The Hemp Connection [Search results for estrogen] 

Hello everyone!

The first post on this topic was very popular. I didn't forget it, I have been busy traveling on behalf of inCYST and haven't had many free, quiet moments to collect my thoughts. They're here today, so I am capitalizing on them to get on with this thread!

Today I want to share some thoughts about estrogen.

As with luteinizing hormone, estrogen levels cycle throughout the month. There is no such thing, really, as a simple"high" or"low" estrogen, it depends on what day in your menstrual cycle you are looking at your estrogen levels. So, as with luteinizing hormone, the goal is to NORMALIZE estrogen levels: to make them high when they should be high, and low when they should be low.

One of the most important, but not frequently discussed aspects of estrogen metabolism to understand, is that we live in an environment that increasingly contains chemicals that interfere with natural estrogen function.

Every hormone in your body comes with a unique shape, designed to allow it to fit only into the receptors made to work with it. So an estrogen molecule won't mistakenly fit in a progesterone molecule, for example. There are many man-made chemicals that are very similar in shape to estrogen. They are so similar to estrogen, that they can fit into the estrogen receptor.

BUT…they are not similar enough that they can fool the receptor into being activated. What happens when your estrogen receptors are filled with inactive estrogen impostors? The body doesn't get the message that there is estrogen in the system, and it starts to make and release more of its own estrogen to make up the (nonexistent) deficiency that it perceives is in need of being corrected.

So your receptors are filled with inactive estrogen, which messes up your reproductive function and your real estrogen, because it is being blocked out of action in those receptors, is available to be active in estrogen-sensitive tissues, which is where some cancers are thought to get their jump start.

Your ultimate goal is not to put more estrogen into your system. Rather, it is to remove the"environmental estrogens" from your body, which gives your own estrogen a fighting chance to work. It's not just about YOUR infertility. Environmental scientists are reporting that other species are also becoming infertile due to the very same chemical influences. (Hence the lizard graphic on this post.) If you want to learn more, here is my favorite website:

As I continue with this series, you will understand why I am explaining all of this. For now, I just want you to understand that hormones are complex, and there are many reasons why they may be out of balance. My personal philosophy is that it is best to identify the source of the imbalance rather than try to force hormones in a direction that may not correct the core problem.

A client recently handed me a supplement called"DIM" and told me her physician gave it to her. The physician said it would help her hyperestrogenemia. She had stopped taking it, and asked if I thought she should resume with it.

Here's the lowdown on DIM, which is the abbreviation for diindolylmethane.

DIM occurs naturally in cruciferous vegetables, such as cabbage, cauliflower, and Brussels sprouts. It was first researched for its cancer-fighting properties; we all know that these vegetables have this quality.

Soon after that, it was discovered that DIM influences estrogen metabolism, promoting the creation of estradiol, or beneficial estrogen (E2) and inhibiting the creation of estrone, or cancer-related estrogen (E1).

DIM may also be an anti-androgen. Although the research I was able to find looked at DIM in the prostate, not in women with PCOS, there is much information on websites selling DIM promoting it as a natural way to reduce facial hair.

If you are considering taking a DIM supplement, be sure to consider the following warnings found on the WebMD website:
Special Precautions & Warnings:

Pregnancy and breast-feeding: Diindolylmethane is safe when consumed in the small amounts found in foods. But don’t take larger amounts. Not enough is known about the safety of larger amounts during pregnancy and breast-feeding.

Hormone-sensitive conditions such as breast cancer, uterine cancer, ovarian cancer, endometriosis, or uterine fibroids: Diindolylmethane might act like estrogen, so there is some concern that it might make hormone-sensitive conditions worse. These conditions include breast, uterine, and ovarian cancer; endometriosis; and uterine fibroids. However, developing research also suggests that diindolylmethane might work against estrogen and could possibly be protective against hormone-dependent cancers. But stay on the safe side. Until more is known, don’t use diindolylmethane if you have a hormone-sensitive condition.

The client who asked the question feels the supplement may actually have helped her facial hair. Note, this is a one-person observation and a testimonial only, it is NOT an endorsement of the supplement.

What I would recommend to this client, and to others who are interested in using DIM:

1. Start with your diet: eat more cabbage, cauliflower, brussels sprouts, and broccoli. (Click here for a cauliflower curry recipe).

2. Be sure your diet contains adequate omega-3 fatty acids and is not high in omega-6 fatty acids (discussed many times in other posts on this blog). Omega-3 fatty acids found in both fish and flax have similar effects on estrogen metabolism.

3. Be scientific about the supplement use. Have your hormone levels measured for a baseline, and have them remeasured 6 months after consistent use of the supplement. Too many times, supplements are recommended without any way to evaluate whether or not they are having any effect. In the case of my client, the supplement was sold to her by her physician and there was never any followup scheduled to evaluate how well it was working. (You'd never do that with a blood pressure medication or antipsychotic, would you?!?!?)

4. Don't assume that once you start taking the supplement you do not need to follow a healthy diet. Supplements usually seem to work better in a healthy body where the biochemistry promotes their effectiveness.

