The Hemp Connection [Search results for cholesterol] 

If you're looking for pasta alternatives, consider soba noodles. This gluten-free Japanese creation is made with buckwheat, a food with potential multiple health benefits. Buckwheat has repeatedly been shown to improve blood lipids, by lowering blood pressure, total cholesterol, bad cholesterol (LDL), and triglycerides, and raising good cholesterol (HDL). It has also been reported to prevent the development of gallstones

Buckwheat is also a potent cancer fighter. It contains anthocyanin compounds (yes, that stuff that makes blueberries so healthy!), and it has been shown to fight tumor growth in a respectable list of body parts.

Photo credit: http://www.thekitchn.com/

Buckwheat is also good for people with insulin resistance. In one study, people who did not regularly consume buckwheat were five times more likely to have hyperglycemia (high blood glucose) than those who did. When it comes to our recent theme of increasing protein and maximizing muscle mass, buckwheat has been found to be a good vegan protein source for accomplishing this goal.

If you have been following my interest in bees and colony collapse disorder (important to PCOS because many hormone-friendly foods are dependent on bees for pollination), eating soba noodles is good for bee health as well. Provided the buckwheat is organic and not laced with pesticide, one acre of the crop supports an entire hive of bees, important in US locations where bees have been found to be declining because of exposure to neonicotinides used on corn. And buckwheat honey is good for you as well; it has a reputation for its antioxidant and antifungal content. You can make a difference! Increasing demand for crops that are healthy for everyone in the ecocycle is a win-win situation.

One note for celiacs: soba is only partially buckwheat. Be sure you read the labels and use a brand like Eden 100% Whole Buckwheat Soba.

The photo above is from a blog post I found on Pinterest. The recipe looked easy and like it was a great noncommittal Americanized way to put a little soba on your plate.

Kayashita J, Shimaoka I, Nakajoh M, Yamazaki M, Kato N. Consumption of buckwheat protein lowers plasma cholesterol and raises fecal neutral sterols in cholesterol-Fed rats because of its low digestibility. J Nutr. 1997 Jul;127(7):1395-400.

Metzger BT, Barnes DM, Reed JD. Insoluble fraction of buckwheat (Fagopyrum esculentum Moench) protein possessing cholesterol-binding properties that reduce micelle cholesterol solubility and uptake by Caco-2 cells. J Agric Food Chem. 2007 Jul 25;55(15):6032-8. Epub 2007 Jul 4.

Tomotake H, Yamamoto N, Kitabayashi H, Kawakami A, Kayashita J, Ohinata H, Karasawa H, Kato N. Preparation of tartary buckwheat protein product and its improving effect on cholesterol metabolism in rats and mice fed cholesterol-enriched diet. J Food Sci. 2007 Sep;72(7):S528-33.

Kuwabara T, Han KH, Hashimoto N, Yamauchi H, Shimada K, Sekikawa M, Fukushima M. Tartary buckwheat sprout powder lowers plasma cholesterol level in rats. J Nutr Sci Vitaminol (Tokyo). 2007 Dec;53(6):501-7.

Bijlani RL, Sud S, Sahi A, Gandhi BM, Tandon BN. Effect of sieved buckwheat (Fagopyrum esculentum) flour supplementation on lipid profile and glucose tolerance. Indian J Physiol Pharmacol. 1985 Apr-Jun;29(2):69-74.

Lin LY, Peng CC, Yang YL, Peng RY. Optimization of bioactive compounds in buckwheat sprouts and their effect on blood cholesterol in hamsters. J Agric Food Chem. 2008 Feb 27;56(4):1216-23. Epub 2008 Jan 24.
Zhang HW, Zhang YH, Lu MJ, Tong WJ, Cao GW. Comparison of hypertension, dyslipidaemia and hyperglycaemia between buckwheat seed-consuming and non-consuming Mongolian-Chinese populations in Inner Mongolia, China. Clin Exp Pharmacol Physiol. 2007 Sep;34(9):838-44.

Pui KC. [Inhibition of tumor growth in vitro by the extract of Fagopyrum cymosum]. Zhong Xi Yi Jie He Xue Bao. 2003 Jul;1(2):128-31.

Alvarez P, Alvarado C, Mathieu F, Jiménez L, De la Fuente M. Diet supplementation for 5 weeks with polyphenol-rich cereals improves several functions and the redox state of mouse leucocytes. Eur J Nutr. 2006 Dec;45(8):428-38. Epub 2006 Oct 11.

Zduńczyk Z, Flis M, Zieliński H, Wróblewska M, Antoszkiewicz Z, Juśkiewicz J. In vitro antioxidant activities of barley, husked oat, naked oat, triticale, and buckwheat wastes and their influence on the growth and biomarkers of antioxidant status in rats. J Agric Food Chem. 2006 Jun 14;54(12):4168-75.

Watanabe M. An anthocyanin compound in buckwheat sprouts and its contribution to antioxidant capacity. Biosci Biotechnol Biochem. 2007 Feb;71(2):579-82. Epub 2007 Feb 7.

Wang ZH, Gao L, Li YY, Zhang Z, Yuan JM, Wang HW, Zhang L, Zhu L. Induction of apoptosis by buckwheat trypsin inhibitor in chronic myeloid leukemia K562 cells. Biol Pharm Bull. 2007 Apr;30(4):783-6.

