One of the pieces of PCOS that I find intriguing, but which really is not well studied, is what is happening with appetite. This is such a crucial piece of the picture, because it doesn't really matter what ANY expert, medical, nutritional, whatever…tells you that you SHOULD be eating, if your appetite hormones are not supporting the advice.
In order for us to better understand what is happening, and therefore derive effective solutions for this problem, we need to toss a couple of assumptions we have about women with PCOS.
It may not be valid to assume that women with PCOS overeat simply because of emotional issues. (Note: I did NOT say there is NO emotional eating, but I suggest that it may be but one of the pieces of the puzzle.) It seems that the primary assumption on the part of many professionals is that once you lose weight, it is a sign that your appetite and intake are back in balance.
As I interview more women with PCOS, I'm learning that even lean women with PCOS struggle with appetite. A very common scenario, it seems, is to do everything right--eating, activity, sleep, stress management…and some days, despite all the effort, appetite seems to take on a life of its own.
If the experts aren't acknowledging this, some of the more strong-willed cysters may be able to learn to ignore these inappropriate hunger and fullness signals. In other words, the only tool they have to combat obesity is detached, restrictive eating. And if they own up to that with their caregiver, they may be diagnosed with an eating disorder.
Nowhere in there is there room for a physiological explanation.
Leptin, ghrelin, insulin, cholecystokinin, and endocannabinoids…all hormones affecting appetite, have been found to be out of balance with PCOS.
Given this and the stories that are accumulating in my files, it simply does not seem appropriate to advocate for an intuitive eating model as the therapy or the goal. It may be achievable over the long run, but it is not fair to recommend a paradigm that assumes that appetite mechanisms are intact, when in fact they are not.
I encourage you to share your observations with whoever is helping you. I have some work to do to collect more of the references and write about this phenomenon, so you have more science to support your advocating for yourself. It is coming.
For today, I just wanted to introduce the thought and encourage the dialogue. The more we hear from you, the more we can look for explanations and solutions.
The last time I wrote about marijuana it brought enough traffic to this blog with the search words,"PCOS" and"marijuana" I figured the subject should be addressed in more detail.
Did you know that our bodies naturally make their own cannabinoids? They are compounds that are needed for a variety of processes, ranging from appetite to pain sensation to mood to memory.
Cannabis, an external cannabinoid, affects these functions as follows:
1. Interferes with both long and short term memory. If you're smoking pot and experiencing brain fog, there just might be a connection.
2. Increases appetite (like I had to tell you that!) When your internal (endo) cannabinoid system is out of balance, it too affects appetite. Leptin and endocannabinoids antagonize each other, and when the latter levels become higher, obesity is more likely. Just as cannabis intensifies cravings for sweets, so do high levels of endocannabinoids.
3. Affects fertility. In both directions. Cannabinoids can increase or decrease the probability of an embryo implanting in the uterus. My guess would be that if you're a person who is craving sweets and struggling with weight, you layer smoking pot on top of that…you're pushing that baby farther away from reality, rather than in the positive direction.
What is fascinating is that omega-3 fatty acids, the ones you see all the time mentioned in this blog, are crucial for good endocannabinoid function. If you're omega-3 deficienct, you're more likely to make it harder for your body to respond to its own naturally produced cannabinoids. So that craving for pot may have a valid foundation. The problem is, it's not the lack of cannabinoids that's causing the problem. It's that they are there, all dressed up, ready to help regulate memory, mood, appetite, and hormone function, but the body has lost the ability to understand what those chemicals are trying to tell them. Flooding your system with more of those chemicals holds potential to create an even worse imbalance, even worse cravings, a vicious cycle that it can feel impossible to break out of.
In addition, omega-3 fatty acids help to be sure that when it comes to maintaining muscle mass and reducing fat mass, the endocannabinoids push that relationship in the right direction.
Why not try improving how your body uses these chemicals and see if it helps reduce your need for the external stuff?
1. Work really, really hard on getting those omega-6 fatty acids out of the diet. They are likely to be found in baked goods, chips, all the stuff you tend to want to eat when you have the munchies. So it seems like a really important strategy is to not bring your munchie foods into the house. Fill your kitchen with fruits, vegetables, crackers made with olive oil, etc., to turn to while you're transitioning to a better hormone balance. Remember, the oils you want to stay away from begin with the letters"s" and"c"--safflower, sunflower, soybean, sesame, corn, cottonseed. Canola is ok.
2. Get as many omega-3 fatty acids as you can in your diet. If you supplement, start with a dose of 500 mg DHA per day. If, combined with #1, you don't see a change within 2 weeks, add 500 mg more DHA. I've seen some cases where titrating up like that, over time, the end dose was 1000 to 1500 mg per day. Hang in there. If you're diligent, it works. Lafourcade M, Larrieu T, Mato S, Duffaud A, Sepers M, Matias I, De Smedt-Peyrusse V, Labrousse VF, Bretillon L, Matute C, Rodríguez-Puertas R, Layé S, Manzoni OJ. Nutritional omega-3 deficiency abolishes endocannabinoid-mediated neuronal functions. Nat Neurosci. 2011 Mar;14(3):345-50. Epub 2011 Jan 30.
Watkins BA, Hutchins H, Li Y, Seifert MF. The endocannabinoid signaling system: a marriage of PUFA and musculoskeletal health. J Nutr Biochem. 2010 Dec;21(12):1141-52. Epub 2010 Oct 8.
Kirkham TC, Tucci SA. Endocannabinoids in appetite control and the treatment of obesity". CNS Neurol Disord Drug Targets 5 (3): 272–92, 2006.
Das SK, Paria BC, Chakraborty I, Dey SK. Cannabinoid ligand-receptor signaling in the mouse uterus. Proc. Natl. Acad. Sci. U.S.A. 92 (10): 4332–6, 1995.
Paria BC, Das SK, Dey SK. The preimplantation mouse embryo is a target for cannabinoid ligand-receptor signaling. Proc. Natl. Acad. Sci. U.S.A. 92 (21): 9460–4, 1995.
Practically every time I hear a health professional explain, on the Internet or in person, why a woman with PCOS has carbohydrate cravings, they blame it on insulin resistance. The rationale is, that because glucose is not getting into cells, the cells are hungry and asking for sugar.
Did you know, as rational as this explanation sounds, research does not support it?
A study published in 2004 (and one of the few I've ever even seen that acknowledged that women with PCOS crave sugar) compared several appetite hormones to appetite measures in 16 pairs of women with PCOS matched with controls. They could find no statistically significant correlation between reported appetite and insulin levels. Rather, it was testosterone levels that seemed to be the problem.
