The Hemp Connection [Search results for lactation] 

As you know, we're big on breastfeeding at inCYST. We believe it helps reduce the susceptibility to PCOS, we believe incorrect nutrition information deters women from doing it, and we believe that doing it improves the health of mom as well as baby. We're also very concerned about how few physicians, dietitians, nurses, and other health professionals simply do not know that PCOS can make it difficult to breastfeed. We'd like to be a part of changing that.

I received a letter from the United States Breastfeeding Committee that explains some of the important work they are doing, along with a link to donate to their cause.

If your life has ever been personally touched by a lactation consultant, if our work at inCYST encouraged you to breastfeed, or if you simply believe in what these hard working yet often unrecognized health professionals do, consider honoring their labor this holiday with a donation using the provided link.

Dear Friend,

The United States Breastfeeding Committee is committed to ensuring that working women and their families receive the support they need to have optimal breastfeeding experiences. This Labor Day we are thrilled to celebrate our new national workplace support law by sharing a story of one mother's experience of making breastfeeding work:

"I always expected to be a stay-at-home mother, but after years of working at SAS my perspective began to change. SAS made it so easy to continue working by offering benefits such as on-site childcare, on-site health care, breastfeeding seminars, lactation rooms, lactation consultants and more. In the seminars, I learned about the health benefits to me and my child as well as the bonding opportunities that breastfeeding provides. I truly got the sense that this was something that my employer wanted my child and me to be able to experience. They encouraged me to breastfeed not only for my benefit, but for theirs as well. They understood the benefits for businesses--healthier babies mean less employee time away from work tending to sick children. Happier, healthier moms mean more productive workers.

When each of my children was born, we met with the lactation consultants several times in the on-site health care center. This helped ensure that breastfeeding was off to a good start and gave me confidence in my ability to breastfeed. Upon returning to work, I was able to nurse my two children for the first year of their lives. In the beginning, I walked to the child care center 2-3 times per day. I'd sit with other moms in the nursing room, which has a home-like atmosphere complete with couches, soft music and lighting--just the right environment conducive to nursing infants. (They even deliver lunch from the SAS cafeteria, if you so choose.) I was away from work for about 30 minutes each time. As the months passed, we transitioned to one feeding during my lunch hour. If I wasn't able to make it over for a feeding, I could pump in the privacy of my locked office or lactation room. The flexibility was priceless.

I cherish this time spent with my children. I felt connected to them rather than conflicted about being a working mom. If SAS didn't provide such a wonderful environment, I may have made a different decision about being a working mom. My hope is that every mom is able to enjoy the benefits of breastfeeding their children while still contributing to the working world."

- Leslie W. Anderson, SAS

With the inclusion of the workplace breastfeeding support provision in the Patient Protection and Affordable Care Act, the U.S. joins the rest of the industrialized world in providing breastfeeding mothers with break time and a private location to express breast milk during the workday. The new law marks a turning point in our efforts to ensure that"breastfeeding works" for all moms like it did for Leslie. In passing this provision, our federal government has clearly recognized that breastfeeding support in the workplace is a win-win for families and employers!

But the work doesn't stop when the law is passed…

The Department of Labor (DOL) is tasked with implementation of the new law, and the DOL Wage and Hour Division recently issued a preliminary online Fact Sheet. USBC has prepared guidance and recommendations for the Wage and Hour Division and continues to work with the DOL and other partners on implementation and promotion of the new law.

Please consider DONATING NOW to support USBC in this important work!

Many of USBC's critical programs, and especially our policy and advocacy activities, are funded solely by donations from the Friends of USBC. Your contribution can really have an impact at this critical time to strengthen our efforts to ensure"breastfeeding works" for working moms. Please consider becoming a Friend of USBC by making a donation today!

We look forward to our continued work together and thank you in advance for your support. Together we are making a difference for working families!

Sincerely,

Robin W. Stanton, MA, RD, LD
Chair

United States Breastfeeding Committee
2025 M Street, NW, Suite 800
Washington, DC 20036

Phone: 202/367-1132
Fax: 202/367-2132
E-mail: office@usbreastfeeding.org
Web: www.usbreastfeeding.org

The United States Breastfeeding Committee (USBC) is an independent nonprofit coalition of more than 40 nationally influential professional, educational, and governmental organizations. Representing over a million concerned professionals and the families they serve, USBC and its member organizations share a common mission to improve the Nation's health by working collaboratively to protect, promote, and support breastfeeding. For more information about USBC, visit www.usbreastfeeding.org.

I am very excited to announce the beginning of what will be an ongoing and productive partnership with professional lactation consultants. On April 28, 2009, I will be presenting at a meeting of lactation consultants at Kaiser Hospital in Oakland, California.

The presentation will include:
--a basic introduction to polycystic ovary syndrome
--the importance of nutrition for minimizing risks of pre-eclampsia, gestational diabetes, and premature delivery
--the importance of nutrition for minimizing risks of lactation problems, postpartum depression, and sleep issues in newborn babies.

Lactation consultants are a crucial link in the identification and management of PCOS, and I am thrilled to be able to meet with this group in California to begin networking and learning how we can support each other in our respective work.

I will be posting more information about this presentation on my website as it becomes available: www.afterthediet.com/inCYST.htm.