Wang KJ, Zhang YJ, Yang CR. Antioxidant phenolic constituents from Fagopyrum dibotrys. J Ethnopharmacol. 2005 Jun 3;99(2):259-64. Epub 2005 Apr 7.

Leung EH, Ng TB. A relatively stable antifungal peptide from buckwheat seeds with antiproliferative activity toward cancer cells. J Nutr Biochem. 2008 Oct;19(10):700-7. Epub 2008 Mar 6.
Kim SJ, Maeda T, Sarker MZ, Takigawa S, Matsuura-Endo C, Yamauchi H, Mukasa Y, Saito K, Hashimoto N, Noda T, Saito T, Suzuki T. Identification of anthocyanins in the sprouts of buckwheat. J Agric Food Chem. 2007 Jul 25;55(15):6314-8. Epub 2007 Jun 20.

de Francischi ML, Salgado JM, da Costa CP. Immunological analysis of serum for buckwheat fed celiac patients. Plant Foods Hum Nutr. 1994 Oct;46(3):207-11.

He J, Klag MJ, Whelton PK, Mo JP, Chen JY, Qian MC, Mo PS, He GQ. Oats and buckwheat intakes and cardiovascular disease risk factors in an ethnic minority of China. Am J Clin Nutr. 1995 Feb;61(2):366-72.

Not long ago I created a webinar about bioidentical hormone replacement therapy. I found a great graphic that explains something most people have not considered when it comes to reproductive hormone health. Many of the hormones that we need for proper function of our reproductive systems (whether we're trying to conceive or slow down aging), are made out of cholesterol. Just look at this picture below!

As you can see, we need a decent supply of cholesterol in the body in order to even make progesterone and estrogen! However, we've become very obsessed with the idea that cholesterol is a"bad" thing. So much so that in 2001 the National Cholesterol Education Program lowered the level of ideal cholesterol so much that the number of people who ideally should be on cholesterol-lowering medications…tripled.
This may be more pertinent to women with PCOS, approaching menopause, who are more likely to be placed on statin medications than younger women who are trying to conceive.
However, I just wonder, a lot, if it's not really a coincidence that as we focus on cholesterol and getting it out of our bodies, we also seem to be developing more problems related to hormone imbalances…infertility, early menopause, even Alzheimer's, which is starting to be recognized as a consequence of insulin resistance, which is associated with PCOS.
Bottom line: Eat well, and be careful of obnoxiously high cholesterol levels, but try to avoid an obsession with a"lower is better" mentality. Cholesterol is an essential compound, and not to be feared.

Aaahhh eggs, the misunderstood member of the nutrition family. Poor guys…when I graduated from college, in the height of the low cholesterol-low fat craze, we were indoctrinated to teach that"egg" was just another word for poison.

My how things have changed!

A couple of months ago I heard Dr. Susan Kleiner (www.goodmooddiet.com) speak at a conference. She shared that not once has there been a research study demonstrating that when you take eggs out of the diet, that this dietary change reduces cholesterol. As well, there has been research demonstrating that adding eggs (plus yolks) to the diet does NOT raise cholesterol. All those yolks I threw down the drain all those years…for nothing.

I figured I'd better find some hard research to back THAT one up, so here's a quick list of interesting titles I found in PubMed:
Dietary cholesterol from eggs increases plasma HDL cholesterol in
overweight men consuming a carbohydrate-restricted diet
Egg yolk improves lipid profile, lipid peroxidation and retinal abnormalities
in a murine model of genetic hypercholesterolemia.
There are many more, but here I just wanted to make my point. Egg yolks are not the ugly stepchild of the protein family anymore.

In fact, there are some great nutrients to be found in eggs.

1. Lutein and xeanthin are two carotenoid compounds that can help maintain visual health. One group of researchers reported that 6 eggs per week can help increase lutein and xeanthin levels in the macula, the part of the eye that degenerates in this country's leading cause of blindness, macular degeneration.

2. Eggs contain choline. This compound is very important for brain function. Choline is the building block for acetylcholine, the neurotransmitter involved in memory, and the one that many Alzheimer's medications seek to increase.

This compound is exceedingly hard to get in the diet. In fact, about the only two places you can find it, are egg yolks, and soy. (Well, also in cooked chicken, beef, veal, and turkey livers, but I didn't think that would have any of you running for your grocery lists so it goes in parentheses.)

If you've got PCOS, you've probably been told to avoid soy. So that leaves egg yolks for getting this very important memory booster.

3. If you hate fish but you need to increase your fish-based omega-3 intake, omega-3 eggs are a very cost-effective option. If you struggle to get enough vegetables in your diet, omelets and frittatas are great ways to get them in. Just be sure you use olive oil when you cook them.

I thought it might be timely to include eggs on this blog, because as food prices rise, they can certainly be much more cost-effective than salmon, as well as other proteins that are now taxing your grocery bill.

Mutungi G, Ratliff J, Puglisi M, Torres-Gonzalez M, Vaishnav U, Leite JO, Quann E, Volek JS, Fernandez ML. Dietary cholesterol from eggs increases plasma HDL cholesterol in overweight men consuming a carbohydrate-restricted diet. J Nutr. 2008 Feb;138(2):272-6.

Fernández-Robredo P, Rodríguez JA, Sádaba LM, Recalde S, García-Layana A.
Egg yolk improves lipid profile, lipid peroxidation and retinal abnormalities in a murine model of genetic hypercholesterolemia. J Nutr Biochem. 2008 Jan;19(1):40-8.

