I have heard from friends who were at the recent American Dietetic Association Food and Nutrition Conference and Exposition in Boston, that a panel of four experts on fats, asserted that omega-6 fatty acids are not pro-inflammatory. This is in contradiction to what you will see on this blog and what we teach, so I wanted to address it.
My primary source of information regarding fats is the International Association for the Study of Fatty Acids and Lipids (ISSFAL). This organization is not sponsored by any commodities organizations with anything to gain or lose from the outcome of good, hard, science.
The American Dietetic Association, on the other hand, is heavily sponsored by commodities and food manufacturers. I actually went to a meeting sponsored by one of their special practice groups a few years ago, the major sponsor of which was Frito-Lay. Over the weekend, Twitter was a-flutter with dietitians aglow from the SWAG they were filling their suitcases with. So much so, that at one point I tweeted back, that for that meeting,"stuff we all get" should be called"food we all get".
This is an association that has backed itself into a huge corner with regards to the money it receives in order to pay its bills. Look hard, and you will find Pepsi, Coca-Cola, Hershey's…for starters. (Actually you don't have to look hard at all…they seem to be proud of these associations.) So you have to understand that if you attend their conferences, you're most likely to get information that is nice, and promotes the sale of the trade show floor of products simultaneously being exhibited in hopes of gaining"official" endorsement. ADA is not going to hurt its sponsors.
Look outside of the ADA and this is what you will see. The relationship between omega-6 fatty acid intake and inflammation is so strong, that Wake Forest University and Harvard University have teamed up to open up a Center for Botanical Lipids and Inflammatory Disease Prevention. Would they do that if they believed they'd be sending renowned scientists on a wild goose chase? I don't think so.
I have posted their mission statement, right off of their website, below.
I ask you to consider, why it is, that there is an international association devoted to research about omega-6's, omega-3's, and inflammation, and a center devoted to the study of these fats, both committed to studying fat, that says that omega-6's are inflammatory, while dietitians are hearing at their meeting that this isn't so? Apparently a little bit of FWAG buys you a whole lot of loyalty.
It doesn't seem to matter what the scientists are saying as long as product gets pushed on the front lines.
Research indicates poor diets, including high concentrations of saturated and omega-6 (ω6) polyunsaturated fatty acids (PUFAs) but lacking omega-3 (ω3) PUFAs, can initiate and exacerbate underlying inflammation associated with cardiovascular disease (heart disease and stroke), metabolic syndrome, diabetes and asthma. Overwhelming evidence demonstrates that ω3 PUFAs naturally found in fatty fish and fish oil reduce cardiovascular diseases; however, US consumption of fish oils is low due to the taste, smell, and fear of contaminants. This proposal postulates that botanical-based oil supplements offer a potential solution to several of these challenging problems. The Wake Forest Center for Botanical Lipids and Inflammatory Disease Prevention brings together investigators from four internationally-recognized lipid groups and a world-renowned human genomics center to examine the cellular and molecular mechanisms and clinical potential of botanical fatty acids currently available as dietary supplements with a focus on enhancing wellness and preventing disease. Center projects will examine the health effects of adding medium chain botanical fatty acids that bypass the rate limiting Δ6-desaturase step of PUFA biosynthesis in humans. A central hypothesis of this proposal is that this approach markedly enhances conversion of botanical PUFAs to long chain beneficial PUFAs. Projects 1 and 3 examine the mechanisms behind the pleiotropic effects of botanical PUFAs with regard to macrophage/monocyte activation, inflammatory states and eicosanoid generation related to atherosclerosis and asthmatic inflammation, respectively. Project 2 examines differences in PUFA biosynthesis between African Americans and age- and sex- matched Caucasians within both healthy and metabolic syndrome populations to better understand who may be most responsive to fatty acid-based botanical supplements. These interactive and synergistic studies have a strong, contemporary and translational scientific basis and should allow this team of scientist to identify additional targets of prevention and therapy, and permit further refinement of dietary supplementation to maximize its effects on human wellness.
Numerous lines of scientific evidence indicate that poor diets including the ingestion of unhealthy concentrations and ratios of short, medium and long chain polyunsaturated fatty acids (PUFAs) have played a key role in the initiation and exacerbation of chronic inflammatory diseases including cardiovascular disease (heart disease and stroke), metabolic syndrome, diabetes and asthma over the past 40 years. The central objective of The Wake Forest Center for Botanical Lipids and Inflammatory Disease Prevention is to test several key hypotheses thatwill fill significant knowledge gaps regarding how fatty acid-based botanical supplements or supplement combinations work to prevent human disease. This information can then be employed to determine the best use and refinement of supplements to maximize their effectiveness for human wellness.
I've told many a client they're sick and they've been playing catch up since before they were even born. Others feel the same way, too…this was recently published in USA Today:
By Liz Szabo, USA TODAY Keishawn Williams is already talking to her baby, although her child isn't due until November.
"What are you doing?" asks Williams, 22."Are you awake? Are you asleep? Why are you sitting on my bladder?"
Although Williams may not realize it, her body and baby are also conducting a separate, even more important conversation that may influence her child's health for the rest of its life. Although neither mother nor child is aware of this crucial dialogue, Williams' body already is telling her baby about what to expect from the world outside, says Mark Hanson, a professor at the University of Southampton in England.
And thanks to those biological signals, the choices that Williams makes today — by getting good prenatal care, eating nutrient-packed vegetables and avoiding alcohol, tobacco and caffeine — may help her baby long after birth, Hanson says. Research into the"developmental origins of adult disease" suggests that Williams' healthy living may help her child avoid problems such as cancer, heart disease, depression and diabetes not just in childhood, but 50 years from now.
Though adults still need to eat right and exercise, a growing number of studies now suggest the best time to fight the diseases of aging may be before babies are even born, says Peter Gluckman of the University of Auckland in New Zealand.
Williams' baby is still too young to kick, let alone ponder its future. But its body is already adapting and preparing for its specific environment, Gluckman says, by reading cues sent through Williams' blood and amniotic fluid.
"Every baby in fetal life is adjusting its pattern of development according to the world it predicts it will live in," he says.
Reading cues while in utero
During the crucial"window of opportunity" before birth and during infancy, environmental cues help"program" a person's DNA, says Alexander Jones of Great Ormond Street Hospital in London and the University College of London Institute for Child Health. This happens through a delicate interplay of genes and the environment called epigenetics, which can determine how a baby reacts for the rest of its life, Jones says.
Through epigenetics, chemical groups attach to DNA. Although they don't change the order of the genes, the chemical groups can switch those genes on or off, Jones says.
Many things, such as chemical contaminants, can cause epigenetic changes. So babies exposed in the womb to synthetic hormones may begin responding abnormally to the natural hormones later made by their own bodies, says Hugh Taylor of Yale University School of Medicine.
That's why, doctors believe, many babies exposed before birth to a drug called DES, or diethylstilbestrol, later developed rare cancers or fertility problems, Taylor says.
Doctors stopped prescribing DES, which had been used for decades to prevent miscarriages, in 1971. But Taylor and other scientists are concerned that"hormone-disrupting" chemicals, such as those used in pesticides and even common plastics, could cause similar problems.
Babies and children also can develop abnormal reactions to stress, says Jack Shonkoff of Harvard University, co-author of a June paper on early influences in health in The Journal of the American Medical Association.
In the short term, reacting to typical, everyday difficulties can help people develop a healthy response to stress.
But persistent,"toxic" stress — such as neglect or extreme poverty — may program a child's nervous system to be on perpetual high alert. Over time, this can damage the immune response and lead to chronic ailments, such as heart disease and depression, the study says.
Diet as a predictor
A pregnant woman's diet tells a fetus a lot about its future environment, including how much food will be available after birth, Jones says.
A baby conceived during a famine, for example, might learn to be"thrifty," hoarding every calorie and packing on fat rather than muscle, even at the expense of developing vital organs, such as the kidneys, liver and brain. Because of a lack of calories, the baby also may be born small.
In a famine, those early adjustments and predictions about the future could mean the difference between survival and starvation, Jones says.
But babies may run into trouble if the world doesn't match their predictions, Jones says.
A baby who has learned to hoard calories, for example, may grow up to be fat or diabetic once he or she finally gets enough to eat, Jones says. Doctors believe this occurs not just with babies whose mothers are starving, but with those who are malnourished because of a mother's medical problems, poor nutrition or exposure to tobacco smoke, which damages the placenta.
It's well known, Taylor says, that women who smoke are more likely to have low-birth-weight babies, who are in some ways"starved" for nutrients in the womb. Babies born too small are at risk for many immediate problems, such as underdeveloped lungs and bleeding in the brain.
If they survive, these youngsters also face long-term risks.
Studies show that small babies who gain weight rapidly in infancy or childhood — a sign that bodies are already making the most of every calorie — also have higher rates of adult heart disease and diabetes, Jones says.