Because insulin resistance has some effect on how much free testosterone is available to affect appetite, it could be argued that the effect is still there, but more indirect. However, another study reported that it is the eating of too much sugar and the resulting change in liver function that ultimately determines free testosterone levels, not insulin. (In this particular study the diet was up to 70% sugar, to be sure the desired metabolic effect was achieved and could be studied.) The resulting fat production by the liver was correlated with reduced levels of sex hormone binding globulin, the blood protein that binds to testosterone and inactivates it.
So while the cravings are there, be sure not to blame their cause on a solution that may not help. Our philosophy at inCYST is that balancing fatty acids helps calm down the nervous system and reduce its need for sugar. It also helps the liver better process fats, thus preventing the testosterone issue described above.
I know, I know, you're getting tired of hearing about fish oil.
I won't belabor the point, today I'll just challenge you to think outside the same old test tube.: )
Hirschberg AL, Naessén S, Stridsberg M, Byström B, Holtet J. Impaired cholecystokinin secretion and disturbed appetite regulation in women with polycystic ovary syndrome. Gynecol Endocrinol. 2004 Aug;19(2):79-87.
Selva DM, Hogeveen KN, Innis SM, and Hammond GL. Monosaccharide-induced lipogenesis regulates the human hepatic sex hormone–binding globulin gene. J Clin Invest. 2007 December 3; 117(12): 3979–3987.
Last week I had the opportunity to hear James May, the founder of Wisdom Natural Brands, based here in Phoenix, tell his story of how he became involved with developing the stevia industry. Below is a white paper he shared with us that is referenced and provides a lot of very interesting information. This is a business paper, not a scientific publication, but it does contain references that can get you started if you're looking for more information.
It's not just a sweetener, apparently it has some endocrine and appetite effects as well (may decrease your appetite for sugar), and a new study suggests it may help to improve memory.
Also, I'm providing a link to a brand new website, Stevia University, which is a resource for all things stevia. Be sure to bookmark it!
Stevia Rebaudiana Bertoni Prepared by James A. May and provided as an educational service by Wisdom Natural Brands Stevia has been correctly framed as the promised sweetener that can help resolve many of the world's sweetener, obesity, and diabetes concerns. Stevia can also solve much of the poverty of the farmers in third world countries by giving them a cash crop to grow, even improving the productivity of their soil and the quality of their other crops. Stevia can be the next generation of the world's most preferred steetener. Consumers are becoming even more excited as they learn that stevia extract was not originally a chemical invention targeted for a totally different purpose, such as a drug or insecticide, which, after it was tasted, became an artificial sweetener (1). Stevia, in its various forms has always been a natural sweetener that also offers numerous health benefits. In its natural forms it has been in use in parts of South America for more than 1500 years and, as a high intensity sweetener, in Japan and Asia for over 35 years. (2) Millions of people have ingested stevia daily and there has never been a documented adverse reaction reported (3). Modern consumers have joyful anticipation for increased use of this sweetener that does not cause fat storage, does not adversely affect blood sugar or blood pressure, reduces caries and gum disease, does no harm, is good for the human body and — can taste great — depending on the extraction methods utilized. The Joint Expert Committee on Food Additives (JECFA) of the World Health Organization has studied and approved 9 of the numerous naturally occurring glycosides residing in stevia leaves to be safe for human consumption in high intensity sweeteners. They are: stevioside, rebaudioside A, rebaudioside B, rebaudioside C, rebaudioside D, rebaudioside F, dulcoside A, rubusoside, and steviolbioside. Any combination of these glycosides totaling a minimum of 95%, the balance being other components of the stevia leaf, meets the standard set. HECFA refers to steviol glycosides rather than stevia glycosides in determining acceptable daily intake (ADI) amounts of 4 mg per kilogram of body weight. This provides a 100-fold safety factor, meaning the human body can handle 100 times this amount and still be within the safety limits. However, steviol is one of three metabolites (i.e. the breakdown aglycones being steviol, isosteviol, and a unit of glucose) of the stevia glycosides, therefore, this related to 12 mg of the naturally occurring stevia glycosides per kilogram of body weight. Stevia glycosides are broken down into the three metabolites by bacterial action in the intestinal tract. It is well documented that steviol and the other metabolites are entirely excreted from the body. In a presentation of the recent science regarding stevia at the 2009 annual meeting of the Calorie Control Council, Claire C. Kruger, PhD, DABT, CEO of Spherix Incorporated, a biopharmaceutical company, reported that"Stevia glycosides have very low toxicity in animals and there is no evidence of risk in humans, including repeat dose systemic toxicity, carcinogenicity, developmental, or reproductive effects. The weight of evidence indicates that steviol glycosides are not genotoxic." She also reported that"Stevia extracts and steviol glycosides show no DNA damage in a broad array of in vitro and in vivo assay," and that the"safety of ingestion of steviol glycosides in hmans has been corroborated in clinical trials; measures of tolerance, body weight, clinical chemistry, hematology and urinalyis did not show any evidence of untoward effects." She reported that critical newly published studies (5) resolve questions about any untoward effects after long term repeated exposure to steviol glycosides. The Proceedings of the 3rd Stevia Sumposium 2009, held in Belgium reported recent scientific studies that found that,"Stevioside (i.e. the combination of Stevia glyucosides- lowered glucose, insulin and cholesterol. It had no effect on triglycerides or glucose tolerance," and that it"inhibited atherosclerosis by reducing macrophage, oxidized LDL and lipids. Furthermore, stevioside treatment increased the smooth muscle area of the plaque. This increase, together with the reduction of macrophages resulted in an increase of the smooth muscle cell-to-macrophage ratio". The scientists concluded by stating that"this is the first report showing an association between stevioside treatment and increased adiponectin and insulin sensitivity, improved antioxidant defense and reduced atherosclerosis. The decrease of oxidized LDL by stevioside is particularly important in view of our recent observation that LDL is associated with metabolic syndrome components." (6) No allergic reactions to stevia have been reported (7). A patent application submitted to the US Patent Office, dated February 17, 2011, makes several significant claims, as a result of their scientific research, pertaining to stevia and brain function."Thus to summarize, stevia extract enabled improved learning and memory performance, to a similar, or better, extent as a natural reference substance, ginkgo biloba, and a pharmaceutical positive control compound, rolipram. These data showed that stevia-treated mice not only learned better than other groups but also retained their memory for a longer time period." When the product was given to human subjects they reported that,"Cognitive function, alertness and the ability to focus on work are seen to improve." The product they used was make by cooking leaves in water and is basically the same product sold by SweetLeaf (R), as stevia concentrate, since 1982. SweetLeaf Stevia Sweetener is the only commercially available stevia extract that is made with a revolutionary new technology that uses only cool purified water and a series of filters. All other brands, currently in the market, utilize old technology that incorporates various chemicals, solvents and alcohols, including ethanol and methanol. Because stevia extracts can be between 200 and 300 times sweeter than sugar, they must be blended with other ingredients utilized as a carrier to make them palatable as a table-top sweetener. While all other brands use a sugar product, SweetLeaf(R) uses inulin, extracted from chicory root, which is a natural soluble fiber and prebiotic, thus creating a sweetener that improve health and vitality. SweetLeaf (R) wass the first stevia brand in the United States to acienve the FDA GRAS (Generally Recognied As Safe) designation. REFERENCES 1. Aspartame was developed in 1965 by GD Searle, a pharmaceutical company, to be a prescription only drug for peptic ulcers. After it was tasted the company began the process to obtain FDA acceptance as a sweetener,which was achieved in 1981. According to Discover Magazine, 20 Things You Don't Know About Sugar, Sucralose (Splenda) was originally developed to be an insecticide (Oct. 2009, 121). 2. May, James A, The Miracle of Stevia, Kensington Publishing Corp. New York City, NY, 2003, 7, 32-42. 3. Geuns, Jan MC. Review:The Safety of Stevioside Used as a Sweetener, Proceeding of the first symposium: The Safety of Steviiside, KULeuven, 2004, 112. 4. http://www.steviauniversity.com/. Health and Healing Benefits of Stevia. 5. Ferri et all 2006; Jeppesen et al 2006; Barriocanal et al 2008; Maki et al 2008. 6. Gerraert, Benjamine et a, Natural Sweetener Stevioside Inhibits Atherosclerosis by Increasing the Antioxidant Defense in Obese, Insulin Resistant Mice, Atherosclerosis and Metabolism Unit, Deptarmtne of Cardiovascular diseases and Leuven Food Science and Nutrition Research Center Laboratory of Functional Biology, Katholieke University, Leuven, Belgium. 7. Geuns, op cit p. 85.