Wenzel AJ, Gerweck C, Barbato D, Nicolosi RJ, Handelman GJ, Curran-Celentano J. A 12-wk egg intervention increases serum zeaxanthin and macular pigment optical density in women. J Nutr. 2006 Oct;136(10):2568-73.

Goodrow EF, Wilson TA, Houde SC, Vishwanathan R, Scollin PA, Handelman G, Nicolosi RJ. Consumption of one egg per day increases serum lutein and zeaxanthin concentrations in older adults without altering serum lipid and lipoprotein cholesterol concentrations. J Nutr. 2006 Oct;136(10):2519-24.

Kind of an obvious choice this week…

…I wanted to highlight eggs since they are a food many people don't eat, thinking about the cholesterol.

It used to be, when I was brand-new to this profession, I was taught to tell people to avoid eggs. Because of the cholesterol.

It turns out, the cholesterol in eggs has been shown to not increase serum cholesterol, and taking eggs out of your diet doesn't really decrease your cholesterol.

Besides that, eggs…

…are cheap.
…have one of the highest quality proteins available.
…are one of the very few foods contain choline (in the yolk), which is very important for maintaining memory, potentially reducing your risk for Alzheimer's disease.
…are a good source of vitamin B-12, another nutrient that isn't always easy to get.
…are convenient to eat.
…if you get the omega-3 kind, can be a source of DHA, which is not easy to get in your diet if you don't like or don't have access to fish.

So have fun with your holiday and take advantage of the fact that you've got all those boiled eggs in the frig. Have them for breakfast. Put them on your salad at lunch.

And know it's something good you're doing for yourself!

Since vitamin D deficiency has been identified with a long list of health issues, including PCOS, I've been hearing readers, clients, colleagues, and friends talk about loading up on this nutrient with supplements. They're going about it in a not-so-scientific fashion, and I've wondered if that wasn't going to introduce a whole new spectrum of health issues.

A friend and colleague recently mentioned that she had just had a cholesterol test taken, and the LDL (bad cholesterol) reading had increased since her previous test. One of the changes she could identify was between the two tests, she had started to supplement with vitamin D.

I did a pretty thorough search both on the Internet and Pub Med to see if this was a common problem and didn't find anything. I then went to a listserve of about 1,000 nutrition colleagues to see if they'd seen it. Turns out, a few of them had also seen their cholesterols increase with vitamin D supplementation.

There is a tendency with nutrition, to adopt an"if a little is good, a whole lot is better" attitude. Unfortunately, imbalance in either direction, be it deficiency or excess, can be problematic.

The old recommendations for vitamin D were 200 IU per day. All of a sudden, a website popped up recommending 5000 IU per day. I couldn't find any research to support this magnificent dosage leap. I would have thought, given that magnitude, that some kind of dosing study that had ruled out that 500, 1500, 2000 IU were not sufficient. But no, the recommendations simply jumped without explanation.

And every time I tried to find out what the basis for this jump was, I kept being referred back to the website making the recommendation.

My points are:

1. Know your vitamin D and your cholesterol levels.
2. Start out with 200 IU or even 400 IU per day and see how that affects both your vitamin D levels and your cholesterol levels.
3. Consider that the reason vitamin D levels may be deficient is more complex than the simple fact that dietary vitamin D is low…did you know that many of the same health issues associated with vitamin D deficiency are also related to omega 3 fatty deficiency as well as omega 6 fatty acid excess? Most nutritional problems, if they are related to imbalance, cannot be corrected with a supplement. The overall balance of the diet needs to be considered in the plan of correction.

I finished up my nutrition education during the height of cholesterol phobia/low fat mania. The message we were taught to teach about egg yolks dies hard.

Several years ago colleague Susan Kleiner, Ph.D., R.D., shared in a presentation I attended, that there really isn't hard research that shows, without a doubt, that eating egg yolks increases cholesterol. Neither is there really evidence to show that removing egg yolks from your diet reduces cholesterol. Other dietary choices, such as the ones we teach on this blog, are far more effective at normalizing your blood lipid tests.

Eggs are such a cheap, easy source of protein. Scrambling them with vegetables is my favorite way to clean out my vegetable bin.

If you're trying to increase and maintain your vitamin D levels, keep in mind that it is found in egg yolks. And the levels of vitamin D in egg yolks, according to the US Agricultural Research Service, is higher than thought. Each large standard egg contains 41 IU.

If you're still not convinced and questioning, consider that this same analysis showed that the amount of cholesterol in eggs is 14% lower than previously reported, 185 milligrams per egg.

Egg yolks also contain choline, the precursor for acetylcholine, the neurotransmitter involved in memory. It's not easy to find in food…if brain fog and memory are problems your PCOS has brought you, perhaps rethinking your relationship with egg yolks could be helpful.

I'm not sure what the change is, perhaps farmers have been changing the composition of poultry feed in response to the dietary concerns of their customers.

Whatever it is, I'm hoping the new results in a few more egg yolks showing up on diet diaries I review here in the office!

In the spirit of Mardi Gras week, I thought I'd highlight a kissin' cousin of that Cajun crawfish…shrimp.

Shrimp are one of those foods people love…and they have learned to be afraid of. When I started out in this field, I was taught to teach patients to avoid shrimp because of their high cholesterol content.