Specialized X-rays have shown babies of young mothers with poor diets in India, for example, are born with extra belly fat, even though they seem to be a normal weight. Once these babies start getting an adequate diet, they are likely to put on weight, Gluckman says.
"Even by the time of birth, they're on a different pattern of development," Gluckman says.
Teaching future mothers
Adversity in early life can increase a child's risk of disease, but it doesn't seal his or her fate, Shonkoff says.
Although emotional abuse in childhood increases the risk of adult depression, for example, supportive relationships with adults can help children cope and recover, Shonkoff says.
Communities also can help, Gluckman says. By helping women such as Williams get good prenatal care and nutrition, for example, communities can reduce the number of fetuses who are malnourished and born small, Gluckman says. Babies who are born at normal weight are more likely to maintain that healthy weight.
Because half of pregnancies are unplanned, women need to learn about nutrition — and maintain healthy diets — long before they conceive, Gluckman says.
"We have got to give far greater focus to mothers, the women who are likely to become mothers and to the care of newborn children than we have in the past," Gluckman says.
Williams, who also has a 1-year-old son and 5-year-old daughter, says she's trying hard to give her children a bright future. She breast-fed both and now works as a breast-feeding peer counselor at the Family Health and Birth Center in Washington, D.C., where many patients are low-income or minority mothers.
The birth center also aims to help babies by getting their moms good prenatal care.
About 6% of black mothers who delivered at the birth center had low-birth-weight babies, compared with the citywide average of 14.2% for black mothers, says the center's Ruth Watson Lubic.
"Twentieth-century medicine dealt with child health and adult health separately," Shonkoff says."What 21st-century medicine is telling us is that if we want to change adult health, we have to look in babies, even before they're born."
Blood platelets are blood components that are important for blood clotting function. Platelet levels are very important to balance--if you don't have enough, you will have a difficult time stopping bleed from a cut or scrape. Too many, and you may have trouble with blood clots, which can block blood flow. Depending on where these blockages are, they can cause heart attacks, strokes, and thromboembolism.
Inflammatory diseases like PCOS are associated with changes in platelet function. In fact, women with PCOS do have problems with"sticky blood"--that is, blood that forms clots too easily. This aspect of PCOS is not weight dependent--you can have the same problem if you are lean as a woman who has weight to lose. Some of the changes in your clotting function are a function of the disease and likely would exist without any medical intervention. Other changes may be due to medications you are being prescribed. Birth control pills promote platelet activity, while metformin, decreases it.
Did you know that the same lifestyle choices inCYST promotes for weight loss, better fertility, healthier skin, and every other aspect of PCOS, is also good for healthier platelets?
1. Omega-3 fatty acids promote healthy blood clotting function. They also help to promote better melatonin balance. Melatonin is an important compound to platelets; it helps them to be less"sticky".
2. Physical activity improves circulation. Blood that is not moving is blood that has a tendency to coagulate. The more physically active you are, the less opportunity you have for platelets to collect and decide they should stick together.
3. As I just mentioned, melatonin is important to platelet function. If you're prioritizing sleep, you're giving melatonin a chance to do its job. Deprive yourself, and you give platelets the go-ahead to congregate. Melatonin is so important for platelet function, some researchers believe it may be a therapeutic supplement in people with heart disease, with similar functions to aspirin and Plavix. Who knew, a little bit of extra shut eye might be equally as powerful?*
*Any medication you have been prescribed for the purpose of altering how your blood flows and clots should not be discontinued without the consent of the physician who prescribed it. This could be a deadly choice. For anyone who is interested, I do have research I found describing some of the benefits of melatonin supplementation in heart disease. I'm happy to share it. Please share with your physician and discuss before making any changes.
If you're on any medication for blood thinning or platelet management, consider making some simple changes in your overall lifestyle that may have far-reaching benefit.
Luque-Ramírez M, Mendieta-Azcona C, del Rey Sánchez JM, Matíes M, Escobar-Morreale HF. Effects of an antiandrogenic oral contraceptive pill compared with metformin on blood coagulation tests and endothelial function in women with the polycystic ovary syndrome: influence of obesity and smoking. Eur J Endocrinol. 2009 Mar;160(3):469-80. Epub 2009 Jan 12.
Dereli D, Ozgen G, Buyukkececi F, Guney E, Yilmaz C. Platelet dysfunction in lean women with polycystic ovary syndrome and association with insulin sensitivity. J Clin Endocrinol Metab. 2003 May;88(5):2263-8. Rajendran S, Willoughby SR, Chan WP, Liberts EA, Heresztyn T, Saha M, Marber MS, Norman RJ, Horowitz JD. Polycystic ovary syndrome is associated with severe platelet and endothelial dysfunction in both obese and lean subjects. Atherosclerosis. 2009 Jun;204(2):509-14. Epub 2008 Sep 17.
Amowitz LL, Sobel BE. Cardiovascular consequences of polycystic ovary syndrome. Endocrinol Metab Clin North Am. 1999 Jun;28(2):439-58, viii.
Kebapcilar L, Taner CE, Kebapcilar AG, Sari I. High mean platelet volume, low-grade systemic coagulation and fibrinolytic activation are associated with androgen and insulin levels in polycystic ovary syndrome. Arch Gynecol Obstet. 2009 Aug;280(2):187-93. Epub 2008 Dec 24.
I've never experienced infertility. I was overweight as a child/teen, but I've been the same weight for most of my adult life. I'm relatively healthy. I'm not saying this to intimidate anyone, but rather to share an insecurity I've had about what I do for a living.
I always wonder how in the world women who have those issues can even find me relevant and helpful if I've never had to experience them?
The last two months have presented me with a situation that, even though it may not be apparent on the outside, has very much changed me on the inside. I've learned a lot about control, gratitude, and what is truly important in life.
And I feel like this journey, challenging as it is, is molding me into someone better equipped to help the people who come to inCYST for help.
Regular readers of the blog will remember that I wrote about my sick kitty in October. I thought I was dealing with a simple urine crystal issue that a diet change would fix. I'm a dietitian, I know how to change diets. This was simple, or so I thought.
Well, Rodeo simply never recovered from the crystal incident. He would not eat. He became lethargic. About a month after the vet visit, I noticed, he just wasn't breathing well. Being the data fiend that I am, I started monitoring his respirations. They seemed stable, so I figured maybe he was allergic to the new diet he'd been prescribed for his urine crystals. I changed back to the old diet and waited to see if he responded.
Then he crashed. I got the last appointment on a Friday evening with his vet, and learned that he was dealing with one of four potential diagnoses. One was a fungal infection (no problem), one of those was a 100% fatal virus (that would require euthanasia), one was cancer (fatal over time), one was heart disease (manageable but life-shortening).
I had to wait almost a week for the pathology report to come back, and to get an appointment for an ultrasound with a cardiologist. (Yes, my cat has more specialists in his Rolodex than I do at this point).
The good news is, it's not the fatal virus, and it's not cancer, but it is heart disease, and it's a serious problem. There is no cure, but there is a lot I can do to manage the situation.
Sound familiar?
I told the vet,"If you can give me heart disease, I'll take heart disease. I can do that." Two sentences I never, ever envisioned coming out of my mouth at any point in my life.
I can tell you this. I have a reputation for being pretty even-keeled in even the most adversarial of situations. During my eating disorder treatment center gig, it was not uncommon for cans of Ensure to be flung my way after a tough counseling session. Nothing phases me after that!
But the night I came home from the vet with a couple of medications and no idea what was happening, I laid on my bed and cried my heart out. I didn't even notice that Rodeo had jumped up on the bed. He felt like crap, and he was sitting there trying to take care of me. I realized, of my two kitties, he is the one most affected by my emotions. And here he was, more concerned about me than about the X-ray, the aspiration, and all the poking and prodding he'd been through.
That was reality check #1. I knew I needed to allow myself to feel what I was feeling, but I needed to learn how to do it in a way that didn't turn itself back on the problem in a negative way.
As I imagine has happened with many of you, my life changed in a mere instant. I became hyper aware of respiratory rates, fluid intake, food intake, urine output, medication times…my life was filled with new details I had no choice but to learn to live with.
Even though I run a business, it's the holidays, and I had committed to coordinating vendors for a huge market here in Phoenix. Even though my five major plans for December revenue pretty much collapsed within days of getting the kitty diagnosis. Somehow, I had to figure out how to make it all work.
This is where I started thinking of all of you. How many of you readers are busy, successful women, juggling a million different responsibilities, happily living out your lives…when you're told you have to start monitoring what you eat, when you eat it, when you ovulate, when you menstruate, what your blood glucose number is…and on top of it all, every expert on the planet expects you to figure out when to work out, to plan the perfect meal combination, each and every meal, to buy the supplements, and on top of it, manage your anxiety, frustration, and anger over the situation?
Do these health professionals even have a clue? Did I ever have a clue with any of my clients I thought I was helping with inCYST? That's what's been going on in my head in the two months since Rodeo's diagnosis.