It was 1975, and my father had a powder blue polyester double-knit “leisure suit,” a weight-loss plan disguised as a plan to single-handedly re-roof our house, and a keen interest in alternative nutrition and well-being. The latter took the form of upside-down eating, in which we had our smallest meal at dinner and our largest meal at breakfast. My friends thought it was very strange that we ate steaks and pork chops for breakfast, along with huge salads.
We were also eating texturized soy protein, roughly ground grains made into coarse earthy breads, spoonfuls of lecithin, mung bean sprouts, and a whole lot of strange things that you could only get out of the bulk food barrels at Elliot’s Natural Foods. We had a copy of “The Whole Earth Catalog” on the coffee table, and there was also a well-worn copy of my dad’s new bible, Adelle Davis’ “Let’s Eat Right to Get Fit.” There was some new thinking going on in this middle-aged straight-laced German guy, and I was curious about it. Extremely curious. I read the books, and ate whatever weird stuff I was supposed to be eating.
Things got even more curious when my father signed the entire family up to learn Transcendental Meditation (TM), which was developed by the Mahareshi Mahesh Yogi in the 1950s. Although it started elsewhere, by the 1970s, it had penetrated as far as “The Big Tomato,” my hometown of Sacramento, California. He went to a couple of introductory lectures, and the next thing we knew, all five of us were learning TM! It sure seemed exotic at the time, but it’s a technique I have practiced off on and on for over three decades. It’s so simple, I find it the easiest place to return to when I’m most stressed.
TM is a mantra-based meditation technique that has been scientifically validated for stress reduction, blood pressure reduction and, most recently management of the symptoms of Post Traumatic Stress in veterans. The National Institute of Health has spent in excess of $20 million validating the benefits of TM. It increases mental clarity, creativity, and overall health, and decreases stress by decreasing the activation of the sympathetic nervous system. When the sympathetic nervous system’s activity decreases, so do adrenaline, noradrenaline, and cortisol levels. Therefore, it is quite effective for stabilizing mood and even controlling appetite, because your appetite tends to go out of control when you’re feeling stressed.
Technically, it must be taught through an authorized trainer (see www.tm.org), but a great deal of introductory information can be gleaned online. I’ve written previously here about the benefits of meditation, and I’d love to introduce you to this technique.
Simply sit quietly and comfortably. This is essential to all forms of meditation. The mantra would be assigned by your teacher, but you can choose a syllable or sound with no inherent meaning (other forms of meditation might focus on a word with a meaning, such as “love” or “peace.”). The act of focusing on the mantra draws your mind out of its normal state of anxiety, chatter, and activity. If your mind drifts, return your attention to the mantra gently and repeatedly, for a period of 20 minutes per day. Results have been verified with as little as eight weeks of consistent daily practice. Optimally, practicing twice a day for twenty minutes each time is the goal, but benefits can be derived from as little as five minutes a day.
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
References: Dillbeck M.C. and Orme-Johnson D. W. Physiological differences between Transcendental Meditation and rest. American Psychologist 42:879–881, 1987. Jevning R., et al. The physiology of meditation: a review. A wakeful hypometabolic integrated response. Neuroscience & Biobehavioral Reviews 16(3):415-24, 1992. Orme-Johnson D.W. and Walton K. W. All approaches of preventing or reversing effects of stress are not the same. American Journal of Health Promotion 12:297-299, 1998.
Heard from an inCYST fan yesterday, and I thought her words might be inspiring to other fans. Of course, the real reason this success story exists, is because she acted on what she was learning. We were merely there to encourage and support.
Many, many congratulations!
I have been meaning to email you for some time now to give you some positive feedback of your inCYST website and online radio segments. I found out I had PCOS last August and since then it has been a complete whirlwind for me. I found out because I was trying to get pregnant, and I truly believe that I would not have gotten pregnant if it weren't for both the inCYST website and the PCOS Challenge radio show (which is where I first heard about you). I'm due July 20th!: )
I seem to get something out of every post, but recently I especially appreciated the 'Note to physicians on Metformin' as well as the 'Lesson in reaching out for support' segments. On the metformin issue, that was the first time I've ever heard a professional mention that the current standard dosage may be too high for some. I believe this is true for me. I was told to get up to 2000 mg/day, but could never seem to do it. I stayed between 1000 and 1500/day and got regular periods that way (and thus became pregnant).
I also listened to the lesson for support segment. That caller (bless her heart!) could have been me talking. What a wonderful source of support that segment was! My favorite portion of that segment was when you pointed out that it might not always behoove us to listen to our appetite. I totally agree with this. Sometimes my appetite is right on, and sometimes it really deceives me. Before I knew I had PCOS, I remember feeling shameful because the mass media always said that overweight people have emotional problems and just need to deal with that in order to lose weight. Oprah Winfrey always sends this message on her shows. I believe that for many and for me, it is way more of a blood sugar issue.
Monika, I can't stress to you the importance of the work you are doing here. Thank you for dedicating so much of your time and energy into this population. I feel so fortunate to be a part of the inCYST network.
OK! We've cruised past the candy corn…mastered the Thanksgiving pie…what is it about these nasty carbohydrate cravings that make it so darn hard to keep a respectful distance from all of these holiday sweets?!?!?
