Menstruation (those hormones surging will slam your gut, as well as your mood);
• Travel (unusual schedules, foods, or water supply);
• Stress and anxiety (ever have to go running for the toilet right before a big test, or a job interview?);
• Too much alcohol or caffeine;
• Side effect of medications, particularly metformin when it’s first introduced. Many women also report bowel disruption from birth control pills;
• Irregular eating habits – oddly spaced meals, excessive carbs, which can be constipating (remember the BRAT diet – bananas, rice, applesauce, and toast – for diarrhea);
• Wheat, dairy, soy, or other food sensitivity or allergies; and
• Undiagnosed celiac disease (inability to tolerate the gluten most commonly found in wheat).

In other words, if you’ve got PCOS, there’s an excellent chance you also struggle at least intermittently with some sort of gastrointestinal distress. The effects can range from mildly embarrassing and uncomfortable (a little gas, some cramps) to wildly humiliating and awkward, up to and including bowel accidents while out in public, urgency that brings your condition to the attention of friends or family members, acute pain from chronic cramping, and fear of having an undiagnosed serious illness. These problems can cause or contribute to social anxiety and depression.

From a health psychology perspective, there are many things that can be helpful in managing gastrointestinal distress. Chief among them:

• Improved diet (consult with your doctor or dietician about your specific condition), or shifting the content/balance of your diet – this may also help with mood;
• Medications, extra fiber, or supplements to help regulate the bowels (again, consult with your doctor or dietician about what’s best for you specifically);
• Daily meditation, or other stress reduction techniques, such as yoga or Tai Chi;
• Talk therapy to reduce the stress and anxiety that triggers an attack of IBS; and
• Hypnotherapy is also recognized as an important treatment for IBS.

While these symptoms may be embarrassing, and even seem shameful, it’s important to know that you don’t have to suffer from them. They are not normal and, while they may not be entirely curable, there are many effective ways of managing or reducing them to a point where you’re no longer self-conscious about going out of the house. Treatments usually result in fairly quick improvements, so there’s no reason not to try implementing some changes. Here’s to your healthy gut!

Reference:

Dig Dis Sci 2010 Apr;55(4):1085-9. Epub 2009 Aug 21. Polycystic ovary syndrome is associated with an increased prevalence of irritable bowel syndrome. Mathur R, Ko A, Hwang LJ, Low K, Azziz R, Pimentel M. Source: Department of Obstetrics/Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

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

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

This site is all about PCOS, and the Mental Health Monday column is all about coping with PCOS, and yet there’s a whole different yet related realm that we don’t discuss at all – and that’s all the OTHER medical stuff we have to deal with on a regular basis:

• Family member’s appointments – you may have to make the appointment, drive someone to the appointment, pay for the appointment, or actually sit through the appointment or treatment. This is magnified when dealing with someone else’s chronic illness, such as an asthmatic child, or a parent with cancer;

• Medication management for children or elderly family members, which can be complex and confusing, especially when you’re managing your own medication and supplements;

• Dental care – ranging from minimally bothersome to all-consuming, depending upon what you start life with, and how you take care of it;

• Routine check-ups (Oh… yeah… right?! We’re supposed to go the doctor, theoretically, once a year, just because) with someone who is supposed to “know” you so that they can help when you’re having an issue;

• Cosmetic dermatology/plastic surgery (if one chooses to indulge in such things, which can be addictive, time-consuming, expensive, painful, and require a fair amount of discretion or story-telling to disguise);

• Coordinating care between physicians, hospitals, and pharmacies, because it seems like lab results and x-rays always go missing, the mail order pharmacy refuses to fill your prescription as currently written, and you are quite certain that the blood draw you had last week will suffice to answer ALL of THIS doctor’s questions so no, thank you, you do NOT wish to have another blood draw.