Reality check #2 for me was realizing what I was doing any time I had a free moment, especially during the week when I didn't know what I was dealing with. I found myself surfing the Internet, Googling symptoms, reading everything I could find about lymphoma and cardiomyopathy, looking for the worst in kitty, looking for anyone, anyone at all, who could tell me that there was a supplement or pill I could give him that would just make this all go away.
That behavior is known as magical thinking. It is a very common thing to do when faced with a situation that leaves you feeling cornered. Getting older. Cancer. Weight that won't come off. Infertility. It's about trying to find something, anything at all, that can give you the illusion that you're in control of something. Note that I used the word illusion. You're really not in control. You've transferred your need to be in control of outcome to a concrete, more manageable option. That's all. The only thing magical thinking succeeds at, is allowing us to avoid the pain of a situation. In many cases, it keeps us distracted from constructive and helpful things we can be doing.
So…knowing from working with all of you that this is what I was doing, I told Rodeo's vet what I do for a living, that I'm a real biochem nerd, and that I was probably dealing with my stress by reading waaay too much about cardiomyopathy. I told him at any time I was becoming annoying and intefering with his treatment plan and Rodeo's progress, he had permission to put me in my place. We negotiated a few things I wanted to try, one we're using, most we're not.
And I am adhering completely to what the doctor ordered. Even if it means staying up past my bedtime to get a med in, even if it means passing on a social invitation if it interferes with the treatment plan, even if it means using money I wanted to spend on something else to buy medication. The vet is not cheap. But he's incredibly smart. If kitty is going to get better, I can't be bargaining with him because of the inconvenience the instructions impose on my life as I wish it was.
Reality check #3 has been about how much control issues can be triggered when life throws a curve ball. We can do everything exactly perfectly. And Rodeo has a bad day. Or Rodeo can go dumpster diving, eat a fish head, throw it up, and be perfectly fine. At least for a day. How Rodeo feels today, is not at all about what I did for him this morning. It is about the consistency of what we do over time.
Oh, I'm so embarrassed to even be saying this, but this simple reality took me awhile to"get". I wanted him to always breathe perfectly. To eat when I gave him the food. To love the deli turkey. It doesn't happen that way. Some days he eats like he's the size of Zenyatta, other days, nothing strikes his fancy. I have had to learn to roll with it, and to not view one incident as failure, but as a challenge to figure out what another option might be.
On the days when things don't go as planned, I have to adjust my life. Yesterday morning, for example, meds did not go in at 8 am as scheduled. I spent 4 hours getting them in, but realizing that the four hours it took to make that happen was four hours I'd planned to spend making my contribution for a holiday potluck I was to attend tonight…I made the choice to cancel my attendance, focus on medication, and spend the evening tonight taking care of myself here at home.
Reality check #4. You know what happened when I stopped stressing about how I was going to do both the medications and the potluck and OMG what happens if I'm at the potluck and he bottoms out?!?!?! Rodeo settled in to one of the absolute best respiratory patterns and ate better for me than he did all week. I suspect he picked up on my more relaxed demeanor and was able to put energy into himself that he was putting into me. Some of the things I am inadvertently doing affect kitty as much, if not more, than the things I am supposed to be doing.
Reality check #5. I sometimes find myself getting annoyed at people complaining about things that now seem minor in the big scheme of things. All these people complaining about having to much to do for Christmas? In my eyes they are lucky they are able to participate. I have to remind myself, their situations are different and even though I might envy them, in their own scenarios are lessons from the Universe in action that may not include a cat. Still working on that one.
There are many early Christmas gifts this situation has brought me.
First of all, I have kitty happily sleeping on the bed today. He doesn't fit into a stocking and probably wouldn't consent to it if he did…but he's here compliments of two of Santa's finest elves…er…angels in elves' clothing, Dr. Oyan and Dr. Paige.
Secondly, my priorities, as healthy as I thought they were, needed some addressing. I have been able to let go of situations that I simply have no time to accommodate. I have more time to myself, since I'm home more, and that has given me quiet time to think about what inCYST will be for all of you in 2011. I hope you like the inspirations you'll see in the next 12 months.
Thirdly, I feel like I have a much better idea of what it is that you all need from inCYST in the first place. I am still at a disadvantage for not having experience every single thing you all have exactly as you have, but I have been humbled, I'm dealing with a challenge, and it cause me to consider every inCYST choice I make in an entirely different fashion. Humility is never a bad thing on which to base intention.
Fourthly, I've learned that it's not always bad if success has to be redefined. Of course I'd love it if there was a cure for cardiomyopathy. But there isn't. I can be angry about it, not follow the vet's instructions because I managed to find an obscure website on the Internet that contradicted them, turn to supplements which would put more control in my hands than his, or do nothing and hope the Calgon cardiomyopathy fairy will just swoop in and whisk us away to Kitty Tahiti.
None of that is going to happen. I got over it, decided to listen to the vet, and to redefine success as staying informed, being proactive and communicative with new information, and to the best of my ability, prioritize my life so that I can enact the recommendations I've been provided with. It's slowly turning things around. Not curing them. But, gratefully, allowing kitty to breathe. Oxygen in heart cells…is a lot more important than a complete and total cure. We have learned to think simply.
Finally, I still don't know what it is like to be infertile, not be able to lose weight, or live with insulin resistance. But at least I am more aware of how important it is to always remember that no matter who are you are, when you look to inCYST for help, guidance, support, inspiration, your story, especially the part we don't know about, or cannot immediately relate to, is important to consider in everything we say and do.
I hope all of you are enjoying your holiday season, whatever customs you practice.
One last thing. To all of my friends who are tired of hearing me talk endlessly about the cat, now that he's stabilizing I can get back to the gym and put the stress there. I appreciate all of your ears and support.
I have heard the following recommendations made by the American Heart Association repeatedly for years now. And I hear them parroted everywhere by well-intended medical experts who, it seems, did not stop to check the math on which the recommendations are based:
Population Recommendation Patients without documented coronary heart disease (CHD) Eat a variety of (preferably fatty) fish at least twice a week. Include oils and foods rich in alpha-linolenic acid (flaxseed, canola and soybean oils; flaxseed and walnuts).
Patients with documented CHD Consume about 1 g of EPA+DHA per day, preferably from fatty fish. EPA+DHA in capsule form could be considered in consultation with the physician.
Patients who need to lower triglycerides 2 to 4 grams of EPA+DHA per day provided as capsules under a physician's care.
Patients taking more than 3 grams of omega-3 fatty acids from capsules should do so only under a physician's care. High intakes could cause excessive bleeding in some people.
Evidence from prospective secondary prevention studies suggests that taking EPA+DHA ranging from 0.5 to 1.8 grams per day (either as fatty fish or supplements) significantly reduces deaths from heart disease and all causes. For alpha-linolenic acid, a total intake of 1.5–3 grams per day seems beneficial.
I couldn't sit back anymore. Ellen Reiss Goldfarb, RD, a member of this blog's inCYST Network for Women With PCOS collaborated with me on hopefully setting the record straight. We hope it helps, especially to get a mathematically-correct set of recommendations out to the public so they can go grocery shopping with a better sense of empowerment.
Regarding the omega-3 recommendations recently discussed, you all may want to consider that there are several contradictions within that make it very difficult (maybe even impossible) for the average American to follow them. As dietitians, it is important that we understand this math so that we help, not confuse or hurt, people who look to us for advice.
First of all, we are telling people that they are not to eat more than 3 grams of omega-3's per day unless they are under a physician's care. However, if you try to get 1.8 mg of combined EPA + DHA combined, in the form of food first, 3 ounces of Alaskan salmon, which contains 384 mg of EPA plus DHA, would have to be eaten in a DAILY QUANTITY OF 14 ounces in order to get there. Are you really saying that if you're eating enough fish to get the amount of omega-3's we recommend, that the MD has to manage it??? You are unnecessarily putting yourself out of business if you are!!!
Secondly, given those numbers for salmon, the densest seafood source of omega-3's, there is no way eating fish just a few times a week is going to get you to the level of omega-3 intake these recommendations are making. It is so frustrating watching colleagues parrot these recommendations and wondering if we're the only ones who've actually sat down and done this math.
We also went to three popular fish oil brands and calculated out how many pills you would need to get the upper level of DHA + EPA recommended. Two of those, Nordic Naturals and Carlson's, if taken at the level needed to get there, would also place your client at levels you say a physician needs to manage.
Realistically and honestly, how many of you are really doing that?
With regards to bleeding, in all of our collective years actively recommending fish oil, only one client encountered a bleeding problem. The people at greatest risk for that are people who are on medications such as coumadin…and if you work closely with a physician who"gets it"--the dose of that medication can be dropped as EPA levels rise and help normalize blood clotting function. Always start low, titrate up, look closely for symptoms in people not on contraindicated medicatoins and let the MD check blood levels in people who are…and work very hard to minimize omega-6 intake. You'll get a lot more bang out of your omega-3 buck if you focus on the omega 6 to omega 3 ratio than if you only think about one.