I am especially grateful to Pat Ross, who has orchestrated this meeting and laid the groundwork for it to happen. Here's to our two heads being a whole lot better than just one…Pat, thank you much, see you in April!

Since we talk so much about the importance of fish oil for women's health, we get forwarded articles and studies from colleagues who'd like to know what we think.

Late last night, Minh-Hai Tran forwarded me an article entitled,"Healthy and Pregnant: Forget the Fish Oil".

The hairs on the back of my neck immediately prickled on seeing this title…knowing the potential for confusion this could cause with readers like ours, who've heard us talk so much about an opposing viewpoint.

Here's a closer look at what the article says and how it fits into our treatment model.

I've always followed the guidelines established by the International Society for the Study of Fatty Acids and Lipids (ISSFAL) when evaluating studies and formulating recommendations. Here are their recommendations, right off of their website. I comment on the current study's accommodation of these recommendations in italics below each item.

1. Dietary fat intake during pregnancy and lactation, as a proportion of energy intake, should be the same as that recommended for the general population.

I was not able to find if there was any standardization of diet during this study. This is a common error in study design when evaluating the effectiveness of a supplement. Any added chemical in any study is going to respond differently, depending on the biochemistry of the environment into which it is introduced.

The pre-pregnancy weights of the women in the study were not mentioned, either. I would imagine that this would potentially affect the outcome of the study.

2. The n-3 LC-PUFA, DHA, must be deposited in adequate amounts in brain and other tissues during fetal and early postnatal life. Several studies have shown an association between maternal dietary intake of oily fish or oils providing n-3 LC-PUFA during pregnancy and/or lactation and visual and cognitive development as well as other functional outcomes of the infants.Pregnant and lactating women should aim to achieve a dietary intake of n-3 LC-PUFA that supplies a DHA intake of at least 200 mg/d. Intakes of up to 1 g/d DHA or 2·7 g/d n-3 LC-PUFA have been used in randomized trials without occurrence of significant adverse effects.

It appears from the comment of the lead researcher that a dose of 200 mg DHA per day is what was used in the study. Our experience at inCYST is that it can take significantly more DHA than that to see benefit. This is especially true if the diet in which the supplement is included is high in omega-6 fatty acids, which interfere with omega-3 activity. The study size is large--around 2,400 women, which would have given these researchers an opportunity to collect dietary intake data and evaluate if there were different results in women whose diets were high in omega-6 fatty acids vs. those which were higher in omega-9 fatty acids. Huge opportunity lost, and important advice for anyone currently putting together any kind of study regarding omega-3 fatty acids. The entire diet, not just the dosed supplement, is important to standardize and measure.

I would have been interested to see various levels of DHA--200, 500, 750, 1000 mg, to see if the same results resulted. Using the lowest dose possible is going to be the treatment least likely to produce positive results.

3. Women of childbearing age can meet the recommended intake of DHA by consuming one to two portions of sea fish per week, including oily fish, which is a good source of n-3 LC-PUFA. This intake of oily fish rarely exceeds the tolerable intake of environmental contaminants. Dietary fish should be selected from a wide range of species without undue preference for large predatory fish, which are more likely to be contaminated with methylmercury.

I agree, that there may be more to this issue than DHA. For example, much information is coming out about the importance of adequate vitamin D for reproductive health. Is it the fish oil or the vitamin D in the salmon…or the interaction between the two that is important? Future studies need to separate out and explore these questions…in the presence of a controlled diet.

Intake of the precursor, a-linolenic acid, is far less effective with regard to DHA deposition in fetal brain than the intake of preformed DHA.

5. There is no evidence that women of childbearing age whose dietary intake of linoleic acid is adequate need an additional dietary intake of arachidonic acid.

This was not a concern with this study.

6. Some studies have shown that maternal intake of fish, fish oils or n-3 LC-PUFA results in a slightly longer duration of gestation, a somewhat higher birth weight and a reduced risk of early preterm delivery. The clinical importance of such effects with regard to infant health has not been fully elucidated.

This finding was confirmed in the new study. I look forward to future studies understanding why.

7. Screening for dietary inadequacies should be performed during pregnancy, preferably during the first trimester. If less than desirable dietary habits are detected, individual counselling should be offered during pregnancy as well as during lactation.

It does not appear that individual omega-3 fatty acid status was evaluated in the women in the new study. So if the women were deficient, a low DHA dosage likely would not have been enough to elucidate a treatment response. If the women had adequate DHA in their tissues before coming pregnant they likely would not have experienced a treatment response.

All due respect to the well-intended researchers, some important aspects of study design were not incorporated, limiting the conclusions that can be drawn from this study. I hope they include a dietitian in future studies.

All due respect to MSNBC, please consider the damage and suffering you potentially inflict on women who could drastically benefit from a simple dietary intervention, on behalf of titling an article purely with SEO (search engine optimization) in mind. Post partum depression is a serious disorder, hurting many others in addition to the woman whose biochemistry produces it.

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.

As you have seen me allude to in previous posts, and which you will begin to hear a lot more about as we better network with lactation specialists, inCYST believes strongly in the importance of breastfeeding. Breast milk is where babies get their omega-3's, and a disproportionate percentage of the women we work with, it seems, were either not nursed, nursed for a shorter than ideal timespan, and bottle fed during a time when omega-3's were not to be found in formula.