5. Even though eating these foods has never been found to be dangerous to pregnant women, because the supplemental form is much more concentrated than what is found in food, it is strongly recommended not to take this supplement if you are trying to conceive or if you are pregnant. As it's been with us since we've been in existence, we are of the opinion that it is not appropriate to be treating hirsutism while you are trying to conceive. There is time for that later.: )

Wattenberg LW, Loub WD, Lam LK, Speier JL. Dietary constituents altering the responses to chemical carcinogens. Fed Proc. 1976 May 1;35(6):1327-31.
Jellinck PH, Makin HL, Sepkovic DW, Bradlow HL. Influence of indole carbinols and growth hormone on the metabolism of 4-androstenedione by rat liver microsomes. J Steroid Biochem Mol Biol. 1993 Dec;46(6):791-8.

Chen I, McDougal A, Wang F, Safe S. Aryl hydrocarbon receptor-mediated antiestrogenic and antitumorigenic activity of diindolylmethane. Carcinogenesis. 1998 Sep;19(9):1631-9.

Lord RS, Bongiovanni B, Bralley JA. Estrogen metabolism and the diet-cancer connection: rationale for assessing the ratio of urinary hydroxylated estrogen metabolites. Altern Med Rev. 2002 Apr;7(2):112-29.

Le HT, Schaldach CM, Firestone GL, Bjeldanes LF. Plant-derived 3,3'-Diindolylmethane is a strong androgen antagonist in human prostate cancer cells. J Biol Chem. 2003 Jun 6;278(23):21136-45. Epub 2003 Mar 27.

Tadi K, Chang Y, Ashok BT, Chen Y, Moscatello A, Schaefer SD, Schantz SP, Policastro AJ, Geliebter J, Tiwari RK. 3,3'-Diindolylmethane, a cruciferous vegetable derived synthetic anti-proliferative compound in thyroid disease. Biochem Biophys Res Commun. 2005 Nov 25;337(3):1019-25. Epub 2005 Oct 3.

I had the most wonderful Sunday afternoon with a newly pregnant client and her husband. She's been told that her progesterone is low, and she was interested in knowing if there is anything she can do, naturally, to help improve the outcome of her pregnancy. We discussed five different categories of actions. Since this is an issue many women face, I'm adding them to the lineup of planned posts, today being the first of five installments.

Progesterone can be low if estrogen is high. In many cases, it's not the natural estrogen your own body is making, but environmental chemicals resembling estrogen that confuse the body.

To reduce your exposure to unnecessary estrogen…

1. Stay away from plastic. Store your leftovers in glass containers. Be absolutely sure your food does not come in contact with plastic or Saran during heating. Avoid plastic water bottles; metal varieties are pretty easy to find in your Whole Foods or REI store.

2. Use natural cosmetics and hair dyes. inCYST Provider Carmina McGee, who is a licensed aesthetician as well as a registered dietitian, has shared that the primary offending chemical, phthalate, is gradually disappearing out of cosmetics. But just to be sure, read your cosmetic and nail polish labels. Make your cosmetic shopping easy by using an all-natural brand such as Body Shop or Arbonne.

3. Get to know your local eco-friendly decorating and remodeling stores. I recently painted my condo with paint that was free of volatile organic compounds (also known as non-VOC). I used the Benjamin Moore brand which was available at a local Ace Hardware, because I liked the color selection…but there were several eco-friendly brands, and remodeling stores I found while shopping around. One store also had quite a few"green" cleaning supplies as well as carpet glue.

4. If you are not sure of the contents of inks, glues, cleaning solvents, fertilizers, pesticides, fire retardant fabrics, etc., minimize your contact with it. Here's a great list from the National Institutes of Health for your reference.

5. Minimize your intake of dietary estrogens. This one can be a little tricky, since one of the tricks we've been recommending for getting pregnant has been supplementing with flaxseed oil, a natural source of estrogen. Once you know you're pregnant, best to back off on the flaxseed. (Special note: This release I'm linking is so new the actual study is not yet listed in the National Library of Medicine database. As soon as it is, I'll be sure to evaluate and report in more detail here.)

The other food to be aware of is soy--whole soy foods such as edamame and tofu are ok, but stay away from isolates that are often used as fillers.

6. Keep your sleeping environment as dark as possible at night. Close the drapes. Use eye shades. Eliminate televisions and computers from the bedroom.

What I really like about this first list is that it is, really, about living cleaner and greener. So choices you make for your pregnancy are doing double duty and helping out the planet!

Next time I'll take a look at insulin resistance.

Our blog statistics have shown over time, that we get quite a bit of regular traffic from the other side of the world. I have to admit, my advice is hemisphere-centric, since I've never been south of the Equator. So I invited a friend from Australia, Olwen Anderson, who works with PCOS in her part of the world, to share a little bit of advice. Here's hoping for our Aussie readers, it introduces you to someone close to you who can help you, and that what Olwen has to say, is helpful!

Legumes are a girl’s best friend… when you have PCOS

Olwen Anderson is an Australian Nutritionist-Naturopath who specialises in treatment of hormone imbalances and gut disorders. Her blog contains lots of PCOS-friendly recipes: Visit www.olwenanderson.com.au

Been diagnosed with PCOS? Meet your new nutritional “best friend” – legumes.