If you don't know how to use omega-3's to promote health, you may actually CREATE health risks for your clients, which I don't think any of you want to do.
Here are the numbers from our calculations for your reference.
Amount needed to meet n-3's needed to meet upper DHA + EPA recommendation/total omega-3 content of that amount 3 ounces salmon 14 oz DAILY/15.2 total gms n-3 Nordic Naturals 3.27 capsules/3.6 gm total n-3 Carlson's 3.6 capsules/6.0 gm total n-3 Barlean's 3.0 capsules/2.3 gm total n-3
Monika M. Woolsey, MS, RD Ellen Reiss Goldfarb, RD
My blogger name is hormonewoman; I chose that for a reason. When hormones get out of balance, and out of balance is where they are when we don't take care of ourselves, that's when chronic diseases like PCOS become common…not to mention troublesome.
A relatively new hormone (well, it's been around as long as there have been humans but it's new as far as us scientists knowing it and understanding it) is adiponectin. This hormone helps to combat heart disease and diabetes. And it is apparently sensitive to the kinds of fats we choose to eat.
A population of mice was divided into four groups, each one receiving one of the four following fats: soybean oil, fish oil, coconut oil, or lard. Their biochemical response was measured after 2 days and 60 days on this diet. With every type of fat, except fish oil, adiponectin levels were reduced. Soybean oil and coconut oil produced the most significant reductions.
We're just not going to get around it, are we? Some kinds of fats just aren't health-friendly. Some food options, just need to be passed by.
Bueno AA, Oyama LM, de Oliveira C, Pisani LP, Ribeiro EB, Silveira VL, Oller do Nascimento CM. Effects of different fatty acids and dietary lipids on adiponectin gene expression in 3T3-L1 cells and C57BL/6J mice adipose tissue. Pflugers Arch. 2008 Jan;455(4):701-9. Epub 2007 Aug 24.
This is a guest post by a new member of the inCYST network, registered dietitian Christie Wheeler, MS, RD. Her bio and contact information are located at the end of her article. Medicinal vinegar dates back to Hippocrates with uses ranging from hand washing to treating stomachaches. Most recently, a surge in research on vinegar and its effect on blood sugar has emerged. Dr. Carol Johnston, the Director of the Nutrition Program at Arizona State University, has thoroughly investigated this topic for over 10 years. I happily sat down with her to discuss the conclusions of her research and extrapolate on what it means for women with PCOS.
What are some of the health benefits of vinegar?
Conclusive research shows that when diabetics consumed 1-2 tablespoons of vinegar with a starchy meal, the rise in blood sugar was significantly less compared to people that consumed a placebo with the same meal. Diabetics who regularly consumed vinegar with meals saw a reduction in their hemoglobin A1-C levels, which measures the three month average of blood sugar. Additionally, consistent vinegar consumers saw a lower fasting blood sugar level.
How does vinegar decrease blood sugar levels?
The mechanism by which vinegar prevents a rise in blood sugar after a meal is not yet understood. Acetic acid is the primary acid found in vinegar and is thought to prevent enzymes from digesting starches. Vinegar does not have the same effect of lowering blood sugar after a meal with simple carbohydrates from fruits or refined sugar, as it does a meal including complex carbohydrates from grains, legumes or dairy. It may work by preventing the breakdown of complex carbohydrates, allowing them to pass through the digestive tract without being absorbed or raising blood sugar. A current trial at ASU is testing this theory by measuring nitrogen excreted through the breath, which will show if fermentation of undigested starches is happening in the intestines.
Are the benefits the same for everyone, or is vinegar consumption more important for people with certain conditions?
Since high blood sugar is a risk factor for heart disease and vinegar consumption also lowers blood pressure, research suggests that regular vinegar consumption may protect against, as well as help treat, symptoms related to diabetes and heart disease. One to two tablespoons of vinegar with meals will certainly not harm anyone while the potential benefits make it worthwhile to try.
Are there other foods or beverages high in acetic acid?
Vinegar is used in many recipes and condiments, like mustard and Kombucha (a fermented beverage). These options open for more variety in increasing acetic acid in the diet. While you can opt to buy commercial products that contain vinegar, you can easily make your own as well. Consider adding 2 tablespoons of apple cider vinegar to 16 ounces of water with an ounce of 100% fruit juice or honey. More information about Kombucha may be found here: http://www.wonderdrink.com/news/kombucha-raw-vs-pasteurized/
Being that vinegar is an acid, is there a concern of consuming too much at one time (or in the long-term) that may lead to harmful side-effects?
Current research suggests that vinegar is only helpful for reducing blood sugar levels after a starchy meal. It does not seem to help diets that are already low-glycemic or where the sugars consumed are simple (monosaccharides) versus complex (disaccharides). Therefore, daily ingestion may not be necessary for everyone. It may still be beneficial though, since the American diet tends to be low in fruits and vegetables, high-glycemic, and acidic.
What dose do you recommend? Does it matter what type of vinegar (red wine, balsamic, apple cider, etc.)?
The recommended dose of vinegar is one to two tablespoons at meal-time. Any vinegar works because acetic acid (the defining component of ‘vinegar’) is the active ingredient. Use the vinegar to make dressings (2 parts vinegar + plus 1 part olive oil). Use the dressing on salads, vegetables, sandwiches, or simply for dipping bread.
Any tips for increasing intake?
Make like a Brit and keep vinegar on the dining table!
Vinegar may not be something you need to add into every meal, but beneficial health properties make it a condiment worth enjoying with a heavy hand.
Additional Resources:
Vinegar: Medicinal Uses and Antiglycemic Effect. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1785201/
Vinegar Improves Insulin Sensitivity to a High-Carbohydrate Meal in Subjects With Insulin Resistance or Type 2 Diabetes
Christi Wheeler, MS, RD, works in the nutritional management of special health needs for children, freelance nutrition writing and private nutrition counseling for children and adults. While she enjoys counseling individuals to pursue weight loss goals, her focus has shifted to provide nutrition information in way that is understandable and applicable to all age groups, genders and fitness levels. Christi practices in Phoenix, Arizona. For more information, please visit her website,www.superiorsustenance.com.
I can tell by looking at this blog's visitation statistics that a very high percentage of its visitors are looking for help with an immediate problem that has"hit them where it hurts", so to speak. You may have acne. Or want a child. Or be looking for a successful weight loss plan.
The fact is, however, that sitting in my seat, it is equally important to offer insight and solutions for those problems as it is to educate about the big picture.
The fact is, 10% of women with PCOS will be diabetic by age 40.
The fact is, PCOS increases your risk of heart disease and high blood pressure.
And…since diabetes is increasingly being associated with Alzheimer's disease, the fact is, you may end up being at risk for that as well if you're on this blog looking for help with your acne.
Fortunately, you don't have to do one thing for your fertility, another for your acne, and another to prevent Alzheimer's. All the suggestions you see here work to help all organ systems function better.
And the fact is, there is a whole lot you can do to decrease your risk of having any of the problems mentioned above.
The fact is, you can't decrease your risk if you don't take action. That part of the solution is totally in your control.
In this particular study, the alpha-linolenic acid (ALA)concentrations in fat tissue were evaluated in 1819 people. (ALA is a type of omega-3 fatty acid found in flaxseed, flaxseed oil, soybeans, canola oil, and nuts, to name a few.)
Individuals with higher levels of ALA had a lower risk of heart attack.
The fact is…if you cook more often with canola oil, eat more nuts, put some edamame on your next salad, and/or add some ground flaxseed to your next bowl of oatmeal, you just might experience the same benefits as the people in this study.
If it can't hurt and it might help, there doesn't seem to be a reason not to try at least one of those things!
Campos H, Baylin A, Willett WC. Alpha-linolenic acid and risk of nonfatal acute myocardial infarction. Circulation. 2008 Jul 22;118(4):339-45. Epub 2008 Jul 7.
I've gotten a handful of questions about almonds recently so it seemed like it was time to give them their own personal blog post. It's a good day to talk about the benefits of a handful of almonds, since it's also National Wear Red Day and heart disease is an important risk factor for women with PCOS. They're repeatedly shown to have heart healthy benefits. Eight peer-reviewed studies reported at www.almondsarein.com consistently produced the same results: lower LDL and lower total cholesterol. Other findings included increased HDL, and lower triglycerides.
The disclaimer is that the almonds were used to replace other foods in the diet. In other words, if you know your diet needs some"cleaning up", it won't help to keep eating the problem foods and add the almonds. You need to simultaneously reduce intake of other foods and replace those calories with almonds.
Fortunately, almonds are a tasty snack and can be added to your morning oatmeal, your lunchtime salad, or your favorite muffin recipe. If you'd like to take it one step further and cook more with almonds, the almond people have a great web page with a search engine to give you some ideas.