Turns out, dietary cholesterol in foods such as eggs and shrimp do not influence our own cholesterol nearly as much as pro-inflammatory fats, saturated fats, and trans fats. Some researchers even suggest that shrimp consumption may IMPROVE cholesterol and triglyceride levels!

In addition shrimp, lucky for a shrimp lovin' woman like myself, is extremely low in fat! A 3.5 oz (deck of card-sized) serving of fish has about 1 gram of fat…whenever I'm questioned about shrimp I always remind the person with the question that shrimp is so low in fat, it almost squeaks from lack of lubrication against your teeth when you bite into it.

Shrimp is also a great source of protein, vitamin B12 (crucial for mental health), tryptophan (needed to make serotonin), and vitamin D (thought to be important in managing PCOS). In addition, shrimp helps omega-3 balance by contributing a moderate amount of DHA. And, when you're replacing red meat with seafood, you're exchanging pro-inflammatory omega-6 fats with healthier fats, which ensures that your omega-3's are not metabolically destroyed before they have a chance to benefit you.

So if you see shrimp cocktail, shrimp fajitas, grilled shrimp on the menu…go ahead! Enjoy! It's contributing to your health while providing a tasty adventure.

I got a little sidetracked with things, sorry for not getting to this sooner.

Progesterone is a topic I've covered before in other posts. Rather than repeat myself, I'll just link you to each part in that 5 part series.

Important things to remember about progesterone:

The basic building block for making progesterone, is cholesterol. Cholesterol is also the building block for testosterone and cortisol. If your body's balance is shifted in the stress management direction, it is likely that any cholesterol you might have had to make progesterone…was used up to make cholesterol.

One of the absolute most important things you can do to improve your progesterone levels, therefore, is to manage your stress.

I noticed after writing the original five part series that traffic to this blog increased significantly. The most common keywords were,"foods to enhance progesterone". Unfortunately, simply adding foods or supplementing with progesterone is not going to be the answer. If you really, truly want to have good progesterone balance, a commitment to better stress management is going to be a very important part of the solution. Some days it will be easy to do that, other days you will be challenged. Being gentle with yourself and accepting the best you can do on any given day…is what you deserve to give yourself credit for!

Here are the other five links with more information.

Watch out for environmental estrogens
Tackling insulin resistance
Enjoying food
Stress management
Physical activity

Not long ago, I stopped into Planet Raw, in Santa Monica. It's a very popular hangout for raw foodists, so I wanted to see what the buzz was about. I actually enjoyed perusing the shelves, and they did have some fun things to buy for the more adventurous cook. I'll probably eat there from time to time, as it's a stone's throw away from my office.

However…I had a most disturbing conversation with one of the employees. When she learned that I was a dietitian, she commented,"Cool, maybe you can help then. We're having trouble finding protein sources. Do you have any ideas?"

So I mentioned Growing Naturals, the rice protein powder that I wrote up last week.

"Oh, we don't do rice."

When I asked why, she responded by explaining that Planet Raw's owner"doesn't do rice".

So I suggested pea protein.

"Oh, we don't do peas, either."

When I asked why, she responded by explaining that Planet Raw's owner"doesn't do peas".

I could see I wasn't going to get anywhere because I was in a food religion debate, not an evidence-based scientific discussion, so I politely guided the conversation to its end.

I later went to the website (which you can Google for yourself, I won't provide free advertising for this place through linking), and could find absolutely nothing explaining this philosophy. I saw plenty of advertising for expensive certifications as raw chefs, and courses for raw foodists…which, in essence, kind of seemed like me to be expensive courses on how to promote malnutrition.

I do my best to be positive and inspiring rather than confrontational on this blog, but sometimes I get pushed past my limit of tolerance. This philosophy, especially for women with PCOS who need a decent amount of protein in their diet to reduce the influence of insulin resistance, is simply dangerous.

Of course, a diet that is heavy on the raw, is perfectly fine. It means you're eating plenty of fruits, vegetables, nuts…all great sources of vitamins, minerals, antioxidants, and fiber. But a completely raw diet needs to be taken on with a lot of thought, not be a source of pride with regard to how many foods you can find an excuse not to eat. Here is why.

At the same time raw food diets have been studied and found to have benefit, they have also been associated with many problems women with PCOS already have.

lower bone density,
amenorrhea and underweightness in women,
dental erosion with a raw vegan diet,

elevated plasma homocysteine and low serum HDL cholesterol" and vitamin B12 deficiency.

Bottom line? Enjoy your occasional lunch at Planet Raw, and buy their coconut flour. But don't depend on them for advice when it comes to how to eat this diet in a way that allows you to reduce the influence PCOS has on your life.

For the record, I am NOT anti-raw. I am anti-malnutrition, and anti-inflammation. Be sure you know the difference if you choose to pursue a raw foodist lifestyle/food religion.

Fontana, L; Shew, JL; Holloszy, JO; Villareal, DT. Low bone mass in subjects on a long-term raw vegan diet." Archives of Internal Medicine 165 (6): 684–9, 2005.

Koebnick, C; Strassner, C; Hoffmann, I; Leitzmann, C. Consequences of a long-term raw vegan diet on body weight and menstruation: results of a questionnaire survey. Annals of Nutrition & Metabolism 43 (2): 69–79, 1999.