It gets more complicated with PCOS, because women with PCOS, as much as they may want to nurse their babies, can't do so, because their hormone imbalance makes it impossible.

It is a crucial part of our mission to reinforce that PCOS is not just about infertility, but about many disrupted aspects of reproduction. We want to keep the disease from becoming generational.

So we'd like to encourage you to support recently introduced breastfeeding legislation.

The Breastfeeding Promotion Act (H.R. 2819, S. 1244) includes five provisions:

1. Amends the Civil Rights Act of 1964 to protect breastfeeding women from being fired or discriminated against in the workplace.
2. Provides tax incentives for businesses that establish private lactation areas in the workplace, or provide breastfeeding equipment or consultation services to their employees.
3. Provides for a performance standard to ensure breast pumps are safe and effective.
4. Allows breastfeeding equipment and consultation services to be tax deductible for families (amends Internal Revenue Code definition of"medical care").
5. Protects the privacy of breastfeeding mothers by ensuring they have break time and a private place to pump (applies to employers with 50 or more employees, see text of legislation for details).

All you have to do, to be sure your legislators hear your voice, is follow the instructions at this link.

This question comes up from time to time, and since inCYST is so big on flaxseed, it's a good idea to have information at your fingertips.

Around the Internet, caution regarding the use of flax while pregnant is easy to find. The rationale for this caution is that mothers and fetuses are especially sensitive to hormones.

The Internet is also full of advice from flaxseed manufacturers promoting its use, because it can be converted to DHA, which as this blog consistently discusses, is crucial for conception, pregnancy, and development of a healthy baby.

Neither of those assertions is totally correct.

I dove into Pub Med last night and looked for any research to support the advice against flax during pregnancy. I couldn't find it. What I DID find was a whole host of animal studies, primarily done on pigs and cows, with mostly positive findings. It's always important to remember that animal studies do not always extrapolate completely to humans, but they do give us an idea of what's going on.

Effects of flaxseed consumption during pregnancy (again, in pigs and cows) included:
--healthier immune systems in babies
--better growth in babies
--after having one baby, a shorter time to ovulation (restored fertility)
--breast milk with a higher omega-3 fatty acid content and a lower omega-6 to omega-3 fatty acid ratio
--higher brain omega-3 content in babies
--increased levels of EPA, another omega-3 important for prostaglandin function and healthy blood clotting
--higher pregnancy rates
--larger follicle size
--higher conception rates
--lower miscarriage rates
--higher progesterone levels

IMPORTANT DISCLAIMERS
While I'm always excited to report positive links between nutrition and fertility, you all should know when I look through the research I am actually searching hard for the BAD news. This is such a high-risk specialty! The very last thing I would want to do is encourage our readers to make choices leading to frustration, disappointment, heartache, and loss of our own credibility. So I want to make it clear, the benefits of flax can be achieved only if it's used with respect.

Flax cannot replace fish oil. Some flax supplement manufacturers promote its use because it is converted into DHA and therefore can be used as a supplement for flax. Not true! The studies I perused found different effects for both, meaning you need both in your diet.

If your diet is imbalanced, flax won't make up for it. One study I found showed that when protein intake was low, flax supplementation was not beneficial. This would be a scenario not uncommon with our vegetarian readers, if their definition of vegetarian eating focuses more on what to eliminate rather than what to include, or is the remnant of an eating disorder. As always, supplements work best in a well-nourished environment; they cannot replace balanced, nourished eating.

Finally, if you choose to use flax…IT MUST BE GROUND. In other words, the flaxseed tortilla chips at Trader Joe's were not what made these studies work.: )

I've heavily referenced this post to save the skeptics the work.

I hope you find this helpful!

Rao SS, Kale AA, Joshi SR, Mahadik SP. Sensitivity of fetus and pups to excess levels of maternal intakes of alpha linolenic acid at marginal protein levels in Wistar rats. Reprod Toxicol. 2007 Nov-Dec;24(3-4):333-42. Epub 2007 Jul 28.
Yu B, Khan G, Foxworth A, Huang K, Hilakivi-Clarke L. Maternal dietary exposure to fiber during pregnancy and mammary tumorigenesis among rat offspring. Int J Cancer. 2006 Nov 15;119(10):2279-86.
Ambrose DJ, Kastelic JP, Corbett R, Pitney PA, Petit HV, Small JA, Zalkovic P. Lower pregnancy losses in lactating dairy cows fed a diet enriched in alpha-linolenic acid. J Dairy Sci. 2006 Aug;89(8):3066-74.

Petit HV, Twagiramungu H. Conception rate and reproductive function of dairy cows fed different fat sources. Theriogenology. 2006 Sep 15;66(5):1316-24. Epub 2006 Jun 2.
Farmer C, Giguère A, Lessard M. Dietary supplementation with different forms of flax in late gestation and lactation: Effects on sow and litter performances, endocrinology, and immune response. J Anim Sci. 2010 Jan;88(1):225-37. Epub 2009 Sep 25.