Polycystic Ovary Syndrome (PCOS) is a complicated, often frustrating condition that affects many women who are experiencing infertility, or may even be a primary cause of infertility. Symptoms typically include recurrent ovarian cysts, excess hair growth (or hair loss similar to male pattern baldness), acne, skin darkening, difficulty losing weight, and, of course, trouble getting pregnant. Often, the condition is not accurately diagnosed until failure to get pregnant results in referral to a reproductive endocrinologist, who has specialized training in PCOS and other endocrine disorders.
Any of these conditions taken singly are difficult to deal with – but the combination is often overwhelming for patients who have been diagnosed with PCOS. PCOS is particularly difficult because it’s under-diagnosed, so you may have years of vaguely troubling symptoms before the diagnosis is made and treatment begins. The physical side effects are unattractive and visible to the world — “I’m fat, pimply, and hairy,” as one of my clients stated tearfully. Friends and relatives may assume that you’re lazy or eat too much, and that’s why you aren’t losing weight. As a result, depression and low self-esteem are very common among women with PCOS.
I was diagnosed with PCOS in my early twenties, and, as both a patient and a professional, I have learned that there are many things you can do to improve the quality of your life and your health with PCOS. You can take control of your health and mood now by doing the following:
Get educated: Do some research on the web, ask your doctor a lot of questions, join a support group and use it, read the RESOLVE newsletter, and stay on top of developments in treatment.
Obtain skilled medical help: Although an internist or general practitioner may diagnose PCOS, it is more likely that a gynecologist, endocrinologist, or reproductive endocrinologist will do so. If you have PCOS, you will most likely want to have an endocrinologist who will prescribe appropriate medications, monitor you for the potential development Type II diabetes, and coordinate with your reproductive endocrinologist while you are trying to get pregnant. Because it is common to experience higher rates of thyroid disorder and heart disease when you have PCOS, it is a good idea to have frequent monitoring.
Your physician can also:
help you lose weight with the assistance of certain medications, and/or referral to a skilled dietician, who can teach you how to eat in a way that contributes to balancing your hormones and managing your symptoms;
refer you to a good dermatologist, who can help to control or eliminate skin conditions related to PCOS, such as skin darkening and acne, and even help with treatments for hair loss;
suggest a therapist or support group to help you cope with the stress of infertility, symptoms of depression, and frustration of dealing with a chronic disease;
Exercise: Yoga will resynchronize your brain, produce deep relaxation, reduce stress, and enhance your acceptance of your body, just as it is in the moment. The cross-lateral motion of walking is also highly effective in regulating PCOS-related insulin resistance, controlling weight – and, surprise! – resynchronizing your brain waves.
Look better so you feel better: In addition to seeking the help of a dermatologist for skin and hair conditions, you might want to actively manage excess hair growth cosmetically. There are many ways to do this, but electrolysis is the only method that has been proven permanent. A licensed electrologist will have a great deal of experience with PCOS patients. Your dermatologist can provide you with a reliable referral.
Although weight gain around the middle is frustrating and hard to overcome when you have PCOS, you can learn how to dress well, no matter your size or shape – and you deserve to do so! Seek out current fashions that are figure-friendly, and get help when you need it – if you’re just not good at putting outfits together, ask a friend who is good at it to go shopping with you, use the free services of a department store personal shopper, or spring for a stylist who will help you figure out what works on you.
Don’t forget your brain: Education is only one element of what your mind needs to effectively cope with the stress of PCOS. Sometimes friends, partners, and physicians aren’t quite enough to help you work through your anger, frustration, irritability, and sadness about having PCOS, not being able to get pregnant, or the difficulty you experience losing weight in spite eating well and exercising regularly. A licensed counselor or therapist can help you decrease stress, develop personalized coping methods, enhance your support group, and identify additional resources. Many therapists utilize mind/body methods that include meditation, guided visualization, mindfulness, and other ways of supplementing your good health practices.
By actively taking care of your physical and mental health and appearance, you can learn to feel better by knowing that you are doing the best you can with a challenging condition.
Dr. Gretchen Kubacky is a licensed clinical psychologist in private practice in West Los Angeles. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders. If you would like to learn more about Dr. HOUSE or her practice, please visit her website atwww.drhousemd.com, or e-mail her atGretchen@drhousemd.com.
Reprint permission granted by RESOLVE: The National Infertility Association, 2009.www.resolve.org.
Our network is pretty busy in the media! Today I thought I'd give you some links to some of the great things you'll find in print, online, and on television. As you can see, they love their stuff and they know their stuff. If you are in search of someone to hep you with your nutrition goals, please consider one of these professionals.
From Sally Hara, MS, RD, CSSD, CDE, Kirkland, Washington: Carb-Loading Tips (and other nutrition hints) For Endurance Events
From Sarah Jones, RYT, Phoenix, Arizona: Free yoga class featuring Sarah Jones, RYT, at Lululemon Athletic, Biltmore
From Meri Raffetto, RD, Temecula, California Grilled Corn and Avocado Salad
From Danielle Omar, MS, RD, Fairfax, Virginia Brazilian Passion Fruit Mousse
From Debra Benfield, MS, RD, Winston-Salem, North Carolina How Developing Awareness (and Eating Lunch Away from Your Desk) Can Change Your Body and Life
From Linda Caley, MS, RD, Colchester, Connecticut Review of beverages on Better Connecticut
From Hana Feeney, MS, RD, CSSD, Tucson, Arizona Keeping Hydrated During the Heat on KVOA-TV
From Monika Woolsey, MS, RD, Phoenix, Arizona Explosion of Interest in Eating Locally and Veganism Embrace the slime! Juice, roast, grill okra for health benefits That's just peachy: stone fruits plum good for diabetes, heart disease, obesity California's senators vote for open GMO labeling, other states not so fortunate
I have, or think I have, Polycystic Ovarian Syndrome (PCOS). In any case, I have a lot of symptoms that make my uncomfortable physically and mentally, and I really need your support on this one. Please know:
• I’ve been through a lot. Most doctors haven’t diagnosed me correctly, and I’ve had to deal with a lot of challenges getting to a place where I can try a new doctor, and have some trust that it might actually go well this time.
• I may have one or more female relatives who were undiagnosed and/or untreated for PCOS, and/or who died as a result of PCOS-related complications, such as heart disease, diabetes, or endometrial cancer. I may appear to be fearful and over-anxious as a result.
• I’m frustrated with how long it’s taken to get a diagnosis, not having complete information, and being treated as if my PCOS isn’t an important medical condition.
• I need to be treated with respect, especially when I describe symptoms that don’t make sense to you, or don’t fit the pattern. I need you to stretch your imagination, and ask even more probing questions.
• I may have medical trauma, especially if I’ve had lots of surgeries, one or more miscarriages, failed IVF attempts, a long bout with assisted reproductive technology, or if I received several diagnoses simultaneously. I’m trying not to be scared of you, but I’ve been poked, prodded, questioned, and inspected about as much as I can handle. I’m tired of having blood drawn, trying new prescriptions that don’t work or have horrible side effects, and having to show up at the gynecologist’s office a whole lot more than once a year. I’m tired of devoting huge chunks of my time, income, and emotional resources to chasing after a remedy or a cure. That doesn’t mean I’m not willing to do more, but it does mean that it may take me a bit to adjust to the idea of MORE.
• I need you to be patient while we’re figuring this out, and not give up on me. I understand from talking to other women with PCOS that it can take a while, a number of blood and fasting glucose tests, and some consultation before you can determine for sure that I have PCOS. I also know that sometimes you can’t be 100% sure, but maybe I need the same medical treatment anyway. I’m prepared for that, and I need to know you’re not going to get bored with my case before we’ve figured it out.
• I do my research. I’ve read books and articles about PCOS, and I follow a few blogs and chat boards about PCOS, so I know what other women with PCOS are going through. I know I’m not a doctor, but I may bring you information or questions gleaned from these sources. I hope you’ll take it seriously.
• I have valid opinions about what’s best for me, and sometimes that doesn’t mean traditional western medical care, or prescription medications. Right now, I’m open-minded, and I promise to keep you informed about anything else I’m trying. I hope you’ll support me as I try natural alternatives, dietary management, etc. And if you think something I want to try is actually dangerous to my health, please don’t pull any punches.
• I respect your input, and I still may need time to consider whether your recommendations are what’s best for me. It can be really overwhelming to be in your office, considering a lot of new information, and having to make what feels like very important decisions. Sometimes, I may bring a friend or my significant other with me, to help me stay focused. I still may need additional time to consider the options, and do my own research before I make a decision.
• I need you to be my healthcare partner, and my advocate. I view this as teamwork. You’re the one with the most knowledge about bodies in general, but it’s my body, and I’m definitely the expert on my body. Some other doctors don’t get that, and I need you to advocate on my behalf with them, especially on very important matters, like surgical decisions.