When you think about food as medicine, legumes should almost be a compulsory prescription for good health. These amazing little vegetables are packed to the brim with nutrition that can help moderate your hormones. They taste great; and once you learn how to prepare and use them, they will open up a whole new culinary world for you.

Legumes include chick peas (or garbanzo beans), black eyed beans, haricot, lima beans, kidney beans, soy beans and many other dried beans that are a staple food in many countries. In fact, legumes are one of the powerful plant foods common in countries where people routinely live happy, productive lives to 100 plus.

Phytoestrogens and fibre are two outstanding features of legumes that will benefit you. Phytoestrogens are naturally occurring plant chemicals that have a molecular shape similar to estrogen. When digested, they ‘latch on’ to the estrogen receptors of cell membranes, and effectively block real estrogen molecules from connecting with the cell. This means that when you have plenty of the right fibre in your diet, you’re automatically reducing the effects of excess circulating estrogen.

Its good bacteria in your intestines that convert plant phytoestrogens to their active form. These good bacteria feed and breed on soluble and insoluble dietary fibre. Fortunately legumes are packed with fibre, so your intestinal bacteria will love them. When there’s plenty of fibre in your diet, your body produces more sex hormone binding globulin. This transporter molecule travels through your bloodstream, picking up and removing excess hormones, including excessive androgen hormones like testosterone. Exactly what you want to happen in your body.

Even better, legumes are packed with nutrients: Some protein, a little of the good fats, and complex carbohydrates. They’ll take ages to digest, resulting in smoother blood glucose management; and they’re packed with minerals too.

But won’t they make me flatulent?

Many women worry that if they start enjoying legumes, they will become windy. To prevent this, start with small quantities (about one tablespoon) and build up over a few days to half a cup so your intestinal bacteria have a chance to adjust.

It’s easy to incorporate legumes into your diet every day:

- Sprinkle chick peas (garbanzo beans) through your salad

- Enjoy some home made baked beans for breakfast with poached salmon

- Fresh broad beans, steamed and mashed, make a great vegetable side dish

- Include legumes in your stews, casseroles and soups. Like minestrone soup; or lentil stew.

You can buy legumes canned; but the dried variety, cooked, taste so much better. (Also, avoiding canned food helps you avoid suspected endocrine-disrupting chemicals like BPA). Buy dried legumes, soak for a few hours, boil until cooked, (firm but not crisp), then freeze in portion size containers.

I always keep containers of cooked legumes meal-ready in the freezer. Then, if I want a quick meal, I can take one out, stir-fry in a hot pan with garlic, spices, some kangaroo fillet, a few baby tomatoes and a handful of baby spinach leaves. Fast, healthy, one-pot cooking.

Looking for recipe inspiration to enjoy legumes?

- Visit my web site at www.olwenanderson.com.au (recipes tag on the blog)

- Look at recipe books for cultures where legumes are part of the daily diet: South American, Mediterranean, Indian.

So by now I'm sure you've heard the news about the new mammography recommendations. I wasn't on the panel and I'm not a breast cancer specialist, but I do have some thoughts pertaining to what these findings and the potential implications mean, to women reading this blog.

It's a mixed bag.

1. First of all, it's not the scientists, it's not the government, and it's not your doctor who is in charge of your health. YOU are in charge of your health. If you're using this situation as an excuse to be paralyzed about self-care, you've been defeated and you've turned your health over to someone else.

2. Keep in mind, many women with PCOS have high estrogen levels, meaning they have extra estrogen that can find its way to estrogen-sensitive tissues and cause problems such as cancer. You are potentially an at-risk population that needs earlier mammograms than the average American woman. It is important when discussing your personal need for earlier mammograms, that this health issue be included in the decision making. If your physician does not acknowledge or understand the relationship between PCOS and cancer, it is your right to find a physician who does.
Sticking with the same physician and allowing that attitude to guide your health choices is turning your health fate over to someone who doesn't deserve it.

3. The good news is, women with PCOS are already used to advocating for themselves so doing so with the mammogram issue is not something they're likely unaccustomed to doing. Be assertive!

4. The bad news is, women with weight issues tend to avoid doctor visits because they don't want to be chided about losing weight. If you don't go to the doctor, all of the above don't even matter. Find a physician who will treat you respectfully…AND MAKE A COMMITMENT TO REGULAR PHYSICALS.

5. Remember, getting a mammogram is not the only thing you can do to reduce your risk of breast cancer. Breast self-exams are very important. Women with poor body image are not the best at conducting breast self-exams. If you're having trouble with the idea of looking at and feeling your breasts, the consequences could be as serious as not getting that mammogram. Ask for support.

6. A local television station sends out a monthly self-exam reminder, which I'll forward to all of you as well. If that helps you to remember to do them, then it's our pleasure to be a part of that. Here is information on how to perform a breast self exam.

7. All of the dietary recommendations you see here are made taking into consideration the implications for risk of other diseases, including cancer. Taking care of yourself in ways that benefit your PCOS, also reduce your risk of breast cancer. So eat well, be active, manage your stress…and get some sleep!

Remember, your health is YOURS. Not the government's, not your doctor's, not your insurance company's. Care for it like it's your most valuable possession. Because it is.