Colazo MG, Hayirli A, Doepel L, Ambrose DJ. Reproductive performance of dairy cows is influenced by prepartum feed restriction and dietary fatty acid source. J Dairy Sci. 2009 Jun;92(6):2562-71.
Farmer C, Petit HV. Effects of dietary supplementation with different forms of flax in late-gestation and lactation on fatty acid profiles in sows and their piglets. J Anim Sci. 2009 Aug;87(8):2600-13. Epub 2009 Apr 24.
Brazle AE, Johnson BJ, Webel SK, Rathbun TJ, Davis DL. Omega-3 fatty acids in the gravid pig uterus as affected by maternal supplementation with omega-3 fatty acids. J Anim Sci. 2009 Mar;87(3):994-1002. Epub 2008 Nov 7.

Galbreath CW, Scholljegerdes EJ, Lardy GP, Odde KG, Wilson ME, Schroeder JW, Vonnahme KA. Effect of feeding flax or linseed meal on progesterone clearance rate in ovariectomized ewes.
Domest Anim Endocrinol. 2008 Aug;35(2):164-9. Epub 2008 Jun 5.

We had a really interesting inquiry from a lactation consultant, who had been trying to find information to give her new mothers of multiple births, regarding how much they need to eat to maintain their own nutrition AND produce enough milk for multiple babies.

We have a great resource for that, inCYSTer Chris Wittmer, in Dayton, Ohio. Chris works for a medical practice that manages high-risk pregnancies. Chris' great answer is posted below. I wanted to share it with our readers, so that others looking for this information don't have to work so hard to find it. Enough of you are undergoing procedures that increase the chances of multiple birth, I wanted to be sure that from beginning to end, mother and babies are well fed!

I linked to the book in case anyone wanted to find it without an inordinate amount of hunting.

Thanks so much, Chris, and I hope this helps!

There are very few"official" recommendations for nutrition for mom while breastfeeding multiples, but Barbara Luke, who is the"guru" of nutrition for pregnancy with multiples has extrapolated some numbers/recommendations for a singleton mom to multiples. They are included in her book:"When You are Expecting Twins, Triplets, or Quads", 2nd edition, chapter 10.

The overall caloric recommendations are
--1000-1200 calories additional for twins (500-600 calories per baby),
--1500-1800 additional calories for triplets and
--2000 to 2400 additional calories for quads.

For twins her recommendation is 3200 calories/day and 160 g protein/day, keeping the distribution of calories approximately 40% carbohydrate, 20% protein, and 40% fat. Elizabeth Noble recommends about 3000 calories/day for twins (400 extra per baby The calcium needs are the greatest-increasing by 50%, so that would be in the range of 3000 mg/day.

Other important nutrients include Omega 3 fatty acids, Zinc, and Iodine. It is extremely important for mom to eat adequately or her milk supply will be diminished. Eat nutrient dense foods frequently to help get in the needed calories and nutrients and continue to drink adequate fluids-preferably milk, juice or water. I don't know if any of this will be helpful, but as has been said before, it is a subject that has not been addressed adequately in the literature. There is a need since the incidence of multiples is rising.

When I ran across this research study, it immediately brought to mind most women I know with PCOS--because they focus so much on restrictive eating as a way to improve their condition. Women with PCOS that has not yet been diagnosed often develop eating disorders as a way to manage it. If their eating disorder is anorexia or bulimia, it encompasses deprivation. And it often bounces back into binge eating disorder when the PCOS wrangles control back in its direction.

And if you've tended to lean toward the binge eating direction, you've likely been advised to lose weight. And much of the advice you have been provided for how to do this, even by licensed health care providers, has been about eliminating--calories, carbohydrates, even entire food groups. Most of what I see on Facebook, Twitter, Yahoo Groups, where women with PCOS are talking about what they're eating, it's about extreme programs and denial.

It seems to be especially prevalent in women who are trying to conceive. So when I saw this study, I wanted to share it.

This is a study done on cows, but I believe there is a good takeaway lesson. So bear with me.

Seventy-two pregnant cows, about a month before their due dates, were assigned to 6 different dietary regimens:

Ad lib eating with canola-supplemented feed Ad lib eating with linola-supplemented feed Ad lib eating with flax-supplemented feed
24% calorie restriction with 8% canola-supplemented feed 24% calorie restriction with 8% linola-supplemented feed 24% calorie restriction with 8% flax-supplemented feed (Linola is a low omega-3 form of flax often fed to cattle)

After the calves were born to these cows, they were fed the same non-supplemented lactation diet.

From one week after birth, the cows underwent reproductive ultrasounds twice a week until they again ovulated. Here are the very interesting findings (I discuss them below).

1. Cows fed without caloric restriction had higher body weights before delivery, but after delivery, they had fewer ovarian cysts.
2. These cows, regardless of what kind of fat they were given, did have a higher incidence of uterine infections.
3. Regardless of diet treatment, the time it took for the uterus to return to its normal size did not differ.
4. It took longer for cows to ovulate after giving birth if they were fed canola oil, regardless of calorie level eaten, than it did if they were fed linola or flaxseed oil.
5. A greater percentage of cows whose diets were not restricted during their first pregnancy were able to conceive a second time with the first round of artificial insemination.