• I need you to be upfront about what this means for my health in the long run. I am willing to do the work to get well and stay well, but I need the big picture. I can’t make appropriate decisions without it. Don’t be afraid of scaring me. I can handle it (even if I do get a little upset in the moment).
• I need you to be aware that it’s very common for women with PCOS to have depression or other mood disorders, and to screen me appropriately, and sometimes with frequency. I need you to be fearless about making referrals when appropriate – and that includes mental health care. If I need a health psychologist, a support group, or some other form of therapy, please tell me so. Thank you!
Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.
If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at Gretchen@drhousemd.com. You can also follow her on Twitter @askdrhousemd.
I've invited the members of our Facebook fan page to ask questions, and here is the first one we got. Here is a little primer on triglycerides.
When you get your cholesterol reading, something that is measured is a type of fat called a triglyceride. What this is, is a type of fat the body uses to carry extra calories in the blood. If you're eating calories in greater quantities than the liver can process them, they hang around in your blood waiting in line to be taken care of. Sometimes that gets measured in a blood test, because high triglycerides are associated with increased risk of heart disease.
Triglycerides' favorite place to be stored, is in the belly, which is why people with high triglycerides often have an apple-shaped body type.
And what is really interesting about high triglycerides, is that they are a place your body can store DHA, that chemical you see me write a lot about here, because it is essential for healthy memory, problem solving, and overall brain function.
Modern medicine tends to think of high triglycerides as a problem that needs to be fixed. I tend to think of high triglycerides as a strong indicator that your life and eating habits are out of balance. They respond extremely well to pulling yourself back into moderation; therefore, I strongly encourage you to take a look at the list of changes you can make, summarized here, and give them your best college try before resorting to medication.
1. Excess calories, in general, all day long. If you are a compulsive overeater, your intake may simply exceed your body's ability to keep up. You don't need to starve yourself, however. Rather, start to explore the reasons why food is so prevalent in your life, begin to tackle the reasons why, replace triglycerides with other activities and coping behaviors that are not so hard on your liver.
2. Stacking too many calories at one time of day. Are you on Weight Watchers…with a tendency to deny yourself food earlier in the day so you can indulge later on? Your liver is not much different from the engine in your car. You can't simply dump fuel into the system and expect it to run efficiently. Your car has a carburetor to regulate the rate at which the engine gets gasoline. When it starts to run too rich, your engine doesn't run well. The only carburetor humans have is a behavioral one…remember, it isn't just about how many calories you eat in the course of a day. It's how you spread them out to up your liver's efficiency.
3. Eating too much sugar. Sugar is so quickly and easily absorbed, that eating too much of it can leave too many calories in the system at once. You still need carbohydrates to fuel your brain and muscle, but the other type of carburetor you have is something called a complex carbohydrate. It takes longer to absorb and digest, therefore slowing down the entrance of those carbs into your system. In general, low glycemic foods also help triglycerides. You know what those are from paying attention to insulin resistance. Eat more of them!
4. Drinking too much alcohol. Alcohol has 7 calories per gram, and it adds up quickly! We don't talk much about alcohol here, but if you are using it to cope, and you have a love of sweetened drinks, you're getting a double whammy. Alchohol is best used in moderation and best used as an accompaniment to a healthy meal. Happy hour drinking, which encourages less control over high fat, high calorie foods, is likely to render you vulnerable to higher triglyceride readings.
5. Not getting enough"effective" omega-3 in your diet. I use the word effective to remind you that if all you do is add omega-3 to your diet without reducing omega-6, the latter will keep the former from having any effect. You have to do both. Physicians will often tell you that the dose of omega-3 you need is too high to be safe, and that you need medication in order to achieve this. I beg to differ, as I have seen, many times, that when you add the fish and fish oil, and reduce the"s" and"c" oils, triglycerides do drop. I have come to believe that since DHA is so important for brain function, when our omega-6 to omega-3 ratio is so high that the brain starts to be at risk for having what it needs to do its job, the body starts creating triglycerides as a desperate attempt to hang on to what omega-3 it has. When you don't need triglycerides as a last-ditch effort, your body won't have to make them.
6. Not enough exercise. One of the benefits of physical activity is that because it requires you to use calories as fuel, it trains your body to use calories. So when you eat them, your body is more likely to use them efficiently. Get out and move, even a little bit at first, but get in the habit!
7. Of course, there are people with genetically high triglycerides who DO need to be on medication. But if you have not tried the suggestions listed above in an attempt to reduce your triglycerides, please try them first before adding another medication to your lineup. And if you do decide to use medication, don't use that as an excuse to eat whatever you want. Eating as best as you can, can help to reduce the amount of medication you DO need to manage your problem.
When you’re first diagnosed with PCOS, it seems overwhelming. Depending upon how you were diagnosed (with or without sensitivity, by someone knowledgeable or someone clueless, in the midst of an infertility crisis, etc.), you might not have been able to absorb any helpful information that was given to you. You might have been overwhelmed, and felt hard pressed to simply do what the doctor was telling you to do in that moment. Or maybe you got into fighting mode, and immediately ordered a bunch of books, read all the medical pamphlets, and found every website dedicated to educating you about PCOS.
Either way, you may have gotten caught up in being too macro or too micro in how you manage your PCOS. By macro, I mean, seeing the big picture, like knowing you need to lose weight, prevent heart disease, and try to stave off diabetes, but not really getting the details of how exactly you’re supposed to achieve those goals. By micro, I mean, you found information of evidence of some details of PCOS treatment – tidbits of information like: eat low glycemic, take fish oil, maybe inositol helps, soy can be a thyro-toxin, etc. You dutifully apply these bits and pieces as you find them, and you may or may not feel better, but still, you don’t really have a clear concept of why you’re doing all these things. You’re just doing them because someone, somewhere, suggested they might be helpful. So step back a bit to see the big picture if you’re caught up in details, and drill down a bit for more detail if you can’t seem to get a grasp on what you need to do, or are caught up in a panic of possibilities.
Self-care is like the financial world. You’ve had a meeting with a financial advisor, or you’ve read enough articles to get the concepts: slow but steady wins the race; your financial future shouldn’t be based on just one investment but should be multi-pronged; a little bit is better than nothing, it pays to watch for hidden fees; and so on. Translating this into self-care terms, I’d say almost the same things: slow but steady wins the race; one supplement or one exercise isn’t the cure-all; doing as much as you can, even if it’s just a little bit, is better than doing nothing; and it’s important to watch out for people who aren’t motivated by your best interests, and who just want to make a buck from your suffering.
PCOS self-care is a life-long project. If you don’t have a solid base, the structure will topple (kind of like the financial structure in this country and many other parts of the world). You need a good plan, and good advisors for creating a personalized nutrition plan, taking care of your mental health, getting enough of the right kinds of exercise, and getting plenty of sleep. If these basics aren’t in place, it won’t matter how many stress management techniques you practice, or which supplements you take, or which specialists you see. Meditation can’t fix five hours a night of sleep. Supplements can’t fix a steady diet of junk. A naturopath can’t re-regulate your body if you’re smoking or doing drugs. It’s pretty simple – build the foundation first, then the rest of the structure will follow naturally. Embellish later, when you’re feeling pretty good with the whole situation. You don’t decorate a house before it’s built. And so it is with PCOS self-care.
Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She has completed the inCYST training. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.
If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at AskDrHouseMD@gmail.com. You can also follow her on Twitter @askdrhousemd.
Bisphenol-A (BPA) is everywhere. In addition to cans and plastic packaging, it is found in thermal paper and carbonless copy paper, which are commonly used for receipts, airline tickets, event tickets, and labels. It is so ubiquitous that it was found in the urine of 95% of all people the CDC tested between 1988-1994.
One study found a strong correlation between body mass index (BMI) and BPA levels. That, to a dietitian, seems like a vicious cycle, since a lot of the foods I personally believe are associated with obesity (sodas, chips) are packaged in BPA-containing materials. So not only do you expose yourself to the chemical when exposing those foods and beverages…you are highly likely encouraging your body to hang on to those chemicals if you're eating them in a way that is out of balance with your daily caloric needs.
Staying lean, however, is not a guarantee you'll be protected. It is looking like BPA can elevate liver enzymes, a common problem with PCOS. And that problem persists even in normal weight individuals.
Scientists do believe BPA passes through the body very quickly. However, some of the problems associated with BPA seem to be nonreversible. And unborn babies and newborns, who are going through rapid development, seem to be highly susceptible to this effect. That means that you can reduce your exposure to BPA and lower your current levels, but you may not be able to undo all of the changes that BPA had the opportunity to make. You can eliminate future problems…but you may not be able to undo all that's been done.
I really want this blog to be positive and not scary. However, this is a very serious issue. Since many of you are eating to conceive and eventually eating for more than yourself, it's important to understand that how you choose to eat can impact more than just you. And it's not just about eating to conceive…it's about eating for a healthier next generation.
The less packaging your food comes in, over time, the less likely it is you'll be consuming BPA.