You may not be imagining things. And you may not be a nutrition wimp. Your body chemistry actually changes with the seasons.
Did you know, for example, cholesterol is actually higher on average midwinter than it is midsummer? Yup, so if you have your annual physical midwinter, get a high reading, and go on medications, the drop in your followup may not be entirely due to medication. It's just how nature does things.
One of the toughest seasonal changes is mood. Back in the days when we were more exposed to the elements, it probably made sense to want to be more sluggish and a little heavier. No need to waste body heat on exercise when we need it for warmth. And a little extra fat for insulation was more than welcome.
Nowadays, we prefer to have our weight be as stable as possible, and this time of year it can be hard to achieve that. About 20% of the population (and 4 times more women than men) experience such a radical shift in mood, hormones, and biochemistry, that they qualify for an official diagnosis of seasonal affective disorder (SAD). Symptoms include: tiredness, depression, crying spells, irritability, trouble concentrating, physical aches, decreased sex drive, trouble sleeping, less desire to be physically active, increased appetite (especially for carbohydrates), and weight gain.
I'm guessing that a pretty high percentage of the audience reading this is thinking,"But this is how I feel all the time!". If you have PCOS, that may be true, but it may become more intense…progressing to out of control…in the dark of winter. Here are some strategies to try to help you get through the winter solstice. Remember, from December 22 on…it's all uphill!
1. Check your vitamin D levels. Low vitamin D may be part of the problem. If it is, be sure to supplement.
2. Do your best to get outside. It's hard with short days and cold temperatures, but even a few minutes a day can make a difference. Even on a cloudy day! Ultraviolet rays are present even with cloud cover. Take advantage of them.
3. Consider phototherapy. I have recommended light devices for clients living in places like Seattle and Alaska, and they can work wonders. All they do is bring sunshine indoors. Working, studying, or reading the mail in the presence of one on a regular basis can help to promote a biochemistry similar to what you naturally experience in the summer.
4. If your SAD progresses to where the symptoms are incapacitating or dangerous, antidepressant therapy has also been found to be helpful. Ask your physician for a discussion about your options.
5. Of course, you know I'm going to say this…prioritize diet. Take advantage of comfort foody crockpot meals like chili, and lentil soup, to help keep your blood glucose stable. Don't forget the protein. It's easy to forget about protein in the mountain of Christmas candy and cookies we're about to tread through, but a little packet of Justin's Nut Butter or string cheese stashed in your purse or briefcase can work wonders for staving off those carbohydrate demons.
6. Don't panic. If you've noticed over the years that your weight naturally fluctuates 5, even 10 pounds between winter and summer, and it naturally self-corrects without radical dieting, you are simply in tune with Mother Nature. Appreciate the fact that you can get by with fewer bulky sweaters and scarves to stay warm, and don't get caught up in unhealthy eating and exercise habits to try and"fix" what is likely a completely natural phenomenon.
Golden, R.N., B.N. Gaynes, R.D. Ekstrom, et al."The Efficacy of Light Therapy in the Treatment of Mood Disorders: A Review and Meta-analysis of the Evidence." Am J Psychiatry 162 (2005): 656-662.
Not long ago a woman with PCOS handed me a diet diary for analysis. She had eaten a burger without the bun and a sweetened ice tea for breakfast. Lunch didn't happen until 2 pm, and it was a brownie with ice cream. And finally, she recorded a bowl of cereal for dinner.
One of the things that jumped out at me was that there were no fruits or vegetables in her meal plan. When I asked her about it…she told me she was avoiding carbs!
Fruits have somehow gotten a bad rap because of their carbohydrate content. But they're not the culprit in an unhealthy diet. In fact, fruits are very high in antioxidants, which can help to repair the damage that life stress and the stress of having a chronic disease can create. In my opinion, you can't afford NOT to have fruit.
I chose oranges this week, because I live in Arizona and I have an orange tree off of my patio. It is the most wonderful treat to wake up, pick a few oranges, and have a glass of fresh squeezed juice. Or, when I need a break in the afternoon, to pick a fresh snack for myself. Nothing tastes better than fruit right from the source. I recently made a great salad vinaigrette using orange juice and olive oil as the base. Even with all these oranges, I'm not making a dent in my supply!
If your diet diary mimicks the one I described above, challenge yourself to try the following. Be sure to have a serving of fruit the size of a tennis ball at each meal, or the total equivalent of 3 servings that size of fruit in the course of a day. Challenge yourself to not eat any sources of refined sugar until you've met your daily quota of fruit. See if, when you focus on fruit, your appetite for other sugars diminishes. And in the process, if changing the kind of sugar you eat doesn't help stabilize your energy levels and help you to feel better.
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.
One of my clients sent me this recipe, which also happens to be gluten-free. I'm thinking it could make a great Thanksgiving day breakfast, giving you a great Thanksgiving taste, fueling a great morning walk or workout, and keeping your appetite in check when the big meal is served. I removed the whipped cream and the sugar from the rims which you will see in the original recipe.
Pumpkin Pie Smoothie
Pumpkin Pie Smoothie (Gluten Free, Dairy Free, Refined Sugar Free + More Free)
1 cup pumpkin puree, chilled (fresh or canned)
½ cup full-fat coconut milk, chilled
½ cup filtered water
1 sliced, frozen ripe banana
1 tbsp almond flour (optional)
1 tbsp hemp seed (optional)
A tablespoon or two of honey, to taste
½ tsp pumpkin pie spice, or more to taste
Prepare glasses by dipping rims into shallow bowl of water and then cinnamon.
Combine all ingredients in blender. Cover and blend on high until smooth, about 30 to 60 seconds.
Pour into prepared glasses or pint-sized Mason jars as I did. Enjoy!
We've been doing some business with companies working with nopales (prickly pear cactus pads). I'd seen a lot of research suggesting that nopales are good for quite a few health issues, particularly blood glucose.
We started selling Ibitta's products a couple of months ago and I was amazed at where the orders were coming from — Memphis, Philadelphia, not simply Arizona and California like I'd expected! I finally called one customer to see why she'd ordered it. Apparently her mother had been bugging her to try it as it is a popular Mexican supplement for weight loss. When her mother finally gave her a bag, she felt it couldn't hurt to try it. She noticed that when she stirred a couple of spoonfuls of Pinalinaza into a glass of water and drank it before a meal, it helped her appetite. And over a couple of months she lost 20 pounds.