In my last post, I talked about the relationship between depression and PCOS; this post addresses anxiety and PCOS. Although we may tend to think of anxiety and depression as two different and distinct conditions or diagnoses, in fact, there's a lot of overlap. As a therapist, I end up assessing to see whether depression or anxiety is the more dominant condition, but I almost always end up treating some degree of both conditions.

Women with PCOS are well aware that their state of well-being is affected by their hormonal balance. Estrogen, progesterone, testosterone, melatonin, and cortisol all play vital roles in mood regulation as well as physical well-being. Depression is often a symptom of estrogen deficiency. Irritability and anxiety can be indicators of progesterone deficiency or estrogen excess. Likewise, testosterone deficiency can contribute to symptoms of anxiety, not to mention reduced energy and initiative (which is where you can start to see the overlap with depression symptoms). Melatonin deficiency contributes to anxiety and nervousness and disrupts sleep, which can further contribute to development of insomnia and depression. Inadequate cortisol as a result of too much stress can also result in symptoms of anxiety and depression.

The endocrine system is so complex, and PCOS patients typically are managed with hormone-affecting medications such as birth control pills and diabetes medications. If not properly balanced, side effects of such medications may include moodiness, irritability, and other symptoms that either mimic or exacerbate anxiety conditions. Medications that are prescribed for treatment of anxiety may include special anti-anxiety medications, but anxiety symptoms are often treated with depression medications, like the SSRIs (Zoloft, Celexa, etc.). Some anti-anxiety medications can be addictive if overused or misused.

To further complicate matters, your physician may not be aware of the complex interaction and possible healing benefits of proper nutrition and PCOS-specific supplementation that can dramatically lessen symptoms, and even eliminate the need for some medications. All of our neurotransmitters (those things in the brain that help generate the happy, sad, and anxious feelings) can be positively affected by the proper fuel as well as mind/body treatments that include stress management, meditation, mindfulness, exercise, yoga, hypnotherapy, etc. Just as the body yearns for homeostasis, so does the brain. The brain actually reshapes itself in response to stress, trauma, and our interactions with other people — that's true for the good as well as the bad.

So even if you have experienced a lot of negative things that are contributing to feelings of being anxious, there are many ways to approach the problem — and medication is only one of the possibilities in a big bag of therapeutic tools. Although your hormones are powerful influencers of mood and anxiety, so are nutrition, supplementation, and a proactive approach to therapy and other forms of support.

I engaged in a Facebook discussion about grapefruit recently. Ruby Reds are currently cheap at Trader Joe's, a fact which made one friend very happy. One of HER friends cautioned that grapefruits have been associated with breast cancer.

I promised to look into it and blog, which is what you're reading now!

In a survey of 50,000 women, researchers found that grapefruit may increase estrogen levels, a known breast cancer risk. It is thought that this relationship may be related to the fact that grapefruits alter a metabolic pathway involved in estrogen metabolism, called"cytochrome p450".

The cytochrome P450 pathway is also important for the metabolism of many medications commonly used with PCOS. Grapefruit and grapefruit juice may alter the metabolism of this pathway in the following ways:
--may induce excessive sedation with benzodiazepenes
--may induce rhabdomyolysis with statins
--may cause hypotension with calcium antagonists
--may alter electrocardiograms with astemizole, cisapride, pimozide, and terfenadine
--may induce overdose with SSRI medications such as Paxil

Wow…sounds like grapefruit could be the kiss of death, doesn't it? Well, those studies certainly sell newspapers and drive up advertising rates on websites who post them, but that's not the whole story.

First of all…when it comes to your medications, if you eat grapefruit regularly, tell your physician. She can calibrate the dose of the medication to reduce the risk of these side effects. Since grapefruits are a winter fruit, you may need to communicate with your physician to account for seasonal changes in your diet.

With regard to breast cancer, even though a couple of years ago the grapefruit/breast cancer link got lots of press time…a recent study reported no association between the two. None of the studies looked specifically at this issue with PCOS, but I suspect with the already present tendency toward high estrogen, there may be an altered metabolic system that could be grapefruit sensitive…and could be problematic…IF YOUR RELATIONSHIP WITH GRAPEFRUIT IS NOT ONE OF MODERATION.

Where women with PCOS might go wrong is if they cycle in and out of diets with limited variety and which focus on grapefruit…um…THE GRAPEFRUIT DIET. If you have PCOS, you may already have a tendency to be hyperestrogenemic. You may be on at least one of the medications mentioned above. And your relationship with food may be more one of feast/famine than one of moderation and variety.

Also, if you have a family history of breast cancer, eating too much grapefruit, all the time, may not be a good idea. Enjoying a seasonal box of Ruby Reds once a year…probably isn't going to be the worst thing you could do to yourself. Even if you have PCOS.

If you moderate the diet, so that grapefruit is one of many fruits you enjoy, and you practice moderation instead of yo-yo dieting, you should be ok with grapefruit.

And you might even get yourself off of some of the medications that were of concern in the first place.: )

http://www.globalrph.com/gfruit.htm

Monroe KR, Murphy SP, Kolonel LN, Pike MC. Prospective study of grapefruit intake and risk of breast cancer in postmenopausal women: the Multiethnic Cohort Study. Br J Cancer. 2007 Aug 6;97(3):440-5. Epub 2007 Jul 10.