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

Koebnick, Corinna; Garcia, Ada L; Dagnelie, Pieter C; Strassner, Carola; Lindemans, Jan; Katz, Norbert; Leitzmann, Claus; Hoffmann, Ingrid. Long-Term Consumption of a Raw Food Diet Is Associated with Favorable Serum LDL Cholesterol and Triglycerides but Also with Elevated Plasma Homocysteine and Low Serum HDL Cholesterol in Humans. Journal of Nutrition 135 (10): 2372, 2005.

Some friends of mine here in Phoenix are working on a unique project, in conjunction with Intel, to promote the viablility of sunflower oil as a biofuel.

Whether your engine is your alternative auto…or your own body, sunflower seeds can be a nice addition to your fuel mix.

I've encouraged that you avoid sunflower OIL, since when you refine the oil out of the seeds, and consume it in disproportionate ratios to other fats, which is what happens when you use it to fry foods, the total composition of your fat intake tends to be pro-inflammatory. However, when consumed unprocessed, as in seeds, there are some great benefits to sunflower seeds in the diet.

One of the most important is vitamin E. It's an incredibly important antioxidant that can help prevent cholesterol buildup, even reduce cholesterol. It's also very important for protecting your brain, which with PCOS is crucial. That is where your hormone control center is located. It's been found to help reduce the magnitude of hot flashes.

Sunflowers are very high in phytosterols (which you'll be hearing more about soon in future blog posts). Sunflower seeds have one of the highest concentrations of phystosterols. They're also high in magnesium, a mineral often deficient in women with PCOS, which means that it may help you with stress and anxiety.

What is fascinating about sunflower research is that most of it has been done on livestock, not humans. It is well known among dairy and poultry farmers that their animals will be healthier and live longer if sunflower seeds or sunflower meal is added to their diet. Economically, they have learned that there is a profit to be made from using this knowledge. We're not quite there yet with humans…we're still biased in thinking the answer to every one of our aches, pains, and diagnoses, is a pill. (If you could see my"research institute projects to consider" list right here, it gets longer and longer as I write about all these great things like vinegar, strawberries, sunflowers, that should be given more attentio and hopefully will.

But don't wait for me to get going on those studies! Sunflower seeds are so easy to add to your diet. They can't hurt and they might help…and they're tasty! I see no reason why you can't be your own research subject as soon as you write your next grocery list.

How do you like your sunflower seeds? Here are some of my favorites.

1. In my oatmeal.
2. In my trail mix.
3. Sprinkled on soup
4. Sprinkled on salad.
5. Added whole to homemade bread, pancakes, etc.
6. Ground and added to flour or breading for meat.

Park CS, Fisher GR, Haugse CN. Effect of dietary protein and sunflower meal on blood serum cholesterol of dairy heifers. J Dairy Sci. 1980 Sep;63(9):1451-61.
Ziaei S, Kazemnejad A, Zareai M. The effect of vitamin E on hot flashes in menopausal women. Gynecol Obstet Invest. 2007;64(4):204-7. Epub 2007 Jul 30.

A study was recently released suggesting that dark chocolate can help to reduce cholesterol in diabetics! Whoo hoo! Here's the article summarizing some of the benefits of chocolate.

http://www.drcutler.com/cholesterol/dark-chocolate-may-help-lower-cholesterol-in-diabetics-800137266/

Note in the article, however, researchers are still weighing the evidence about whether or not the fat and sugar in chocolate the way we like to eat it outweighs some of these benefits.

You can't binge on it or replace other foods with it…chocolate should be a component of a healthy, balanced diet.

Here are my five favorite ways to include chocolate in ways that reduce the downsides.

1. Used in mole sauce. Mole sauce is a complex Mexican delicacy made from a combination of cocoa and other spices such as cinnamon. It's not something you'll find in your average Tex-Mex restaurant, but look for it in more upscale venues like our own local (James Beard nominated) Barrio Cafe, often with chicken or turkey.

2. In hot chocolate. Cocoa powder (undutched) in lowfat milk is always a great bedtime treat! I kind of like the Abuelita brand Mexican hot chocolate because it too has the cinnamon touch.

3. In chocolate milk. Remember, women who have one fat-containing source of dairy per day are more fertile than women who do not. Chocolate milk is a double whammy of goodness!

4. As cacao nibs, in your morning oatmeal. Cacao nibs are the dried cacao seed, from which chocolate is derived. You can buy them in stores like Whole Foods and they're a great way to flavor your breakfast.

5. As cacao nibs, in your afternoon trail mix. Frequent a store with bulk food bins and create your own concoction of cacao, healthy nuts, a little bit of dried fruit…and voila! You've got something to nibble on when the afternoon munchies hit.

Chocolate galore…and no candy bar in sight. Enjoy!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I recently had a client ask me if she needed to avoid "tropical" fruits for better health. The woman was told by a friend, who's doctor told her, to stay away from any "tropical" fruits because of the "palm" fruit oil that they contain, and that they would raise her blood cholesterol. I assured the woman that"tropical" fruits do not contain oils and would not raise her blood cholesterol. I wondered to myself, how did this doctor come up with something like this? Today I read an article that may help explain the misinformation.