OK, the obvious omission in this study is the overfed cow. But cows are not natural binge eaters so it's understandable why this condition was not included in this study. But…what this study really highlights, is that restricting calories is not really the best fertility-friendly strategy. (The degree of restriction was actually far less in these cows than what many of our inCYST fans impose on themselves. It was the equivalent of a 1350 calorie diet for someone who would normally need 1800 calories to maintain their ideal weight.)

Secondly, even though we do talk about using canola oil because it has a nice omega-6 to omega-3 ratio, continuing to eat your favorite fried foods and using a"healthy" fat may not really be a productive strategy. You will help yourself most if you learn to eat foods that are not too high in fat.

Bottom line, it's not about the quantity of calories, it's more about the quality. It's not about extremes, it's about balance.

If you're having a hard time with balance, let us help you!

Colazo MG, Hayirli A, Doepel L, Ambrose DJ. Reproductive performance of dairy cows is influenced by prepartum feed restriction and dietary fatty acid source. J Dairy Sci. 2009 Jun;92(6):2562-71.

This post is part of the Women's Health Blogfest. Please click on the links below to read more from other contributors! And thanks to everyone who took the time to participate!

In the almost 10 years I have been studying PCOS, I've learned much about what drives a woman's motivation to seek out information. The top reasons women find this blog are:

1. to improve their fertility,
2. to more effectively manage their weight, and
3. to feel and look better

As I've read and met women with the syndrome, I've learned that PCOS is about a whole lot more.

1. A woman's breastfeeding practices seem to significantly influence her child's hormonal health. Many women I've worked with were formula fed at a time when baby formula did not contain essential nutrients.
2. Whether or not you as a woman with PCOS were born to term, and potentially whether or not you were part of a multiple birth, seem to be red flags for PCOS risk later in life.
3. Just because you're a teenager, too young to want to conceive, or a woman who has already had her children, doesn't mean PCOS isn't something to be concerned about. It can mess with your mood, and in turn your energy level and relationships. It can provoke eating disorders. It can elevate your cholesterol. And…through its link to diabetes, it may increase your risk for Alzheimer's disease.

A blog attempting to tackle a syndrome with such widespread effects is not easy to manage. I've been working since we've started to find experts in areas outside of nutrition to complement what I as a dietitian can discuss and promote. I'm really excited to be partnering with lactation consultants to address breastfeeding issues specific to PCOS, and to have Gretchen Kubacky, PsyD, on board, to help us understand what PCOS can do to thinking, mood, and energy. We have one dietitian, Karen Siegel, who is also an acupuncturist, and another acupuncturist will soon be contributing her insight as well.

For the very first time, we are collaborating with Green Mountain at Fox Run in Ludlow, Vermont, to offer PCOS Program weeks this coming September! It's been a dream of mine to see this kind of program and there is no better place where it could be launched. Green Mountain is also participating in this blogfest, if you'd like to learn even more, be sure to read their contribution.

We don't just care about your ovaries. We care about all of you, from birth through retirement, and we hope that as we grow and diversify, the expert opinions you will see expressed here on this blog will address the many important ways we can keep our hormones working positively for us.

Thanks for stopping by our contribution to the Women's Health blogfest. If you enjoyed us, you can follow us with the signups you see here on the blog, through our Facebook inCYST group, or through Twitter, via @incyst.

For more information on women's health:

Angela White at Blisstree’s Breastfeeding 1-2-3 – Helpful Skills of Breastfeeding Counselors
Angie Tillman, RD, LDN, CDE – You Are Beautiful Today
Anthony J. Sepe – Women's Health and Migraines
Ashley Colpaart – Women's health through women
Charisse McElwaine – Spending too much time on the"throne?
Danielle Omar – Yoga, Mindful Eating and Food Confidence
Diane Preves M.S.,R.D – Balance for Health
Joan Sather A Woman's Healthy Choices Affect More Than Herself
Laura Wittke – Fibro Study Recruits Participants
Liz Marr, MS, RD – Reflecting on Family Food Ways and Women's Work
Marjorie Geiser, MBA, RD, NSCA-CPT – Healthy Women, Healthy Business: How Your Health Impacts a Powerful Business
Marsha Hudnall – Breakfast Protein Helps Light Eaters Feel Full
Michelle Loy, MPH, MS, RD – A Nutritionista’s Super Foods for Super Skin
Motherwear Breastfeeding Blog – How breastfeeding helps you, too
Rebecca Scritchfield, MA, RD, LD – Four Keys to Wellness, Just for Women
Renata Mangrum, MPH, RD – The busy busy woman
Robin Plotkin, RD, LD – Feeding the Appetites of the Culinary, Epicurious and Nutrition Worlds-One Bite at a Time
Sharon Salomon, MS, RD – Calories, longevity and do I care
Terri L Mozingo, RD, CDN & D. Milton Stokes, MPH, RD, CDN of One Source Nutrition, LLC – Crossing the Line: From Health to Hurt
Wendy Jo Peterson, RD – Watch Your Garden Grow

Fenugreek you say? What the heck is fenugreek? It's a spice popular in India, northern Africa, and the Middle East that has multiple benefits for PCOS:

--it can lower your lipids
--it can help to control blood sugar
--it can help improve milk production in women who have trouble breastfeeding
--antioxidant action in the face of high blood glucose

In women struggling with lactation, fenugreek tea (made with the leaves of the plant) has been found to be beneficial. The Fenugreek spice has been added to flour to provide functional properties and it has found to be beneficial in this format as well.