Spencer EA, Key TJ, Appleby PN, van Gils CH, Olsen A, Tjønneland A, Clavel-Chapelon F, Boutron-Ruault MC, Touillaud M, Sánchez MJ, Bingham S, Khaw KT, Slimani N, Kaaks R, Riboli E. Prospective study of the association between grapefruit intake and risk of breast cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC). Cancer Causes Control. 2009 Aug;20(6):803-9. Epub 2009 Feb 18.

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.

Chastetree berry is a very common supplement used by women with PCOS. Does it work? If so, how?

In order to better understand this interesting but complex herb, I thought I'd make this a series spread across several posts. I'm starting with the hormones affected by chastetree berry: luteinizing hormone (LH), estrogen, progesterone, and prolactin. Today I'll focus on LH.

Luteinizing hormone is the hormone that causes ovulation. It is also the hormone that promotes development of the follicle into a corpus luteum, the intermediary step between egg and embryo.

Luteinizing hormone is interesting in that what constitutes a"normal" level depends on what stage of a menstrual cycle you are referring to. Levels are low at the beginning of a cycle, they ramp up to a peak just before ovulation. After ovulation, they drop back down again. This graph shows a typical LH cycle in a woman who does not have PCOS.

In PCOS, there are two key variations on normal LH function to consider. First of all, when levels are supposed to be low, they tend to be high. Secondly, at the point they should be surging in order to induce ovulation, they are too low to do so. Here is a graph of LH function that is common to women with PCOS.

As you can see, restoring good LH function is not a matter of raising or lowering LH levels. It's a matter of restoring cyclicity…in other words, making sure LH is high when it should be high, and making sure it's low when it should be low. When you read information about vitex, or LH, in your own research, you should be looking for the word"normalize", rather than"raise" or"lower".

Next: a look at estrogen and ovulation.

I recently wrote about how much more attention horses get with regards to nutrition's importance in fertility than we humans do. Since so many of my inCYST friends also seem to be cat lovers, I thought I'd share some pertinent wisdom from the feline world.

You may already know my friend Kate, whose blog http://www.moderncat.net/ is famous world-wide for its information about stylish kitty accessories.

Today Kate has posted some information about handmade pottery dishes for cats. If you've ever had a cat with acne, you've probably been told to switch from plastic dishes to clay ones. The reason for this is that acne-causeing bacteria can grow on the plastic dishes.

Humans don't do so well with plastic, either. Not only is there a risk for bacteria, but some plastics can mimic estrogens. They're not really the kind of estrogen our body likes to use, and it confuses our feedback systems to have the wrong kind of estrogen floating around the body.

As it gets warmer, and we tend to carry water bottles around to stay hydrated, we have to be aware of how we transport that water. Plastic bottles left in purses, cars, etc, are simply not a good idea. Be sure you look for a metal bottle. You can find them in most stores these days, but if you're having trouble in your area, here's one I found at amazon.com: Eco-Friendly Wide Mouth 25 oz, 750 ml Stainless Steel Sports Water Bottle — BPA Free

Now you can keep kitty healthy, yourself healthy, and by keeping all those plastics out of landfills, you are keeping our planet healthy as well. A great and easy way to celebrate Earth Month!

I dedicate this post to Susan Dopart and Jeffrey Batchelor. Susan is a contributor to this blog…her post about the power of fish oil and flaxseed oil combination has been pretty widely read around the Internet.

Susan and Jeffrey e-mailed me from a recent trip to Switzerland where they were going ga-ga over the wonderful food. I mentioned that Emmenthaler Swiss cheese has been found to have a higher content of omega-3's than the average cheese, and Susan recently mentioned that she's found a store at home in Santa Monica, where she can special order the stuff she loved so much in Switzerland.

So today I walked over to the grocery store to get my lunch and it turned out it was cheese sampling day. Kara, the local Cheese Goddess, happened to be there and since she is so knowledgeable about cheese I call her the Human Cheese Rolodex, I pulled her aside and picked her brain about what might be some fun options for healthy cheese.

Her recommendations were based on the following criteria I gave her:
--grass fed (corn fed cows turn out like corn fed people, too much inflammatory
fat in their tissue)
--organic (hormones are very chemically similar to estrogen and can disrupt
hormone balance

She gave me a list of some options. She told me that artisan cheeses, made by smaller dairies, tend to grass feed over grain feeding, but that is not always so. You need to ask.

Point Reyes Bleu Cheese
Cypress Grove
Winchester Dairy
Sierra Nevada Organic Dairy
Rouge et Noir
Bravo Farms
Fiscalini Cheese
Rumiano
Gioia
Bellwether Farms
Maytag Dairy
Carr Valley
Black Goat Dairy
Beecher's Cheese

Most of these come from California, hence the Happy California Cow picture.

The most interesting cheese Kara told me about was Beemster cheese from Holland. These cows graze on pesticide-free grass in pastures that lie below sea level. These pastures are located on top of a former sea lagoon, and their soil is made of a blue sea clay, and the combination of how this clay nourishes the grass these cows eat, produces cheese with 20% less sodium than the average cheese. I am curious whether this pasture history means somehow there are some omega-3's getting into this cheese…but I couldn't find anything online to answer that question.