"Both palm and palm kernel oil come from palm plants (often called “oil palms”) and are categorized as “tropical oils”. These two types of oils come from different parts of the palm plant. Palm oil, which is sometimes called “palm fruit oil,” comes from the fruit; palm kernel oil comes from the seed (a.k.a. the kernel)." The words "tropical oils" and "palm fruit oil". Could it be that the doctor simply assumed this meant"tropical fruit"? Please read on to better understand more about palm oil.

As I mentioned in the first part of this series, vitex has its strongest effect on four hormones: estrogen, progesteron, luteinizing hormone (LH), and the one this post is dedicated to, prolactin.

Prolactin is primarily associated with lactation. It is also important for sexual arousal, sensing orgasms, and libido. So it's safe to say, you have to have good prolactin metabolism in order to successfully conceive and carry a pregnancy through to nursing!

One of the most important, and often overlooked, influences on prolactin function, is medication. I am most familiar with psychotropic medications because of my specialty, and I believe, with the very high incidence of anxiety, depression, and sleep disorders in women with PCOS, it is incredibly important to use these medications with discretion in order to not interfere with fertility, or successful PCOS management in women who are not in pursuit of conception.

Before considering any supplement, make a list of all the medications you've ever been prescribed and show them to a registered pharmacist. Ask them if any of those medications have any potential for disrupting prolactin function. And if you come up with a"yes" for any of them, ask for a list of alternatives that you and your prescribing physician can use to adjust your treatment plan.

When prolactin is out of balance, funny things can happen. You can produce milk when you're not supposed to (I once had a male client who started to lactate, and it turned out to be a symptom of a pituitary tumor.)

You might not be able to produce milk when you want to. Many, many, many women with PCOS find, much to their dismay, that they get pregnant, and cannot feed their babies. I am shocked at how many medical colleagues with PCOS write me to share that until they heard us mention this at inCYST…they never knew it could be a problem. And they themselves could not nurse their babies!!!

This lack of awareness and the incredible importance of healthy prolactin function to the overall health of mother and baby, is precisely why, our first outreach outside of dietitians, with inCYST, has been with lactation consultants. They understand this physiology best, and they are the most likely to pick up on problems as soon as they become apparent.

Bottom line, PCOS is not just about infertility. It is about successful reproduction, which includes being able to successfully create the next generation of healthy people.

But I digress. Back to prolactin.

Prolactin is controlled by the hypothalamus, the part of the brain we at inCYST are obsessed with learning and teaching about. The hypothalamus also regulates estrogen, progesterone, testosterone, cortisol, thyroid, and growth hormone. You can see why it's your BFF as a woman with PCOS. If you have problems with one of those, you likely have problems with more than one.

Most medical treatments address each of those hormone imbalances as if they are separate, requiring a separate medical treatment…better yet…a separate medication. So by the time you've made the specialist rounds, you've been given a birth control pill, an antidepressant, a sleep medication, a lipid lowering medication (since some of these hormones are made of cholesterol, when they're out of balance…cholesterol will be, too).

We like to think we start where the problem starts. Giving the hypothalamus what it needs to work efficiently. And the number one chemical you can focus on, which should help all of these functions, which I call our"Recipe for a Happy Hypothalamus (SM)"…is DHA, one of the fish oils.

1. DHA makes it harder for the hypothalamus to feel stress. Stress is a very selfish thing. It steals energy away from other things your body might need it for. With enough DHA in the system, the hypothalamus can put its energy into healing the functions that are NOT related to stress, mainly reproduction, sleep, and mood.

2. DHA increases dopamine receptor density. Prolactin is dopamine-controlled, meaning the more receptors there are to communicate with the dopamine that is there, the less prolactin your body needs to make.

An interesting aside--dopamine imbalance is common in people who crave and/or binge on sugar. So if you've got cravings AND your prolactin levels are not right…you just might be DHA-deficient.

I have one more post coming on chaste tree berry that will summarize important findings and recommendations.

But, with regards to prolactin, what I will say is that two very important things you can, and should, do, to move yourself back into balance, are:

1. Make sure your medications are not the source of the problem, and
2. Make sure your food choices are promoting healthy dopamine function.

Even if you DO decide to try an herbal formula, it is much more likely to work for you, if you provide it with an environment that allows it to do what it does best.

The topic for this blog post was suggested by a reader. I figured it was likely important, since many of you struggle with depression and arthritis or some sort of chronic pain, and you're self-medicating. The effects of THC, the active ingredient in marijuana, on hormones, is quite extensive. I am summarizing the findings reported in the reference I list at the end. Bottom line, it's probably not the greatest idea to be regularly introducing marijuana into your system if your hormones are out of balance and you're trying to correct that problem. Even if you're not trying to become pregnant but you're sexually active. The effects outside of your own self are potentially significant.

Interestingly, improving your omega-6 to omega-3 dietary ratio helps to correct some of your own human cannabinoid levels, which may help to decrease the desire to get them from an external source. It may also alleviate the depression and joint pain that you may be using marijuana for in the first place. Some experts suggest that this imbalance of our "natural THC" may be one reason women with PCOS have strong carbohydrate cravings--it's another form of the munchies!

Reduced FSH and LH levels.
Suppressed prolactin, thyroid, growth hormone
Provokes cortisol release and reduces production of adrenal steroids, which makes it hard to maintain hormone levels.
Interferes with ovarian prostaglandin synthesis.

HCG-stimulated and FSH-stimulated progesterone secretion is inhibited.
Inhibits estradiol release.