• Tending to non-PCOS medical conditions (allergies, asthma, broken bones, etc.), all of which require another set of doctors, treatment protocols, diagnostic procedures, and medications or support aids (glasses, hearing aids, orthotics, and so on), and all of which take far too much time and energy to implement effectively and routinely; and

• Even the veterinarian! Yes, dealing with your pet’s medical issues so closely parallels dealing with your own medical issues that it can be quite stressful for many PCOS patients, as it brings up feelings of loss of control, challenges in understanding the choices, and frustration about not being able to adequately or appropriately resolve a problem. Plus, veterinary clinics smell medicinal, which can trigger some bad memories.
Amidst all of this, you’re expected to work, and take care of your PCOS, which already makes you a little high maintenance if you’re doing it “right.” And, oh yeah — look good, be socially, politically, and spiritually engaged, and perhaps even be creative, philanthropically inclined, and a good and present friend. WOW. I’m exhausted just thinking about it – yet this is our reality.

After years and years of dealing with the medical roller-coaster, for myself and alongside others, I’ve come to realize:

• Doctors think their time is more important than yours; plan for it.

• Pharmacies are really, really picky – know the basics, and check your prescriptions before you leave the doctor’s office.

• Your insurance company definitely doesn’t care, no matter what they say in the nice ads that run during open enrollment time. Be polite, but treat them accordingly.

• At some point, someone (a doctor, a nurse, an x-ray technician, etc.) will say something insensitive, stupid, or cruel. Viewing this as an opportunity for spiritual and character growth is far more productive than engaging in rage.

• Doctors often have no real idea what their colleagues are doing to/with your body, so keep your own medical records, do your research, ask a lot of questions, remind them pointedly, and take all the time you need.

And if you’re still feeling overwhelmed by the plethora of medical information, advice, procedures, and protocols, ask for some help. Poet Mary Oliver writes of “your one wild and precious life.” I say, this is your one precious body, and it merits your full, loving, and respectful attention, even in the midst of a medical storm.

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

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

inCYSTer Michal Hogan recently did a presentation about PCOS at Ohio State University. Michal is a wonderful resource to women in Columbus…if you missed her presentation I strongly encourage you to seek her out for individual counseling. In addition to being PCOS-trained, she is an incredible detective when it comes to working with food sensitivities and allergies. Sometimes those can interfere with your success.

Michal has a lot of success with migraines and fibromyalgia as well, which are common issues occurring with PCOS.

If you'd like to contact Michal, you can call her at 866.396.4438. Or, get to know her at her website, http://www.nutritionresults.com/.

Anyone who has been to a Whole Foods class knows how much I hate what I call the"crunchy aisle"--the place where chips and snacks are located. That's because even in a place like Whole Foods, the oils used in these snacks are the kind we're trying to discourage. Those dreaded"S" and"C" oils.

There's a company in Phoenix that has slowly building a following through Whole Foods, AJ's, and the local farmer's markets that deserves attention. If you're in Phoenix, I encourage you to try them…perhaps if we can help them succeed here, they can offer their good stuff in other markets where we're promoting inCYST!

Dr. Hummus is a brand of hummous that is tahini-free. Meaning it is sesame-oil free. The owner of this company has done this primarily for people with food allergies, but it turns out this helps make its fatty acid balance more in line with what inCYST encourages.

Secondly, the good mediterranean doctor has created a line of pita chips fried in canola oil. Not safflower, sunflower, soybean, or any of the other oils that always cause me to put other crunchy possibilities on the shelf. But canola oil! Again, this was done not for any"healthy" reason, but because in testing all the other oils, the product that ended up having the most acceptable flavor…ended up being the one with one of the healthier oils.

Which has been inCYST's argument all along! When you eat good food, it is often healthier food.

One caveat, even healthy oils can be detrimental in large quantities. A serving size of Dr. Hummus chips is still 10 chips, not the entire container.

If you're in Arizona and you're looking for a great snack, or even lunch, consider Dr. Hummus. If you're not in Arizona, the ingredient guidelines you read here can be applied to your own local hummous maker. There are many brands and flavors that can, as we can attest to here in the desert, make your eating adventure fun as well as healthy.