If you are a true cheese aficionado and must have Beemster cheese…there is a little bad news…only 2000 wheels are made each year, in the springtime. The good news is, that could be an extremely fun pilgrimage.

http://www.beemster.us/the-cheeses/the-taste/

Now some science to round out Kara's trivia.

Cheese has its good qualities, when eaten in moderation.
--It's high in protein and calcium
--It contains CLA, an omega-3 intermediate which may help with weight control
--It's convenient
--If it's the right kind, it contains omega-3's
--If you are like me, whose first language was German, there is no life without cheese.

Moderation is the key, for several reasons
--Cheese is a good source of saturated fat
--Cheese is one of the few nonprocessed foods that contains trans fats
--Cheese has calories

Susan and Jeffrey and I will be at the first Fertile Intentions Couples Infertility Day Spa on October 25, 2008. Along with our co-hosts, we will be discussing cheese as well as many other great things about food, health, stress management, and environmental awareness as they pertain to balancing hormones and fertility.

Please join us if you can!

Last month I had the opportunity to spend a week with 5 women with PCOS at Green Mountain at Fox Run's first ever PCOS week. I learned a tremendous amount from them, maybe even more than I went to teach to them, about the syndrome.

One of the most important insights I gained, was why it can be so difficult to lose weight once you've decided to change your eating and exercise habits.

Insulin has a lot to do with it.

Your body is constantly taking in data, recording the temperature, the light level, energy levels, etc., and adjusting itself to be able to meet the demands of the situations it's recording. When it comes to hormones, it often records and hangs on to information from weeks before. It's as if it wants to be sure it's ready to handle the worst case scenario it's going to have to be asked to deal with. So…if you've been binge eating, and you've changed your habits, information it's taken in about that binge, if it occurred in your recent past, is still in the database. Your body is likely to want to make more insulin than it currently needs, just in case it's asked to have to handle a binge session like one it remembers you engaged in.

If you continue your new eating habits, consistently, that will register positively, your body will trust that it needs to make less insulin, and your lab values will improve.

The challenging part is being patient with your body while the new data has a chance to be recorded and acted on.

If you've got high insulin levels and all of a sudden you decide to go on a diet, or exercise at high levels, the insulin levels won't automatically adjust. It can be very easy to create a hypoglycemic state if you take on too much too soon. And, as your blood sugar levels drop, your hunger and carbohydrate cravings are likely going to be triggered to correct the situation.

Hypoglycemia is a stressful situation for the body, so when this scenario kicks in, it also triggers the release of stress hormones. Cortisol, one of the major stress hormones, is made with cholesterol. As are estrogen, testosterone, and progesterone. If choices you are making are demanding of the body that it makes more cortisol, it's going to be hard for it to make the other three hormones in the proper proportions.

The other thing that is common with PCOS is an intelligent, driven, all-or-nothing tending personality. When you decide to take on diet and exercise, it can be in an extreme fashion. When weight doesn't come off as planned, you can be very hard on yourself, raising your stress levels, possibly bingeing out of frustration.

And thus the cycle starts, all over again.

Hence the title of this post. How do you back yourself out of such a situation?

Ohhhh…you all are going to hate this, but the key word is"moderation". Be gentle with yourself. Rather than taking on an extreme exercise plan and a rigid diet, focus on small simple changes and working to turn them into habits. Be patient. Understand that the changes you're implementing on the outside take time to be registered by your internal hormone control systems.

Probably key? Remember this: THE DAYS YOU FEEL THE LEAST LIKE STICKING WITH YOUR NEW HABITS ARE THE DAYS IT IS MOST IMPORTANT TO DO JUST THAT. It's tempting to blame a bad day on something you've done, to take it personally, rather than let your body do what it does best when it's not interfered with. By bingeing and not exercising on a day you feel badly, you prolong the time it's going to take to get things back into balance.

Awhile back, a good friend of mine who is an airline pilot shared with me that despite the fact that pilots must pass routine and rigorous physicals, most live only about 10 years after retirement…and currently the mandatory retirement age for airline pilots is 60!

I've been interested ever since in why a demographic of individuals who meet our current definition of"healthy" may not necessarily be so. My ulterior motive, of course, is to keep my friend around as long as possible, but in the process of studying about sleep and health, I continue to find some really interesting things relevant to PCOS.

Such as the relationship between shift work and breast cancer. The connection here is that women with PCOS are more prone to cancer in estrogen-sensitive tissues.

Researchers have known for a long time that women who work shift jobs, such as nurses, are more prone to breast cancer. Now, research is emerging to suggest that melatonin physically suppresses the growth of breast cancer cells. Melatonin exerts its effect in numerous ways, from suppressing receptor genes, reducing the activity of proteins that regulate tumor growth, changing genes, inhibiting cell reproduction. The study I'm referring to in this post literally referred to melatonin as an"antiestrogenic" compound.

So 'splain me something, Lucy. Why is it, when I go to the Susan Komen Race for the Cure website…that the keywords"sleep" and"shift work" bring up nothing? Seems to me that the Breast Cancer 3 Day Walk would be more relevant…and preventive to those who participate…if it was a Breast Cancer 3 Day Slumber Party!