Inhibits cholesterol esterase manufacture, and cholesterol is the building block for many reproductive hormones.
Hyperplasia and hypertrophy of the uterus
Changes in vaginal cell thickness, character and mucoid presentation
Reduced uterine weight
Suppresses thyroid function.

A dose of LH that routinely caused ovulation in normal rats was only able to induce ovulation in 40% of the rats exposed to THC.
Two to fourfold greater doses of LH were required to restore ovulation in THC-exposed rats.

The equivalent of one marijuana cigarette per day interfered with cell division and embryonic growth in fertlized eggs. It also reduced intrauterine weight gain by the fetus.

Offspring of rats exposed to THC had abnormal eggs, meaning the fertility of future generations was also affected.

Prevents reuptake of serotonin, dopamine, norepinephrine into the brain, increasing, not decreasing, depression over the long term.

Braude MC, Ludford MP, eds. Marijuana: Effects on the Endocrine Reproductive Systems. 1984

"Brain fog"--trouble with focus, memory, and concentration, is a common but little-discussed issue with PCOS. I believe that for many of you, it impairs your ability to follow through with changes you genuinely wish to make because you simply don't remember to do them.

This is more than just an annoying little problem. Women with PCOS are at high risk for developing diabetes, and people with diabetes are at high risk for developing Alzheimer's disease.

So while you may be more focused on how to feel better right now, look better soon, and become pregnant in the near future, I've got my eye on the big picture.

The good news is that the nutrition recommendations we make here are good for all of the problems you might have with PCOS--weight, skin, fertility, mood…and brain function.
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Fish oil is one of the biggest tools you have. Eating a variety of foods, not forgetting the fruits and vegetables, and getting enough sleep, are all very important to do.

Yesterday I mentioned choline, a chemical that the brain uses to make acetylcholine, the memory neurotransmitter. If you've given up egg yolks because you are afraid of their cholesterol, take note: it's likely not the cholesterol in those yolks that are causing you trouble. And, you're throwing valuable choline down the drain that your brain wants and needs.

This coming week at The inCYSTem, I've put together a week's worth of menus incorporating foods high in choline, some seafood, and good omega 6 to omega 3 balance. A four week subscription to this new program is $15; if you'd like to participate and experience first hand what eating well can do for you…contact me at marika@google.com.

Anyone living out West has had a week of comfort food weather! Here in Phoenix we had as much rain in a week as we normally get in a year. I haven't felt like venturing out, and I want foods that warm me from the inside out.

And that has had me thinking about leeks.

Leeks are the onion's, unfortunately less popular and often forgotten, cousin. I say that because leeks are milder than onions, with a lot of the same health benefits. Many of those benefits are related to PCOS health risks.

Vegetables in the onion/leek/garlic family help to:
--reduce LDL cholesterol and raise HDL cholesterol
--lower blood pressure
--reduce risk of ovarian cancer
--stabilize blood glucose

Most of you probably think of leeks in leek potato soup…but there are so many more ways to cook them! Here's a great feature from Cooking Light to get you started.

So comfort food and PCOS help, unite!

The day after the FDA warning about pistachio nuts came out, I was in a local grocery store. As I walked through the produce aisle, I noticed the produce manager and his clerk with a huge bin; they were emptying out their inventory of pistachio nuts into a huge garbage bin. They had no idea where their pistachios had come from, and they had to throw them away.

I felt sad that so much food had to be wasted.

The day that the FDA warning about pistachio nuts came out, I received a note from Whole Foods Market. They were working to source where all their pistachio nuts came from. A detailed memo was released later in the week regarding the safety of pistachios in their many stores.

Please read this blog post and make your own decisions. But do consider the value in being an informed consumer. If you are judicious about where you shop, it may be worth a little extra investment. If you make a choice to purchase locally grown products at your farmer's market, you're not only supporting a local small business, you know exactly what hands your food passed through before it fell into yours.

There will come a time when pistachios will be considered generally healthy to eat, no matter what the source. And when that comes, keep these pistachio fun facts in mind:

--a one ounce serving of pistachio nuts scores higher on the USDA's antioxidant scorecard than a cup of green tea.
--pistachio nuts can help to reduce bad cholesterol and raise good cholesterol
--pistachio nuts are high in lutein and can help prevent macular degeneration, a leading cause of blindness
--pistachio nuts are a good source of many vitamins and minerals, including: thiamin, vitamin B6, copper, manganese, potassium, dietary fiber, phosphorus and magnesium
--pistachio nuts are a good source of healthy fats, including omega-3's

My point is…I hope you don't eliminate pistachios completely from your diet because of what you've heard in the news. The pistachio recall was specifically for pistachios from Setton Farms. If you can shop at a store or farmer's market where you can be assured pistachios did not pass through this processing plant, they can be a wonderful addition to your PCOS eating plan.

Here's a recipe for white bean pistachio chili to get you started!

When you're dealing with something as chronic and serious as PCOS, you can get focused on what is the perfect food, the perfect meal, the perfect diet…and if it's not perfect…don't bother.

That, in the end, may be your perfect downfall.

Consider two studies, both done with nuts.

In the first one, subjects were divided into two groups. One was, in addition to their regular diet, given only 31 grams' fat worth of walnuts, the other, a similar volume of almonds.