Another woman with PCOS, in military basic training, wrote:
I just wanted to give you an update. Although I knew that Nopales was used…in my Hispanic heritage, I didn't know that it would help me out with my sugar so much!! I ordered the products that you hosted on this site (Pinalinaz … a, etc…) and can't wait to start them! In the mean time, I am eating nopales I bought from the local store. For one week, I've eaten them in the morning every other day. I lost 3 pounds and during that week I was only able to walk for exercise as the week was too busy. I have kept track of my sugar and the nopales has regulated it so much so that now I am falling into a Hypoglycemic instead of Diabetic. I am determining how I can balance it, however this is an awesome break through for me. I was doing the military basic training for two months and only lost 5 lbs because of PCOS. Now that I incorporated nopales, the stubborn sugar is being removed!! I can't wait for shipment!! This is a big breakthrough for me, it is extremely hard for me to digest the sugar and the nopales are doing something right!!
Last Friday, I gave a presentation on PCOS at the local Indian Health Service Hospital here in Phoenix. One of my clients made a big batch of nopales salad for everyone to try. It was lunchtime about an hour and a half later, and several people noted that they weren't really very hungry.
There is research to support these testimonials. A 2007 study reported that 85 g nopales with a meal reduced the glycemic index of the meal. Way back in 1991, researchers reported that nopal had a glucose-lowering effect.
For the non-native eater, the prospect of de-stickering a cactus pad, not to mention what to do with the cactus once that's done, likely keeps many people from trying it. In Phoenix, we have a company, Oro Verde Products, that sells ready-to-prepare cactus pads as well as chopped nopales ready to add to your recipe. It's popular in salads, stews, and scrambled eggs. I've even heard of some people juicing it if they have a powerful blender. Check Oro Verde's website for information and recipes.
Ibitta's products are nice because they're powdered and mixed with flax. I've used them on my oatmeal, in smoothies, in vinaigrettes, and breadings. I even made a vanilla cheesecake with the hibiscus (Jamaica) flavored variety in the crust. They're very versatile and more user-friendly in the typical American kitchen.
These we do carry in the store, if you're interested in ordering.
If you live in Los Angeles, look for Nopatillas, a tortilla made with nopal. This would be super easy to include in breakfast burritos, lunch wraps, etc.
Wherever you are, however you eat it, be sure to try nopales. They could be a great way to help control your blood glucose.
Bacardi-Gascon M, Dueñas-Mena D, Jimenez-Cruz A. Lowering effect on postprandial glycemic response of nopales added to Mexican breakfasts. Diabetes Care.2007 May;30(5):1264-5. Epub 2007 Feb 26.
Frati AC, Gordillo BE, Altamirano P, Ariza CR, Cortés-Franco R, Chávez-Negrete A, Islas-Andrade S. Influence of nopal intake upon fasting glycemia in type II diabetics and healthy subjects. Arch Invest Med (Mex). 1991 Jan-Mar;22(1):51-6.
I actually came into working with PCOS through the back door, as someone who had specialized in eating disorders treatment first. I'd left my work at a treatment center, launched an eating disorder website, and women started calling me saying,"I used to have an eating disorder, now I have something called PCOS…do you know anything about it?"
It happened enough times that I started researching the syndrome, realized there was not a lot of good, standardized information about PCOS, saw the niche that needed filling…and there you have it, the Cliff's Notes version behind the inception of inCYST.
The correlation between the two conditions is so strong that I often wonder if it isn't the exact same problem being given a different name and treatment, depending on whether or not a physician or a mental health professional makes the initial diagnosis.
Because diagnosis and treatment can start in two completely different environments, there can be problems with outcome.
--Physicians accustomed to other diagnoses that respond to a simple medication or surgical procedure, may not have the interest in considering the emotional aspects of PCOS. A dermatologist actually said to me once,"I just want to take care of skin cancer. I really don't want to deal with all of those emotions."
--Even dietitians who work with diabetes and can assume they have expertise with PCOS, may not have the patience to delve through the layers of hormones and emotions and reactions to imbalances between the two, to help a client understand how all of these pieces fit together.
--Psychiatrists may be prescribing medications that exacerbate hormone imbalances and PCOS, and not consider that the weight gain and other side effects are a huge reason for medication noncompliance.
--Psychologists may not understand that anger, even rage, and depression, is very strongly affected by hormone imbalances, not entirely based on what's going on in a person's world. They also need to understand that a client can be absolutely, completely, 100% compliant with every single assignment they're given…and STILL have cravings and not lose weight. They need to not project that disappointment on the client, but take it as a cue that they may be missing an important part of what's going on.
--Eating disorder specialists I've worked with seem to be much more comfortable working with"thin" women with eating disorders. I remember when I worked in the treatment center, the women with binge eating disorder never seemed to get the same sort of attention. There seemed to be a size discrimination even coming from professionals who were supposed to be advocating for the opposite.
--Body image specialists may not completely understand that with PCOS, there are genuine and valid body image issues that are not distorted thoughts. There is facial hair. Acne scarring. Hair loss. And the cysts on the ovaries can create a feeling of bloating that is valid, not imagined.
My personal feeling is that you cannot effectively and successfully treat PCOS unless you are helping both mind and body.
If you're a physician, you need to be sure that your client has adequate emotional support rather and not just increase a medication dosage because you're not seeing progress on lab reports that you'd like to see.
If you're a dietitian, you need to have access to a size-neutral psychologist who understands the syndrome and not be afraid to refer and work together as a team.
If you're a mental health professional, you need to understand that just because your client has a disease with a physiological basis, your place in their treatment is not threatened…in fact, it is more important.
You just need to enhance the number and type of issues you can help them with.
All of us need to stop attaching symptoms and needs to a certain weight. To assume that if we get down to a certain weight the syndrome magically goes away. It's there no matter what. I just had an enlightening conversation with a dietitian who has gone through my training, is embarking on her PhD, is normal weight, and teaching at the university level. Even though she's doing all the right things, she says she STILL has times when her appetite is out of control and it completely frustrates her.
The link between eating disorders and PCOS is very, very strong. We need to embrace it and study it so we can help women tackle both and accomplish great things in their course of managing the syndrome. All of us are going to have to step outside of our personal comfort zones as professionals to be effective, and to stop thinking we can help women with PCOS all on our own outside of the structure of a team. inCYST would like to make that a rewarding risk for anyone who chooses to take it.
So 2011 has been designated inCYST's year of eating disorder outreach. We've got two learning opportunities for you who are interested in learning more.
This coming Monday, at 12:30 pm Eastern time, inCYST dietitian Janenie Wade and her business partner Ellen Shuman will be on our radio show sharing more about their collaboration with A Weigh Out, an online and phone coaching program specifically designed to help women with binge eating disorder and able to account for the presence of PCOS. Come tune in and get your toes wet, and see what they're doing! Maybe it will inspire you to want to do more as well.
This spring, in Scottsdale, Arizona, the Binge Eating Disorder Association is holding its annual conference. It's a great place to start learning more (in a beautiful climate, I have to add!).
Of course, we're always looking for mental health professionals to join us at inCYST as well. Our training is open to anyone who would like to take this on. Just let me know if you're interested.
I've had two different clients share a similar observation in the last couple of weeks, and I thought I'd write about it since it's not uncommon to feel this way in early recovery.