Srinivasan V, Spence DW, Pandi-Perumal SR, Trakht I, Esquifino AI, Cardinali DP, Maestroni GJ. Melatonin, environmental light, and breast cancer. Breast Cancer Res Treat. 2008 Apr;108(3):339-50.

If cutting carbs was the only dietary strategy needed to help PCOS, this blog wouldn't exist. There are clearly thousands of women, based on the traffic statistics for this blog, who've tried that approach without success.

One of the food groups that gets cut out of the diet when we worry too much about carbohydrates, is fruit. And fruits are just loaded with antioxidants that are showing potential to help balance our biochemistry.

Resveratrol is one of those anti-oxidants. It is a compound well recognized for its benefits in reducing cancer risk, inflammation, cardiovascular disease, blood clotting, and other aging-related issues. It is actually a compound that some plants have the ability to produce to fight off pathogens that threaten their own health, that turns out to have the same ability in humans.

A recent study specifically done with PCOS suggests that it has potential for women with this syndrome.

In rats, resveratrol was shown to reduce the excess growth of ovarian tissue. It also inhibited the tendency for insulin to promote this type of excess tissue growth.

Where do you get this great stuff?

1. Red grapes, blueberries, bilberries, and cranberries. Bilberry extract is most commonly found in supplement form. The other fruits are often taken out of a low-carbohydrate diet. Don't make this mistake!

2. Red wine. For those of you who are trying to conceive, please exercise caution with this choice. It's best to pursue the nonalcoholic options provided here. But if you are not in that category, consider enjoying a glass of red wine with dinner tonight! Spanish red wines and New York pinot noirs are your best option, they've been found to have the highest resveratrol concentrations.

3. Peanuts and peanut butter. I love this one. Sometimes we think nutrition has to be complicated…but a PB and grape J sandwich is a perfect PCOS-friendly lunch!

4. Resveratrol supplements. These are primarily made from extracts of the kojo-kon root. Not that supplementation is bad, but I've been around long enough to see that when you isolate a compound from its natural source, you often miss out on other factors and compounds that either help make that compound more effective, or that may be the really important compound in the first place. So I'd encourage the other choices over supplementing. Another consideration that is important is potential conception. I just don't like to recommend supplements to anyone who might become pregnant when I don't know for sure if they have more potential to be helpful or harmful.

5. Dark chocolate and non-dutched cocoa powder. So now if anyone, anyone at all, questions why that really, really high-cacao bittersweet chocolate jumped from the shelf in the Trader Joe's checkout line into your grocery bag…just tell them "the inCYST blog made me do it".

Just a note, in addition to pure chocolate squares, think hot chocolate and mole sauce!

One important point I need to make here is that when resveratrol-containing foods are included in a balanced diet, they can have benefit. It's important to not eliminate entire categories of food. Resveratrol, however, has the ability to affect estrogen levels, in both directions. It's best not to overdose on the supplement because it's"good". Balance is always the goal in PCOS.

Wong DH, Villanueva JA, Cress AB, Duleba AJ. Effects of resveratrol on proliferation and apoptosis in rat ovarian theca-interstitial cells. Mol Hum Reprod. 2010 Jan 12. [Epub ahead of print]

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.

So many times I lose contact with clients after they conceive…it's as if the only thing nutrition is important for, is that one crucial moment. But nutrition is important all the way through pregnancy and breastfeeding! Here's more information on why you need to eat well long after you have been given your official due date.

In a population of mice, one group was fed a regular diet, another group was given a diet deficient in choline, and one was given a diet deficient in riboflavin. These rats were then mated. While the rats were pregnant, they were sacrificed so that their embryos could be examined. (I know, it bothers me too…I refused to accept a very nice research assistantship in grad school because it would have required me to sacrifice rats…I'm just reporting the findings here.)

Here are those findings:

1. Choline deficient rats had higher plasma homocysteine levels. That is an indication of an inflammatory process.

Did you know, egg yolks are a really good source of choline? Maybe you shouldn't be so afraid of the cholesterol…which, by the way…you need to make progesterone and estrogen!

2. Riboflavin deficient rats had taken longer to conceive, and their embryos were smaller.

Another possible explanation for the recent finding that women who consume dairy products seem to be more fertile than those who don't.

3. Both choline-deficient and riboflavin-deficient rats' embryos had more heart defects.

Chan J, Deng L, Mikael LG, Yan J, Pickell L, Wu Q, Caudill MA, Rozen R. Low dietary choline and low dietary riboflavin during pregnancy influence reproductive outcomes and heart development in mice. Am J Clin Nutr. 2010 Feb 17. [Epub ahead of print]

We all throw the word"fat" around as if we really know what it is. If I were to stand at the mall and take a survey, I'd likely get the following answers to the question,"What is fat?"

"Gross"

"Something I have too much of."

"Saturated and unsaturated."

"Something that unfortunately makes food taste good."

Have you ever thought about why we even make and store fat in the first place? Just a few decades ago, nutrition students like me were taught that the primary source of fat was as a storage tissue for excessive calories eaten. Oh! And it helps to insulate you and keep you warm. That was that.

That paradigm is what the vast majority of nutrition advice is based on…that fat is an inactive mass that has little value, really, so when we have too much of it we should do whatever it takes to get rid of it. Diet. Exercise. Liposuction. Bariatric surgery.