Walnuts decreased low-density lipoprotein-cholesterol, almonds did, but not to the same degree.
Walnuts increased insulin response during OGTT by 26% (P < 0.02).

Walnuts decreased hemoglobin A1c, almonds did not.

Walnuts increased sex hormone-binding globulin
Almonds reduced free androgen index

Betcha thought till I got to that last part that I was going to nix almonds, didntcha? Nope.

The message here is not that almonds are bad and walnuts are good, but rather that walnuts and almonds both have benefit to your health, but in different ways. In fact, the name of this study is Differential effects of walnuts vs almonds on improving metabolic and endocrine parameters in PCOS, NOT Exclusively superior effect of walnuts compared to almonds on metabolic parameters in PCOS.

Let's look at a second study, using people with metabolic syndrome.

Fifty subjects were given 30 g/day of raw nuts (15 g walnuts, 7.5 g almonds and 7.5 g hazelnuts), or no nuts. Compared to the first study, I profiled, where no weight change occurred, in this study, there was a moderate weight loss experienced in the half of the group eating mixed nuts. LDL cholesterol decreased, as did fasting insulin and insulin resistance.

So just because when all you're eating is almonds and almonds don't improve insulin function the way walnuts do, it doesn't mean that you can't eat almonds. If you eat the two together, you can get the benefit of both. No single nut will give you a perfect hormone profile, but every single nut on the tree stands to benefit you in one way or another.

So stop paralyzing yourself out of eating foods you enjoy because they're not absolutely stand alone perfect…and mix it up a bit…literally!

Kalgaonkar S, Almario RU, Gurusinghe D, Garamendi EM, Buchan W, Kim K, Karakas SE. Differential effects of walnuts vs almonds on improving metabolic and endocrine parameters in PCOS. Eur J Clin Nutr. 2011 Mar;65(3):386-93. Epub 2010 Dec 15

Casas-Agustench P, López-Uriarte P, Bulló M, Ros E, Cabré-Vila JJ, Salas-Salvadó J. Effects of one serving of mixed nuts on serum lipids, insulin resistance and inflammatory markers in patients with the metabolic syndrome. Nutr Metab Cardiovasc Dis. 2011 Feb;21(2):126-35. Epub 2009 Dec 22.

Some things simply do not happen by accident.

I was on a flight from Chicago to Boston yesterday and struck up a conversation with the man sitting next to me. It turned out, he is a veterinarian who does a lot of work with horses. He asked about my profession, and I gave him the Cliff Notes version, telling him that I did a lot of work with infertility.

Without even having a chance to mention that my friends think I am obsessed with omega-3 fatty acids to the point of often being teased about being the"Fish Oil Queen," he said to me,"Nutrition is very important for fertility in horses. Especially omega-3's."

Turns out, he said, the process of breeding horses is so expensive (if you thought an in vitro procedure emptied your wallet, start pricing stud services!!), that there is a lot of pressure to"get it right" as quickly as possible. And research has discovered, that omega-3 fatty acids are particularly important as part of the success formula.

I commented that it was interesting that in humans the fertility research seemed to focus on the females, while in equine science, it tended to focus on the males. He just smiled and said…"Your women need to be feeding their priceless stallions as well as they feed themselves!"

Here is an excerpt from an equine article I found at http://www.horses.com/. You will have to register to access their other articles, but it is worth the time. Hopefully some day our own nutrition will be as important as veterinarians have found it to be in animals.

Squires said sperm quality problems can increase when artificial insemination with cooled or frozen semen is involved. The problem stems in part from the fatty acids found in equine sperm. Bull sperm contains high amounts of omega-3 fatty acids that enable them to withstand the rigors involved in freezing. Horses, on the other hand, have sperm that is high in omega-6 fatty acids, which hinders sperm ability to be cooled and frozen, and the sperm is low in omega-3 fatty acids. The most important omega-3 fatty acid is docosahexaenoic acid (DHA). An omega-6 fatty acid found in semen is docosapentaenoic acid (DPA).

Squires said in semen, the fatty acid profile of stallions is similar to that of boars (male hogs). Studies in boars have shown that a high DHA to DPA ratio in semen results in enhanced fertility, whereas higher levels of DPA relative to DHA result in reduced fertility.

He said fresh grass is high in DHA, but unfortunately, a lot of stallions are fed hay and grain.

"Men that have reduced fertility have also been shown to have lower levels of DHA in seminal plasma," Squires noted."The ratio of phospholipids (fats containing phosphorous) to cholesterol in the sperm, and the ratio of unsaturated to saturated fatty acids, determines the ability of sperm to handle the rigors of cooling and freezing. Those species that have high cholesterol to phospholipid ratio have sperm that are very resistant to cold shock and thawing.

"Humans, rabbits, and roosters produce sperm that are very resistant to cold shock and their sperm freezes very well," he continued."Sperm from boars and stallions have very low tolerance to cold shock, and, in general, their sperm freezes poorly. Sperm of bulls have high levels of DHA in the cell, where those of stallions have a high level of DPA. Increasing the ration of DHA to DPA in semen has been shown to increase fertilizing capacity and semen quality. Conversely, reducing the ratio of DHA to DPA was accompanied by a reduction in fertilizing capacity."

He said researchers found that adding omega-3 fatty acids to a stallion's diet resulted in a more fluid condition of the sperm membrane, which, in turn, allowed sperm to handle the stress of cooling and freezing with potentially less damage.