First of all, I want to share with you an article on depression that was recently in the Boston Globe.
This article presents the argument that depression is not about a deficiency of neurotransmitters that need to be balanced with medication, but rather, a condition in which neurons are dying a slow death and gradually losing their function. I've had this premise for awhile; it is the basis of my treatment philosophy for PCOS. Fish oil is the best compound nature has for restoring life to neurons, and when you put it into your diet, the brain begins to function again.
My two clients have both observed that as they began taking fish oil, they felt more alert and their memory and concentration seemed to be better. Signs that Elvis is back in the building!
These two clients also observed, though, that they were feeling more emotional. Not all emotions, especially anger and sadness, are easy to feel. So when you begin to feel these emotions, it can feel like things are getting"worse", not better.
Keep in mind, when neurons are malnourished, that means ALL neurons stop functioning, not just the ones affecting memory. The ones affecting emotion, the ones affecting appetite, and the ones affecting hormones.
If you've had PCOS, your hormones have not been functioning as they should, perhaps for a very long time. And that means you've not had the experience other women have, of fluctuating energy, emotions, you name it. Those fluctuations are normal!
So I often get the question,"What can I do?" The most important advice I can give is, be patient with yourself. Become used to what it means to truly cycle. Get to know what a healthy body feels like. It means it is normal to feel bloated, even constipated, just before your period. Your weight might fluctuate. The cycle should be around 28 days when you're back on track, and every single day within that 28 days may feel different. There may be no such thing as getting on the scale and weighing the same thing every single day.
With regard to your emotions, perhaps as your brain becomes more aware, this is an opportunity to experience what emotions might be about. Emotions are messages from the brain, telling you how you are with regard to balance, and what you need to do to restore balance if it isn't there. Anger is often a clue that a boundary has been violated. Loneliness means you need to seek companionship of some sort. Fear suggests that you need to remove yourself from danger. If they didn't feel uncomfortable, you would not be motivated to engage in behaviors that keep you healthy and safe. So rather than running from emotions, embrace them! They're telling you that your health is returning and things are getting back to normal.
PCOS is so hormone driven that emotions end up on the back burner. Excesses of androgens and stress hormones put anxiety and anger in control. But if you find that these feelings are persistent and do not wane after time, or that they seem to be there even when nothing in your life can explain them, they may be signs of hormone excesses and not really environmentally or event-stimulated emotions. When your hormones have you constantly revved up, it can feel strange to not have that kind of energy rush.
I couldn't figure out why, when I first started recommending yoga to clients, they would come back after one class and tell me they hated it. I figured out eventually, that yoga slowed their bodies down but their heads were still spinning. And being pinned to the floor in a yoga pose while your head is thinking angry thoughts can be a very uncomfortable place to be. Those clients got the same advice I'm giving you. Give the new changes some time. Don't abandon your new lifestyle because it initially feels uncomfortable. It's been a long time since your body has felt normal. Be gentle with your self and get to know/understand that"normal" involves hourly, daily, weekly, and monthly cycles. There is no such thing as being the same weight, temperature, size, or temperament every single minute of every single day.
Our philosophy is a little different than what many physicians will have you do. We're not trying to control your hormones, your weight, or even your diet. We're not trying to force a cycle, a pregnancy, or a clothing size. We're guiding you toward healthy choices that allow your body to be in balance. Sometimes giving up control, and letting the body speak to you instead of the other way around, is the absolute best way to get there.
So if things seem a little chaotic and you feel like you're charting uncharted territory, welcome to the world of female physiology! Ask questions, observe, and embrace the wonderful lesson you're learning, that your body will heal if you let it. There is no such thing as being past the point of no return or"stuck" where you are.
If you experience at least three of the symptoms listed below in conjunction with your PCOS, would you please let us know which ones? It's part of a research project. I'll explain in detail in a future post, but I don't want to skew your answers with too much information.
Also, if you have ever experienced migraine headaches, do they ever occur in conjunction with any of the symptoms below, or are they separate events?
Thanks!
diarrhea nausea vomiting food cravings loss of appetite thirst increased urination chills fatigue confusion irritability euphoria wavy or jagged lines in your vision flashing lights dots or spots in your vision blind spots tunnel vision disruptions in hearing auditory hallucinations distortions in smell or taste numbness, a pins-and-needles feeling, or other unusual body sensations difficulty remembering or saying a word other language difficulties
Over a year ago, inCYSTer Ivonne Ward e-mailed me about a product she'd found, called Pinalinaza. Pinalinaza is part of a family of products created by the Ibitta company. Eventually, we made contact with each other, and on a recent trip to Los Angeles, I made time to visit Vice President Frank Medina at the company headquarters in Southgate.
The Medina family, of Mexican heritage, out of a desire to put a dent in the dismal incidence of diabetes in their culture, has decided to create line of products based on native foods. Pinalinaza and Nopalinaza are blends of ground flax (linaza is the Spanish word for flax) and nopal powder. Nopal is a cactus pad that is high in soluble fiber, known to help reduce glycemic index as well as blood lipids. Nopalinaza is the unflavored version of this mix, while Pinalinaza is pineapple flavored.
A third version, Fibrajamaica, is hibiscus-flavored. If you're a follower of this blog, you will recall that I wrote about hibiscus, with its high anthocyanin content, as being our Southwest antioxidant version of the popular blueberry.
These powders are designed so that they can be stirred into a glass of water or juice and consumed daily as a supplement. But I've also been experimenting with them in my kitchen. I recently attended a potluck dinner where I made a vanilla-hibiscus cheesecake with a crust including Fibrajamaica. It was well received!
Fibramanzana, the fourth variety of this product line, is apple-flavored. It is my favorite one to use on oatmeal, and to bake into breads, muffins. etc.
If you're into prebiotics (they're the favorite food of probiotics, the good bacteria in your gut), Ibitta has a carob-flavored inulin product I have quickly came to love.
It's perfect stirred into milk, or Greek yogurt, topped with nuts, if you prefer to dress it up a bit. You can even blend it into smoothies if that's your favorite breakfast.
Inulin is the source of the prebiotics, and it is found in agave plants native to Mexico. I've written about inulin in another post, if you're interested in more detail. It has a lot of health benefits, but because of the controversy over agave, they sometimes don't get the attention they deserve.
Ibitta has also created a very clever product that is consistently described as"addictive" by everyone I've known who has tried it. Called Kakty, the best way to describe this is a chili-lime flavor dried cactus snack. It's got a bit of a gummy bear-like texture; all it is, is dried nopal with a tiny bit of sugar with a predominant chili-lime flavor. It's low glycemic and perfect for the afternoon munchies.
I often send food samples to my dad for taste testing. He has more of a normal American appetite than me, and his feedback helps me to gauge what's going to work on a large scale. Kakty is the one food I've ever sent him that he asked me how he could buy it locally. That says a lot!