In recent years, scientists have been studying fat and learning some really interesting things. Fat is actually an endocrine organ! Just like the pancreas and the liver, our fat tissue manufactures and secretes hormones and chemicals of communication that are used by other parts of the body in other locations. Fat tissue can make estrogen, and it can also even make cortisol! Other hormones that fat tissue can make include leptin, resistin, and adiponectin.

The fact that fat has functions suggests that we should be much more respectful of its existence. Apparently it is created when we need what it does. Simply removing it, without figuring out what conditions triggered it to appear in the first place, is likely why drastic, imbalanced methods of reducing fat don't have long-term success.

I read long ago that insulin has a mild-antidepressant activity. It occurred to me, that when a person is not living their life in balance, and the nervous system is having a hard time doing its job, that we may have been programmed to have back up plans to ensure our survival. Such as not allowing insulin to be used by muscle and fat, rather rendered available to be used by the brain to keep doing what it does. After all, if our brains aren't working, we aren't working…right?

So instead of thinking we are depressed because we are fat…maybe we should consider that we are fat becasue we are depressed.

The type of fat that is found in our abdomens is commonly written about as dangerous to have. Yes, it is associated with a lot of expensive and deadly illnesses. However, it is also where a lot of omega-3 fatty acids are stored. So if we're eating the kind of fat that overpowers the ability of the body to do its job, and not eating enough omega-3 fatty acids in the first place, it's actually pretty amazing, if you think about it, that our bodies have a way to make sure that despite these somewhat self-destructive choices, the fats our brains desperately need, stay in the body and get to where they are most needed?

I stopped thinking of fat as a bad thing a long time ago. When I see someone whose adipose organ is overdeveloped, it makes me stop and think about how far out of balance they must be. If you exercise and train and work your muscles routinely over time, they become big and strong, right? If your life is imbalanced, your fat tissue will be worked out in similar fashion. If you don't need the fat, it is not likely to stick around.

When I see someone with an overdeveloped fat organ, my very first thought is,"That body is having to work sooo hard to stay in balance. That must be an exhausting job."

When you are diligent with self-care, that is you make food choices that promote better balance, you move your body regularly, you don't take on unnecessary stress, and you practice good sleep hygiene, your body won't have to be so dependent on its fat tissue to do all that work. The responsibility is better divided between other body parts.

It's a bit of a shift to wrap your brain around, I know…but I encourage you to think about it. The very fact that you're able to make fat may have been lifesaving, up to this point. But since extra fat was more designed as a backup plan, and not the primary way to stay in balance, perhaps you can think of your choices from this point forward as ways to give that organ a break and not wear it out…not wear YOU out…before your time.

http://www.ncbi.nlm.nih.gov/pubmed/15195692

As a skin care therapist I would often be the first one to recognize a serious hormonal imbalance based on the acne that a client might be struggling with. As nutritionist it’s clear that it’s an “inside-out” problem.

Women with PCOS often have elevated levels of free-testosterone, which is one of the markers of PCOS. When the body breaks down the testosterone, one of the by-products that can occur is DHT (Dihydrotestosterone). There are areas on our bodies that are particularly sensitive to the signals from DHT which are the face, neck, chest and back. The message is “make more oil!”.

We do need some oil on the skin in order to keep it protected and supple, but when it goes on overdrive, it literally backs up in the pore. The oil (sebum) we produce is very sticky so it doesn’t allow the dead skin cells to exfoliate easily so it becomes like have a tight lid on a pressure cooker.

The naturally occurring bacteria on the skin, along with dead skin cells and the oil end up creating a pretty nasty “stew” resulting in reddened, painful and pustular acne. If this material cannot get out of the skin, it can break the pore wall underneath the skin causing more acne (you might notice a little “family” of breakouts that always groups together). Most people, (men get it too for the same reason), focus only on trying to treat the skin externally — but the goal is to get the body back in balance.

Some basic strategies are as follows:

1. Try to eat organic and hormone free as much as possible, especially when it comes to dairy products. The hormones that the cows receive to keep them lactating as long as possible go right into the milk and it’s by-products (cheese, ice-cream etc.) which go right into you — creating a further hormonal imbalance.

2. Stress is a huge trigger for increasing DHT — it is critical to create your own menu of"stress-busters" that can be used throughout the day and work for you! A simple one is to just stop for one to two minutes and do deep breathing. This short-circuits the stress hormone release response.

3. Acne in all forms is primarily an inflammatory disease. Fish oils, which are also beneficial for neurotransmitter balance, do double duty since they help tremendously with inflammation.

4. Eat inflammation quenching foods, rich in antioxidants — fruits and vegetables. Remember when fried foods were believed to cause acne? They may not do it directly, but indirectly they are highly inflammatory.

5. Getting hormones especially your estrogen to testosterone ratio back in balance is the key to getting to the source of the problem. Work closely with your In-Cyst trained expert toward this goal.

Next blog I’ll share information on strategies for dealing with the skin from the outside in.

Carmina McGee, MS, RD, LE
Registered Dietitian/ Licensed Esthetician
805.816-1629 / Ventura, California
www.CarminaMcGee.com
Carmina@CarminaMcGee.com