Gehring, Martin; Tennhardt, L., Vogel, D., Weltin, D., Bilitewski, B. (2004) (PDF). Bisphenol A Contamination of Wastepaper, Cellulose and Recycled Paper Products. Waste Management and the Environment II. WIT Transactions on Ecology and the Environment, vol. 78. WIT Press. http://rcswww.urz.tu-dresden.de/~gehring/deutsch/dt/vortr/040929ge.pdf. Retrieved 2009-10-15.
Yesterday I introduced you to Nightly Beauty by Beauty Foods, a nutricosmetic primarily designed for improving skin health and appearance. I shared my own experience with this product while investigating its potential for PCOS. Hopefully my photos got your attention enough to want to read more! Today I'd like to share some of the science behind my thoughts.
Women with PCOS are struggling with inflammation. It hits everywhere, not just the ovaries. It causes diabetes, heart disease, depression. That much you know. It also ages skin more quickly than it should be aging. So other body tissues break down and aren't readily replaced. Your most important strategy, of course, is to reduce the inflammatory process with the kinds of choices we encourage here on this blog.
Nightly Beauty enhances that process with a few additional ingredients, BioCollagen and hyaluronic acid that aren't easy to correct with simple dietary changes.
Collagen
Collagen is one of the major components of skin. It's only been recently that it's been confirmed through research that supplementing the diet with collagen actually helps skin collagen. Right as we were preparing to post these blog entries, BioCell Technology, maker of the collagen in Nightly Beauty, distributed a press release announcing that the first human study of their collagen supplement confirmed that it actually does increase collagen levels in skin (types I and III). In their words,"results of the study showed that a majority of the participants experienced a remarkable improvement in skin texture, together with hydration, reduced scaling, and improved blood microcirculation".
Of course, since I've had the opportunity to experience this myself as I reported yesterday, I love this! However, this is just the wonderful side effect. There's something even more important for PCOS. Another inflammatory disorder many of you struggle with is arthritis. And when your joints hurt, you can't exercise. BioCell Collagen supplementation has also been proven to increase collagen type II, which is the type of collagen found in joints. They report that joint discomfort and stiffness in research subjects reduced by as much as 40% in 8 weeks.
Your faces are precious, but your quality of life matters more to me. If you can move, you can help your PCOS. If you can help your PCOS, you're more likely to feel better about yourself. This is the main reason I picked up the phone and called Jacque in the first place, I saw its potential for all of you writing and telling me that your joints hurt and no one was connecting it to your primary problem — inflammation.
Hyaluronic Acid
Hyaluronic acid, or HA, is known in the beauty world as the plumper. Many women take HA supplements to plump their lips. It also pulls water into skin, helping to plump and hydrate.
But did you know, HA is also a major component of the gelatinous fluid in your eyes? It's what helps to hold fluid in the eyeball. I didn't, until I started researching Nightly Beauty. Several months prior, I'd noticed my eyes were feeling dry, despite my faithful use of fish oils and upping my fluid intake. It didn't hit me until I started reading about HA and eyes that not long after I started taking this product my dry eyes started improving. Considerably. So I started reading more. Women with PCOS actually do experience more dry eye syndrome than women who don't.
There is considerable research into ways to deliver more hyaluronic acid to eyes, including eye drops and even controlled-release contact lenses. I'm having trouble finding any research either supporting or negating hyaluronic acid supplementation as a potential route of administration…but I'm not surprised. Nutrition is often an afterthought in research problem solving.
This product has not been researched specifically for dry eyes or for PCOS, but for women who are interested in trying something that has documented benefit for other PCOS-related symptoms and who also have dry eyes, it couldn't hurt to try it. I must state that Beauty Foods is NOT making health claims about this product. I am, in this blog post, reporting my personal experience and connecting research relevant to the product for my specific intended audience, independently of them.
If you do choose to try it, and you experience benefits, please let me know. I'd like to keep a running total of results and perhaps…include it as something we research at our new institute.
If you'd like to try Nightly Beauty for yourself, it's on sale this week at http://www.jpselects.com/. It's also available at http://www.beautyfoods.com/.
Let us know what you think!
Collagen-containing nutricosmetic shown to combat aging. http://www.cosmeticsdesign-europe.com/ http://www.cosmeticsdesign-europe.com/Formulation-Science/Collagen-containing-nutricosmetic-shown-to-combat-aging
Bonini S, Mantelli F, Moretti C, Lambiase A, Bonini S, Micera A. Itchy-dry eye associated with polycystic ovary syndrome. Am J Ophthalmol. 2007 May;143(5):763-771. Epub 2007 Mar 23.
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I am so grateful I went to the educational meeting yesterday I almost didn't attend! For the majority of my career, the health benefits of vinegar is something that hasn't been taken seriously by colleagues in my profession. But when I saw the presenter for this topic was respected Arizona State University nutrition researcher Carol Johnston, I figured it was worth going to hear what she had to say.
Turns out, Dr. Johnston, a few years ago, while working on another project, quite by accident, found an obscure research article reporting that vinegar may be helpful in reducing insulin resistance. She decided to pick up on where the study left off, and what she has learned with her work has a lot of pertinence to PCOS.
One of the goals of better insulin function is to reduce a reading known as"postprandial blood glucose"…that is, the blood glucose reading you see after eating a meal. This reading can be important, because high numbers have been associated with heart disease as well as excessive baby weight gain in pregnancy (macrosomia). For those of you who experience the phenomenon of being hungry after eating a meal, part of the reason may be a high postprandial blood glucose.
Dr. Johnston's first study used nondiabetic subjects who were divided into two groups: insulin resistant and non-insulin resistant. None of these individuals were taking diabetes medications. If they were in the test group, they were asked to drink 20 grams of apple cider vinegar, wait 2 minutes, and then eat a (pretty high glycemic) test meal of a white bagel, butter, and orange juice. Both groups tried the vinegar and no vinegar protocols. Blood glucose 30 and 60 minutes later was measured.
They found that when vinegar was consumed before a meal, postprandial blood glucose was significantly reduced. Dr. Johnston proposes that vinegar actually may have activity similar to that of Precose or metformin. While she used apple cider vinegar in her studies, she shared that any vinegar will have the same effect. So whatever your preference, rice, balsamic, wine, or raspberry…get creative in the kitchen!
She also clarified that the difference between the action of cinnamon and vinegar is that cinnamon reduces fasting glucose and vinegar reduces postprandial glucose. So you can use both if you wish, they're not going to replace each others' benefit…they may actually complement each other.
It's important if you choose to try this, and you're on medication, to share this with your physician. The results may significantly affect the dose of medication you need. I can pretty much bet most physicians aren't informed about this, and since I was skeptical until yesterday myself, I'm providing all of the references used to write this article for anyone to download and share. The journals in which they were published are respected ones.
A really important caveat: you can overdo this advice. Large amounts of vinegar over time can cause low grade metabolic acidosis (Dr. Johnston studied this too, knowing the mentality of dieters and people desperate to get off of meds.), which is associated with osteoporosis. This acidosis can be prevented by making sure your diet has a good amount of high-potassium foods. Since those are notably fruits and vegetables, the obvious practical way to use this information is to eat a nice salad with each meal, topped with a vinaigrette dressing. Dr. Johnston recommends a ratio of 2 parts vinegar, 1 part oil, the reverse of what is traditionally used.
Keep in mind too, if you're planning to go to the health food store and buy the vinegar pills…they aren't going to work. Dr. Johnston did three separate studies with them (because she was so surprised they didn't work and she was so convinced they would), and did not get the same results the original vinegar produced.
We had the opportunity to try a new product by Bragg's, a line of vinegar beverages. inCYST intern Sarah Jones and I tried the apple-cinnamon and the concord grape-acai flavors. Both of us felt the drink was a little much to consume as packaged, but they would be fun to use in vinaigrettes, marinades, etc., in the kitchen. I'm going to try some recipes this weekend.
Keep in mind too, that any favorite foods made with vinegar will also be beneficial! Pickles, sauerkraut, Korean kimchi, there are many cultural favorites that can make this fun! Think of ways vinegar can be added to your own marinades and flip the oil to vinegar ratio.
If you're really adventurous, or just want a fun party gag, try these pickle pops we sampled yesterday! Sarah was not so keen on them but I'm German and found it pretty tasty. When I looked this up for you all,, I discovered there is even a jalapeno flavor. That's pushing it even for me, but hey, there's something for everyone.: )
Check back with us too if you're actually measuring your blood glucose after meals and let us know if this was helpful!
The cost of diabetes medications can exceed $6,000 per year, per person. And one of every 8 federal health care dollars, ($79.7 billion annually), is spent on diabetes care. Imagine what we could do to our personal budgets, not to mention that nagging national debt, if we all just walked into Costco and invested in an industrial-sized bottle of vinegar…
Ebihara K, Nakajima A. Effect of acetic acid and vinegar on blood glucose and insulin responses to orally administered sucrose and starch Agric Biol Chem 52: 1311-1312, 1988.