What has also gotten my attention about this company is that ever since we wrote about it, it's consistently one of the most common search words that brings people to this blog. It's clearly popular with those who know about it.
Stomping out diabetes is a big job, and the Medinas have a big vision. But they've also got big potential. We're proud to have them join our eMarket.
Reminder: From now through Labor Day, 100% of all profits generated by the inCYST eMarket will be devoted to the inCYST Institute nonprofit division. We've got startup costs to account for before we can get down to the basics of funding research. This is one way we plan to generate those funds. You can help to make it happen!
I don't have to tell you this is one of your crucial vitamins. It's important for becoming pregnant, staying pregnant, and helping your unborn baby to grow and develop. It's just a super hard nutrient to get in, when your appetite is driven by carbohydrate cravings.
PCOS Diva, once again, has created a wonderful set of menus focusing on including folate. Check them out (below), pick even one to try and see if it's something you can add to your rotation.
Last week I had the opportunity to eat at a wonderful and popular restaurant in Venice, California, Lemonade. Today's picture is a photo of me with my plate and my friend's plate from that lunch. You couldn't go wrong in that place, practically everything on the menu offered a hormone-friendly benefit. It was such a contrast to the weekend before when I found myself in an unfamiliar part of town when the lunchtime hungries rolled around. I walked in to a Burger King. And while I ordered the chicken sandwich, I had to special order to keep the sauce off, and everywhere I looked, if there wasn't a promotional ad encouraging me to eat something sugary or fatty, someone WAS eating something sugary or fatty. I rarely step into these establishments and I felt completely out of my element.
I'm guessing it works the other way around. If you're used to fast food restaurants, a place like Lemonade might seem a little intimidating. So for another writing gig, I went through Lemonade's menu and listed the items they offered that were high in folate.
A big part of eating better is getting used to being in environments that support the change. It's not going to happen in a place where the profit margin is largely supported by foods that do not support health. In a place that is devoted to making healthy eating easy, the hardest decision you're going to have…which I faced in Lemonade…was figuring out WHICH healthy route to go!
If you think the reason you cannot eat better because you don't enjoy cooking, or do not feel like you have the time to do it, get in the habit of patronizing establishments that incorporate the foods we encourage you to eat. Order a little extra to take home for dinner, or if you're eating dinner out, for lunch the next day. Make it hard for yourself to have a reason to walk into fast food world. Eventually, you'll wonder why it was ever even an option.
Folate foods (foods with asterisks are fortified with added folate)
Breakfast cereals Beef liver Cowpeas (blackeyes) Breakfast cereals Spinach Great Northern beans Asparagus *Rice, white Vegetarian baked beans Green peas Broccoli *Egg noodles Broccoli, Avocado Peanuts Lettuce, Romaine Wheat germ Tomato Juice Orange juice Turnip greens Orange *Bread Egg, Cantaloupe Papaya Banana
In addition to PCOS, I specialize in the nutritional aspects of medications affecting the brain and nervous system. That includes psych meds, Parkinson's meds…pretty much any medication that has the potential to affect how the brain and nervous system function.
A few years ago, while compiling a series of fact sheets about the nutritional implications of these medications, I started reading about the anti-obesity medication called Meridia (generic name sibutramine). This drug appeared on the market after the famous phen-fen combination was deemed dangerous. It was supposed to be a kindler, gentler alternative. And it supposedly can reduce the severity of symptoms associated with PCOS.
I was floored by what was showing up, unedited, in the peer-reviewed literature about this medication. But not at all surprised with the announcement yesterday that this drug is potentially dangerous for people with heart conditions.
Repeatedly and consistently, researchers were reporting reactions. Some of the most common problems this medication seemed to incite, were anxiety, hypertension, and elevated heart rate.
If Meridia was a drug intended to treat cancer, or glaucoma, or hangnail, and it caused this battery of symptoms, I don't think the FDA would have tolerated consistent reports that it had the ability to send the cardiovascular system into a tailspin.
Yet, in the obese research subject, in the face of these observations, researchers continued to report some of the following conclusions:
**In a 21 patient study, 40% experienced sleep disturbances and 30% complained of irritability, unusual impatience, or"excitation". RESEARCH CONCLUSION: Sibutramine, 5 and 20 mg, added to a multimodal program assisted participants in losing weight. Weintraub M, Rubio A, Golik A, Byrne L, Scheinbaum ML. Sibutramine in weight control: a dose-ranging, efficacy study. Clin Pharmacol Ther. 1991 Sep;50(3):330-7.
**In a review study, the author reported,"In controlled studies, 84% of sibutramine-treated patients reported adverse events, compared with 71% of patients receiving placebo. The most frequently reported adverse events are related to pharmacological actions of sibutramine, and include dry mouth, decreased appetite, constipation and insomnia. Despite the high incidence of"side effects" in the control population, the author of this article attributed the problems in the tested population to"pharmacological actions of sibutramine". Lean ME. Sibutramine--a review of clinical efficacy. Int J Obes Relat Metab Disord. 1997 Mar;21 Suppl 1:S30-6; discussion 37-9.
**In a study of 226 people comparing sibutramine to dexfenfluramine, researchers reported,"174 patients (77%) experienced adverse events; 17 patients withdrew due to adverse events. Pulse rate increased significantly in sibutramine-treated patients." Then they concluded,"Sibutramine (10 mg once daily) is at least as effective as dexfenfluramine (15 mg twice daily) in achieving weight loss in patients with obesity." Hanotin C, Thomas F, Jones SP, Leutenegger E, Drouin P. A comparison of sibutramine and dexfenfluramine in the treatment of obesity. Obes Res. 1998 Jul;6(4):285-91.
**In a study of 235 people, the following was reported,"a significant increase in heart rate (about 4 beats/min) was noted for patients who received 10 mg or 15 mg sibutramine, compared with the placebo." Then it was concluded,"Doses of 10 mg and 15 mg once daily were shown to be similarly effective, well tolerated and significantly more effective than the placebo." Hanotin C, Thomas F, Jones SP, Leutenegger E, Drouin P. Efficacy and tolerability of sibutramine in obese patients: a dose-ranging study. Int J Obes Relat Metab Disord. 1998 Jan;22(1):32-8.
**In a study of 11 men, it was observed that"the sibutramine-induced increase in energy expenditure was accompanied by an increase in plasma epinephrine, heart rate, blood pressure, and plasma glucose. The conclusion:"Sibutramine caused a significant increase in both energy expenditure and satiety, which may both contribute to its weight-reducing properties. Hansen DL, Toubro S, Stock MJ, Macdonald IA, Astrup A. Thermogenic effects of sibutramine in humans. Am J Clin Nutr. 1998 Dec;68(6):1180-6.