And since we're on the topic of hair loss this week, here's an Ayurvedic remedy using Fenugreek:

Mix ground fenugreed seeds with water and yogurt to make a paste. Rub into hair and wash after 30 minutes.

I'm giving you two recipes, the first one from India, and the second one from Ethiopia. If you like spicy foods, you're going to love adding this herb/spice to your culinary creations!

Methi Murgh (fenugreek chicken) from allrecipes.com

Ingredients
1/4 cup cooking oil
1 (4 to 6 pound) whole chicken, cut into 8 pieces (skin removed and discarded)
1 teaspoon cumin seeds
1 cinnamon stick
1 black cardamom pod
4 whole cloves
1 large onion, sliced thin
1 tablespoon ginger-garlic paste
4 green chile peppers, halved lengthwise
1/2 cup chopped fresh spinach
1/2 cup chopped fresh fenugreek leaves
1 tablespoon dried fenugreek leaves
1/2 teaspoon ground turmeric
1/2 teaspoon ground red pepper
salt to taste
1 cup water
1/2 teaspoon garam masala

Directions

1.Heat the oil in a pressure cooker over medium heat; brown the chicken pieces evenly on all sides, about 5 minutes. Remove from cooker and set aside. Add the cumin seeds, cinnamon stick, cardamom pod, cloves, onion slices, ginger-garlic paste, and green chile peppers to the pressure cooker and cook until the onions are golden brown, 5 to 7 minutes. Stir the spinach, fresh fenugreek leaves, dried fenugreek leaves, turmeric, red pepper, and salt into the mixture and cook until the spinach and fenugreek leaves begin to wilt and darken in color, about 5 minutes. Pour the water over the mixture and return the chicken pieces to the pressure cooker; bring to a boil for 2 to 3 minutes.

2.Fasten the lid on the pressure cooker; cook until the chicken is tender, about 30 minutes. Release pressure fully and remove the lid; sprinkle the garam masala over the dish. Cook and stir until the liquid thickens, 3 to 5 minutes. Serve hot.

Berbere — spiced lentil stew from Sundays at Moosewood Restaurant

Berbere

2 teaspoons cumin seeds
4 whole cloves
3/4 teaspoons cardamom seeds
1/2 teaspoon whole black peppercorns
1/4 teaspoon fenugreek seeds
1/2 teaspoon coriander seeds
8 — 10 small dried red chiles
1/2 teaspoon grated fresh ginger root (1 teaspoon dried)
1/4 teaspoon turmeric
1 teaspoon salt
2 1/2 tablespoons sweet Hungarian paprika
1/8 teaspoon cinnamon
1/8 teaspoon ground cloves

In a small frying pan, on medium-low heat, toast the cumin, whole cloves, cardamom, peppercorns, allspice, fenugreek, and coriander for about 2 minutes, stirring constantly. Remove the pan from the heat and cool for 5 minutes.

Discard the stems from the chiles. In a spice grinder or wtih a mortar and pestle, finely grind together the toasted spices and the chiles. Mix in the remaining ingredients.

Store Berbere refrigerated in a well-sealed jar or a tightly closed plastic bag.

Yemiser W'et (Spicy Lentil Stew)

1 cup dried brown lentils
1 cup finely chopped onions
2 garlic cloves, minced or pressed
1/4 clarified butter
1 tablespoon Berbere
1 teaspoon ground cumin seeds
1 tablespoon sweet Hungarian paprika
2 cups finely chopped tomatoes
1/4 cup tomato paste
1 cup vegetable stock
1 cup green peas, fresh or frozen
salt and freshly ground black pepper to taste
plain yogurt or cottage cheese

Rinse and cook the lentils.

Meanwhile, saute the onions and garlic in the clarified butter, until the onions are just translucent. Add the berbere, cumin, and paprika and saute for a few minutes more, stirring occasionally to prevent burning. Mix in the chopped tomatoes and tomato paste and simmer for another 5 to 10 minutes. Add 1 cup of vegetable stock and continue simmering.

When the lentils are cooked, drain them and mix them into the saute. Add the green peas and cook for another 5 mintues. Add salt and black pepper to taste.

Roberts KT. The Potential of Fenugreek (Trigonella foenum-graecum) as a Functional Food and Nutraceutical and Its Effects on Glycemia and Lipidemia. J Med Food. 2011 Aug 23. [Epub ahead of print]
Middha SK, Bhattacharjee B, Saini D, Baliga MS, Nagaveni MB, Usha T. Protective role of Trigonella foenum graceum extract against oxidative stress in hyperglycemic rats. Eur Rev Med Pharmacol Sci. 2011 Apr;15(4):427-35.
Turkyılmaz C, Onal E, Hirfanoglu IM, Turan O, Koç E, Ergenekon E, Atalay Y. The effect of galactagogue herbal tea on breast milk production and short-term catch-up of birth weight in the first week of life. J Altern Complement Med. 2011 Feb;17(2):139-42. Epub 2011 Jan 24.