The most common question I get as an Herbalista is, "What can I do to feel well again?" There are many things we can do to incorporate wellness in to our body, mind, soul, and earth and I use this 5-step acronym that I've developed to simply my options: FHEEL F= Food

The first step to feeling better is to examine what we're fueling up on. It tends to be in our best interested to avoid fried and fatty foods in general, but especially so for those of us with PCOS. Instead, aim to eat plenty of fresh vegetables and healthy proteins with some fruit, dairy, and whole grains sprinkled in. Try and get a rainbow-colored variety of foods in your diet, striving for more of the darker/richer colored foods (kale, spinach, dandelion greens, mustard green, collard greens, broccoli, beets, blackberries, blueberries, pomegranates, squashes, sweet potatoes, carrots) and less of the lighter and whiter foods (citrus, raspberries, strawberries, bananas, pastas, rice, sugar, white potatoes, butter, dairy).

H= Herbs

If a whole foods diet isn't giving you everything you need in the moment, adding herbs can help! Start with adding simple spices to your meals like garlic (detoxifying herb that is great for the digestive system), rosemary (supports the brain and is antibacterial), and ginger (supports the circulatory and digestive system and is helpful for migraines). Other culinary spices that are easy to incorporate are cinnamon, turmeric, pepper, fennel, cayenne, thyme, sage, and clove. I highly recommend talking with a Holistic Healthcare practitioner, Naturopath, Herbalist, or other trained botanical medicine professional about herbs that can be specifically helpful to your desired wellness goals.

E= Essences and Essential Oils

Both Flower Essences and Essentials Oils are lovely tools that really support more the emotional, spiritual, and mental journey of wellness. Flower Essences have no reaction to medications, allergies, children or pets and work specifically on our current state of emotions. There are as many brands as there are flowers, from all parts of the world, so please read up on the companies as well as the products before choosing an essence. Essential oils are potent blend of botanical oils that have specific methods of delivery. Because there are highly concentrated amounts of naturally occurring chemicals in essential oils, it is extremely important to handle them with an informed and delicate manner. As always, consult with an Aromatherapist or Flower Essence practitioner for recommendations.

E= Energy Therapies and Exercise

When there still seems to be components of our wellness that need some extra attention, energy therapies and exercise can be very beneficial. Research the many benefits of Massage Therapy, Yoga, Acupuncture, Reiki, Polarity, Reflexology, Circuit Training, and many other healing arts and fitness programs. With any area of wellness, there are both reputable, competent companies and practitioners of theses energy therapies, as well as not so reputable nor competent companies and practitioners. Choose wisely after researching local resources in your community. I like to ask where they received their training from, how long have they have been in practice, and also what the whole process is from start to finish before signing up or paying for an appointment. Other energy therapies and exercises that can be helpful are: meditation/prayer, affirmations, journaling, hypnotherapy, life coaching, joining a gym/health club, getting a personal trainer, and dance styles like zumba/jazzercise/ballroom/swing/two-step and line dancing.

L= Lifestyle Changes

Making some more intense changes in lifestyle habits may be necessary in order to achieved our desired wellness goals. Most often, habits like smoking, drinking, eating too much fast food or snacks, not exercising, drinking soda and sugary beverages,and having too much or too little sleep can tremendously impact the state of our health. When setting your wellness goals, really emphasize the reasons for choosing those specific goals and concentrate on those reasons during the challenging moments. Tell your friends and family about your wellness goals the lifestyle changes you are making to help keep you accountable and motivate you during the ups and downs. Create a vision board or goal chart to showcase your progress. There are many tools and apps available to help you at any age or stage of wellness and life so identify those goals, develop a route to wellness, seek advice if you need help meeting those goals and chart your progress to see how well you're doing and how close you are to meeting and exceeding those goals!

I leave you with this last tidbit to remember, words of wisdom I try to live by: Wellness is a Journey, Not a Destination. Strive for Progress, Not Perfection… Know that every step, every breath, and each moment counts as progress, so long as we consciously choose to be well.

~Choose to be and"fheel" well-- The Herbalista