As of 2006, I had found 14 studies reporting an elevated heart rate with use. You can easily find them yourself in http://www.ncbi.nlm.nih.gov/pubmed/; I encourage you to see for yourself. I've supported myself here with enough references and my Saturday has other obligations prohibiting me from using it to repeat work I've already done. I hope I've encouraged you to see for yourself what I've been talking about with colleagues for several years.
I like to call this the Biggest Loser Mentality. It doesn't matter if we make these people vomit, pull a muscle, or give them a bloody heart attack. This market of obese people is just too lucrative to ignore.
If you have PCOS and you are obese, you deserve better. You're not where you are because you have a deficiency of ANY kind of medication in your body. Don't let anyone convince you otherwise.
Two years ago now, I posted information about shirataki noodles, a type of noodle without carbohydrates. This is so because they are made from soluble plant fiber. Since we consistently received traffic from that post, particularly where to buy them, a year and a half ago I posted information answering that question. The traffic has only increased, which tells me these noodles are only gaining in popularity. So I thought I'd dedicate a post to more detailed information for our interested readers!
One important thing to keep in mind is that some brands of these noodles are made with soy, which you may wish to avoid. One brand I know for sure that is soy as well as gluten-free, is Miracle Noodle. I happened to meet and have a nice chat with the owner of this company, Jonathan Carp, at Natural Products West and he did assure me that this is true. This company has a variety of products to keep you creative in the kitchen, including miracle rice, and konjac flour that you can use as a thickening agent in your own gravies, etc.
One of the consistent complaints I hear from people who try these products and do not like them is that they have a somewhat funky smell and taste. This comes from the way they are packaged. If you rinse them with water after removing them from the package, maybe even let them sit in some water for a few minutes, you'll wash off a lot of the liquid that is the source of the problematic taste. Also, it is best to eat these noodles prepared with a somewhat spicy sauce, etc. so the companion flavors are more what your tastebuds focus on. One of my clients likes to stir fry them with vegetables, another loves to serve them with a homemade bolognese sauce. If you need more ideas, check out the recipes at the Miracle Noodle website.
I am updating the"where to buy shirataki noodles" section to be sure you get the type that is not made with soy.
You can buy these noodles directly from the Miracle Noodle website if you're headed over there…but if you can't wait another second, here's your link for immediate gratification.
If you have a favorite way to prepare these noodles please do share!
As I wrote the title for this post, I envisioned the majority of you readers rolling your eyes and thinking,"OK, now she's totally lost credibility. Of COURSE she likes beets, she's a freaking NUTRITIONIST!"
But let me tell you, having a few degrees in the fitness world does not create an appetite for healthy food. I am known to have a love of really great dark chocolate, and to snack on Fritos on occasion. Yes, I do love a lot of fruits and vegetables, but for the majority of my life, foods like beets were left in the serving dish or in the store. I wouldn't eat them because I thought I wouldn't like them.
Then, a few years ago, my mom tried a Mexican Christmas salad when I was home for the holidays. I obliged and put a few slices of beets on my plate. And much to my surprise, I really liked them!
That's my lesson for today. Sometimes it's not that you don't really like a food, it's that you never tried it. Or you tried it once when someone prepared it poorly, and the innocent food, not the inadequate chef, got the blame for the bad experience.
What I find with PCOS, is that if you start to balance your fats, and cravings for sweets begin to dissipate, all of a sudden, foods that never tasted good before, become tasty!
So if there are foods that you have on your personal"don't do that" list, that have been on there for so long you don't even know what got them there…try them again. You might be surprised.
Beets are actually easy to try, because they show up on a lot of salad bars. Just put a few slices on your plate and give it a whirl. You might be surprised at how sweet they taste. Beets are actually processed as a sugar source because they ARE sweet.
Here are some aspects of beets that are particularly relevant to PCOS: -beets are high in folate, that vitamin women are encouraged to supplement if they are trying to conceive, or are pregnant --individuals drinking beet juice (you can simply add some to other ingredients in your juicer if you have one) experienced a drop in blood pressure an hour after drinking it. --beets are high in betaine. In conjunction with choline (remember that one from last week's food of the week?), beets work to reduce inflammatory processes…of which PCOS is one. --beets are high in antioxidants (that's what's in that deep dark color)
Not sure how to prepare them? I made this recipe the other day…and it was tasty! http://find.myrecipes.com/recipes/recipefinder.dyn?action=displayRecipe&recipe_id=1611626
I'm still working on learning to swim the butterfly stroke. Even though I've been swimming most of my life, something new about swimming occurred to me this past week. As calorically intense as swimming can be, I always leave the pool feeling invigorated. And at night…I fall right asleep and sleep through the night without issue.
I'm a pretty regular exerciser, but the nature of swimming, having to hold your breath, forces me to use my lungs differently than I do with any other exercise. I have to breathe more deeply into my lungs, and hold that air longer, than I do when I run or use exercise machines or rollerblade. My endurance with swimming is a little rusty, so, I have to stop and catch my breath which I don't have to do with any other exercise.
I think, because swimming is using my lungs in a more intensive way, it's better oxygenating my body. And that in turn leaves me feeling more energetic, since oxygen is necessary for healthy metabolism. And I sleep better at night when melatonin is triggered to come out and balance all that oxidation with restorative activity.
How well do you breathe? It is common, when stressed, to breathe more rapidly with shallower breaths. When you don't fully use your lungs, it's hard for adequate oxygen to get to your brain…and when your brain is stressed, it intensifies the feeling of anxiety, shortening breathing even more…thus starting a vicious cycle.
And…since the brain's main fuel is glucose, when you're not breathing adequately, you run the risk of having more sugar cravings.
When you're anxious, it is common to want to have an explanation for it. And the tendency is to blame it on something external, like your infertility, your weight, your appearance, your marriage, etc. It may be, at least some of the time, that your anxiety is directly related to how you're breathing.
Try this exercise the next time you're feeling anxious and see how you feel. Or…rather than waiting till you're anxious, try it several days in a row at a time of day you know you feel stressed (and hungry for carbs), such as when you get home from work just before dinner, and see if you start to notice a change in your mood and your appetite.
Lay down on your bed and place a book or pillow on your stomach. Make yourself breathe so that the object begins to move up and down. If you're breathing shallowly, with the top of your lungs, it will be hard to do this. So if the book doesn't move, focus on breathing into your belly button. Breathe like this for 20 breaths. Next time…30.
This is the kind of breathing you would learn to do in yoga class. It's exactly the kind of breathing I do in the middle of a counseling session or meeting when I feel stressed. I simply place a hand on my stomach to check if my breath is getting into the bottom of my lungs.
Of course, exercise is the ultimate way to do this kind of breathing. But it won't work for you in rush hour traffic, during your midterm, or when you're giving that sales presentation. Keep this technique handy in those situations, and exercise when you DO have time.
I'll be interested to hear from all of you about what you notice when you try this!