This post comes from Karen Siegel in Houston, Texas. In addition to being a Registered Dietitian, she is also a Licensed Acupuncturist.

Acupuncture in Pregnancy & Childbirth

Pregnancy is an amazing time in a woman's life. Many women report feeling healthier than they have ever felt before; however, the physical growth of the baby and changes in hormone levels can bring about pain, discomfort and a variety of health problems.

Acupuncture and Oriental medicine can provide a safe, effective alternative for many of the health complications that may arise before, during and after pregnancy. A growing number of women are choosing acupuncture to use throughout their pregnancy and as an optional treatment for an overdue or difficult labor.

Planning for a Healthy Baby

Healthy parents produce healthy babies. With acupuncture and Oriental medicine, parents can improve their health to create the most optimal environment for their unborn child. In addition to their ability to strengthen, support, and balance overall health and well-being, acupuncture and Oriental medicine are an effective treatment for regulating menstruation and hormone levels, reducing stress and addressing any pre-existing medical conditions or concerns that a woman may have.

Acupuncture during Pregnancy

Acupuncture and Oriental medicine can play a vital role in the comfort of a pregnant woman. There is strong evidence to support that acupuncture is highly effective at treating some of the most common problems experienced during pregnancy including morning sickness, heartburn, insomnia, water retention and sciatica.

Here is a list of some of the problems that an acupuncturist often treats during pregnancy:

* Nausea and Vomiting
* Heartburn
* Constipation
* Hemorrhoids
* Edema and Swelling
* Urinary Tract Infection
* Pelvic Pain
* Neck and Back Pain
* Sciatica
* Carpal Tunnel Syndrome
* Leg Cramps
* Fatigue and Exhaustion
* Insomnia
* Anxiety and Depression

Acupuncture for Childbirth

While there are acupuncture points that can provide natural pain relief during labor, acupuncture is more commonly used to induce labor. There are several points that stimulate contractions and influence cervical ripening. There is also an acupuncture point that has been found to turn a breech baby.

Acupuncture Postpartum

Many women feel depleted after the birth experience. Acupuncture and Oriental medicine can help the transition of those first few months after birth to ensure a quick recovery. Postpartum care focuses on the physical, emotional and psychological recovery of the mother from the effects of pregnancy and labor, as well as encouraging breast feeding.

Here are some of the postpartum disorders that can be treated with acupuncture:

* Fatigue
* Postpartum Depression
* Mastitis
* Insufficient or Excessive Lactation
* Post Operative Healing
* Night Sweats

If you would like to know more how acupuncture and Oriental medicine ease discomfort and facilitate pregnancy, please call for more information.

Karen Siegel MPH, MS, RD, LD, L.Ac.
9660 Hillcroft, Suite 202
Houston, TX 77096
713-721-7755

Not long ago, Renata Mangrum (who you'll soon see more of on our blog, she's studying to be an inCYST provider) forwarded me a note from a discussion list for lactation consultants. Someone on that list wanted to know if excessive vomiting during pregnancy (hyperemesis) was common with PCOS. The person asking the question had a patient who was experiencing that problem. There didn't seem to be much information about it in the scientific literature, but when this person lurked on a few PCOS listserves, it seemed to be commonly accepted as an issue.

LESSON ONE: Be sure to report all your unusual symptoms to your physician. When they start to see trends, that is when they can research the problem…the first step toward finding a solution.

I wrote Renata back and told her I'd never heard about it, but I did know that there was a very strong correlation between PCOS and bulimia, another medical diagnosis including vomiting. I did post about two weeks ago to see if any of inCYST's readers had experiences to share with their own pregnancy. One reader did write back to say that yes, she did experience vomiting, and was told it was due to having a low progesterone problem.

LESSON TWO: inCYST is as much about our readers sharing their experiences for us to learn from as it is about our giving advice. It's important that this be an interactive forum with communication moving in both directions.

Curious, I went into the National Library of Medicine database and used the keywords"bulimia" and"progesterone". It turns out, there were several articles reporting progesterone imbalances in bulimia. And, a correlation between imbalanced progesterone and binge eating. (References below.)

Hmmmmm…

What I know from my eating disorders work is that bulimia has many different colors. Sometimes it's induced. Sometimes it just happens. Sometimes women binge specifically so they can induce vomiting. Sometimes they overeat, and induce vomiting to relieve the discomfort that overeating produced. I learned that it is very important to get as much detail about how, why, and when the vomiting occurs, and not just lump all of it into one symptom with one cause and one motivation.

What I know from my PCOS work is that cysters have a low stress threshold. Meaning it takes less stress to activate the stress response. If you are prone to vomiting, that means you might be prone to feeling more nauseous with less stress than the average person. You may have learned over time that throwing up is a quick way to relieve discomfort other people quite simply never feel.

Here are some new insights I'd like to share and propose that all of you consider.

1. If you have bulimia, whether or not you have been diagnosed, and you honestly believe you are doing everything you possibly can to not vomit, and it's still coming, ask your physician if s/he might be amenable to checking your progesterone level. Correcting that (and natural ways to do so are written about elsewhere in this blog), may make it easier to stop vomiting.