Johnston CS, Kim CM, Buller AJ. Vinegar improves insulin sensitivity to a high-carbohydrate meal in subjects with insulin resistance or type 2 diabetes. Diabetes Care 2004: Jan 27(1); 281-2.
White AM, Johnston CS. Vinegar ingestion at bedtime moderates waking glucose concentrations in adults with well-controlled type 2 diabetes. Diabetes Care. 2007 Nov;30(11):2814-5. Johnston CS, White AM, Kent SM. A preliminary evaluation of the safety and tolerance of medicinally ingested vinegar in individuals with type 2 diabetes. J Med Food. 2008 Mar;11(1):179-83.
Johnston CS, White AM, Kent SM. Preliminary evidence that regular vinegar ingestion favorably influences hemoglobin A1c values in individuals with type 2 diabetes mellitus. Diabetes Res Clin Pract. 2009 May;84(2):e15-7. Johnston CS, Steplewska I, Long CA, Harris LN, Ryals RH. Examination of the antiglycemic properties of vinegar in healthy adults. Ann Nutr Metab. 2010;56(1):74-9.
6:30 a.m., Miami International Airport, feeling jet-lagged and just about destroyed from over 24 hours of travel, I looked through my stupor at the people who have come to reside in my head as “The Airport Couple,” a poignant lesson in what happens when you don’t take care of yourself. I love to people-watch at the airport, but this was not my usual people-watching.
They both have canes, are morbidly obese, and have extra-large sodas and pound bags of candy – plain M&Ms for her, peanut for him. The breakfast of champions, especially if it’s Diet Coke. They are struggling to breathe, to move, to walk, and even to eat the candy, yet they persevere. They both have an unhealthy pallor that comes more from poor health than bad airport lighting. Neither one makes eye contact with anyone else, not even their spouse. Their isolation, even in the midst of dozens of people, is profound.
Their misery and shame is palpable, and I feel like I should avert my eyes from their pain, and the practice of their addiction to food/sugar. It hurts to watch them, but I am unable to stop glancing sideways at them, in the way that children do when they notice a grotesquely fat or deformed person and simply cannot keep themselves from staring. I am wondering how they are going to make it onto the plane, and if they’ll even survive the flight, let alone whatever comes next. Selfishly, I hope I won’t have to spend the next six hours stuck sitting next to one or both of them. I feel intense sadness for the way that they’re trapped in their bodies, in their diseases, and their disconnection. I wonder which diseases they have, and how many. I make assumptions about diabetes, thyroid disorders, cholesterol problems, and heart disease. As time passes, and my flight is delayed, I add gout, emphysema, and of course depression to the list.
She is probably 52, but looks closer to 70. Walking is laborious, studied, and painful. Her thighs are so fat that her ability to walk a straight line is distorted. Yet she proceeds to the nearest shop to purchase more snacks for him; clearly, this is a form of care-giving. I think he is older, although it is hard to tell. He is almost immobilized, stuck in the confines of the narrow, hard-railed bench/chairs that are uncomfortable even for people of average size. I look for an oxygen tank, certain that must be part of their apparatus. He is wearing extra thickly cushioned diabetic shoes. I wonder about toe amputations. I think long and hard about this human catastrophe, and how preventable almost all of it is.
We struggle, day in and day out, to manage our PCOS, and whatever other diagnoses come with it. We get tired of eating right, limiting sugar and other carbs, avoiding alcohol and grain-fed meat, getting up at 5:30 a.m. to make it to the gym, taking supplements, and going to the doctor quarterly for check-ups. We complain that it isn’t fair that we’re stuck with this condition. We deal with, or don’t deal with, our depression, our anxiety, our obsessions and compulsions, or the thoughts that we might be bipolar. We adhere to diets and violate the diets. We struggle, and wonder why. I’ll tell you why – you don’t want to be The Airport Couple.
Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She has completed the inCYST training. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.
If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at AskDrHouseMD@gmail.com. You can also follow her on Twitter @askdrhousemd.
You may know of melatonin as a potent sleep aid. So much so, that if you took melatonin and you did not experience an enhanced ability to sleep, you stopped taking it.
Did you know, melatonin is a very powerful antioxidant as well? Some of the benefits of this compound relevant to PCOS include:
--lowered blood pressure --improved memory --reduced adrenal gland activity and cortisol secretion --reduced cortisol response to stress --reduced blood glucose, insulin levels, and insulin response to a glucose load --reduced cholesterol and triglycerides --reduced testosterone levels --increased progesterone synthesis --slows gastric emptying (which can help you to feel fuller, longer)
That's a lot of stuff! And it's not just not sleeping well that interferes with melatonin metabolism. So does fasting and starvation…which includes any kind of radical diet, including the medically supervised ones and the HCG ones. Melatonin levels in all three types of eating disorders, anorexia, bulimia, and binge eating disorder, are disrupted. Obesity suppresses normal melatonin daily rhythms. Omega-3 deficiency reduces melatonin synthesis and total tissue levels.
Vitamin deficiencies such as B12, zinc, and magnesium, can interfere with good melatonin status. When I read that, I immediately thought of the many vegetarians reading this blog, as those are common deficiencies when vegetarian eating is not proactively balanced.
Normal melatonin metabolism may be dependent on physical activity.
I'm well aware that many people reading this blog are looking for a magic supplement to erase the need for making healthy lifestyle choices. If you choose to supplement with melatonin, it likely will not hurt you, and it may help you to restore normal sleep patterns, but it will never replace the power of regular, adequate sleep. Just sayin'.: )
If you've never used melatonin before, and you decide to start, you may want to try it on a night when it's not essential that you be up and functioning early the next day. It can have a paradoxical reaction in some people.
And, if you happen to be a professional pilot, the FAA advises against using melatonin while on duty. It certainly wouldn't hurt on your days off, especially if you've been on some grueling red eye flights, just beware of this disclaimer while officially on duty.
I have an extensive list of references I've collected from which this blog post was derived. If you would like them you can contact me directly.
Bottom line, if you don't value sleep, your body is going to have a really, really, really hard time being healthy.
Practically ever client I have ever had, has come to me with some kind of expectation that the secret to their weight problem/eating disorder/heart disease lies in a magical set of recipes filed away on my computer. If I don't hand them recipes, they feel as though I have failed them.
It's not that I don't mind creating recipes, in fact, it is one of my very favorite things to do! But I feel as if I give you too much structure in what I encourage you to do, you miss the point of cooking. And I feed the delusion that some specific set of instructions on a piece of paper is going to magically fix your problem.
So today I thought I would share what my morning has been like. I hope you will see, that the best kitchen inspirations come from the most surprising places. You often have to put the recipes away in order to see them.
My culinary challenge this week for Chow Locally is developing recipes for mustard greens. My big barrier to this challenge is that try I as I might, and trust me, I have done so many, many times, I just can't get into mustard greens. They are pretty bitter to my palate. But since we have about 125 customers wanting to know what to do with the mustard greens we gave them, and since mustard greens grow pretty well in Phoenix, I got the feeling the Universe decided to tell me it was time to cut the mustard (Ha! Couldn't resist!)
I didn't snap my fingers on this one. I am pretty sure by now, in fact, I have read every single blog post about mustard greens, looking for ideas that sounded like they might work for a wide spectrum of taste buds. When I woke up this morning, needed to try a recipe, I had no idea what I was going to do.
In typical procrastinator's style, I decided to clean my kitchen instead. And…there sat inspiration #1: a couple of inches of stale beer that I was not able to finish last night. It was tasty, a local brewery's White Chocolate Ale, and I didn't want to throw it away. I realized since it was sweet I could get away with less sugar, which I had been thinking of using.
On the way but not totally there, I decided to procrastinate even more by working on my pile of samples from Expo West. This is what my living room floor looks like for about 2 weeks after I get home!
Out from the pile popped my collection of samples from a great family-owned business over in Orange County, Matt's Munchies. They have created a fun variety of healthy fruit leathers. The ginger spice, which is really a ginger and cinnamon-laced mango leather, became ingredient #3.
I poured the beer in a skillet, heated it up to dissolve the mango leather, and then put my chopped mustard greens in to let them braise. I cooked them all the way down until the sugars started to caramelize.
OK, I lied, it did use recipes in this process…but not in the way you are thinking. Because I'd read literally hundreds of recipes in search of inspiration, I noticed that a lot of Indian recipes for greens incorporate just a touch of brown sugar. So I knew if my concoction had something sweet in it, it would caramelize and offset the bitterness that make mustard greens challenging for me. I am not going to give you any more instructions than this, and you won't get a nutrition analysis. You all know the ingredients here are good ones, and to give you more of a script defeats the purpose of my nudging you to free yourselves of overly rigid behavior in the kitchen. I promise you, your very favorite foods will be the ones where you left the script and started having some fun!
Finally, I threw in just a touch of sweetened coconut flakes for color and texture.