When I worked in an eating disorder treatment center, I always felt for women I knew were doing their best to stay in recovery, who couldn't, who were considered by treatment teams as somehow being noncompliant or rebellious. I'm not saying you don't have a responsibility to work on challenging behaviors to the best of your ability, but I do think there may be an important physiological factor being overlooked that may be undermining the very best efforts of some of you.

2. The very first thing I thought of when I envisioned how these pieces fit together, was the poor woman who'd worked her tail off to get out of an eating disorder, finally became pregnant, and despite everything going seemingly well, having vomiting come back, with a vengeance. It might cross your mind to just silently live with it, thinking the first thing your treatment team is going to think is that you've relapsed. Which is why physicians may not be hearing about this.

Don't freak out…be proactive! Tell your physician, tell them your fears, and ask for help. Your problem may be low progesterone, and hyperemesis. And a susceptibility to low progesterone may actually have been the loaded gun that set you up as a candidate to get into bulimia in the first place.

If you have PCOS, with a history of an eating disorder, have become pregnant, and have found yourself all of a sudden vomiting or wanting to vomit again…we're here to help you find solutions. And we very much look forward to that.

LESSON THREE: inCYST needs to continue to challenge itself to think in a hugely interdisciplinary fashion. We are best at that when our readers are comfortable sharing their PCOS stories with us, trusting that we aspire to be inquisitive and scientific, not judgmental and shaming.

Pirke KM, Fichter MM, Chlond C, Schweiger U, Laessle RG, Schwingenschloegel M, Hoehl C. Disturbances of the menstrual cycle in bulimia nervosa. Clin Endocrinol (Oxf). 1987 Aug;27(2):245-51.

Pirke KM, Dogs M, Fichter MM, Tuschl RJ.Gonadotrophins, oestradiol and progesterone during the menstrual cycle in bulimia nervosa. Clin Endocrinol (Oxf). 1988 Sep;29(3):265-70.

Schweiger U, Pirke KM, Laessle RG, Fichter MM. Gonadotropin secretion in bulimia nervosa. J Clin Endocrinol Metab. 1992 May;74(5):1122-7.

Edler C, Lipson SF, Keel PK. Ovarian hormones and binge eating in bulimia nervosa. Psychol Med. 2007 Jan;37(1):131-41. Epub 2006 Oct 12.

Klump KL, Keel PK, Culbert KM, Edler C. Ovarian hormones and binge eating: exploring associations in community samples. Psychol Med. 2008 Dec;38(12):1749-57. Epub 2008 Feb 29.

I'm so excited--tomorrow inCYST launches its webinar training program. This new series will enable trainings to occur online so that professionals interested in learning how inCYST works for PCOS can participate, no matter where they live.

You'll be hearing and seeing these names more often in the future, and I wanted to give a heads up to those of you who might benefit from having these inspiring people in your backyards:

Ilona Fordham, RD, Ursula Ridens, RD, Denise Sautter, RD — dietitians, San Francisco area

Shirley Shelley, Linda Caley — dietitians, Connecticut

Susan Van Dyke, MD (Board-certified dermatologist, Paradise Valley, Arizona)

Ann Marie Arabian, PhD — Psychologist, Beverly Hills, California

Beth Zipper, RD — Delray Beach, Florida (specializes in adolescents)

Rachel Brandeis, RD — dietitian, Atlanta, Georgia

Renata Mangrum, MPH, RD — dietitian, Cleveland Ohio (special interest in lactation and perinatal nutrition)

Every single one of these individuals has great passion for what they do. They inspire me to work hard, hard, hard to make inCYST the go-to place for PCOS information! I look forward to what they will bring to inCYST…and to all of you!

Hello everyone,

It's been a crazy month! I just returned from Oakland where I met with lactation consultants in the Kaiser Health system, hopefully strengthening the ties we have with this specialty important to PCOS. Many women with PCOS who finally conceive learn that their next challenge is successful breastfeeding. So we need to have strong communication between specialties to be sure each of us in your life at different times provides consistent and useful information. Yesterday was an excellent start in that direction.

Next week I am off to work with the Minnesota team, and we'll be brainstorming what can be done for women in their 'hoods.

Before I go, I will be doing my monthly Tempe Whole Foods inCYST class, please, if you are in Phoenix, Chandler, Gilbert, Ahwatukee, and have a couple of hours to spare, come attend! It's a whole lot more information than you're likely to get if you spend that copayment money on someone who has not been trained in your specific diagnosis.

At the end of the month, Ellen Reiss Goldfarb will be hosting her second inCYST Saturday Seminar. Her last one was wonderful and it really is a must-attend for any LA woman who wants the best, most practical information on PCOS.

All information on classes and events can be found at www.afterthediet.com/inCYST.htm

Oh! And the photo? It doesn't have a whole lot to do with PCOS, except maybe that I took a stress management break and visited the California Academy of Sciences with a good friend Sue and her husband Ernie. Sometimes when you think you've got more on your plate than you can handle…the absolute best thing you can do is step off the treadmill and do something completely different. It gives your brain a rest and an opportunity to derive a plan without your anxiety interfering with the process. That's what I did with my friends, just took a break and enjoyed learning about jellyfish and fish eating snakes and chameleons and albino alligators. The jellyfish were very mesmerizing and relaxing to watch, I decided they are kind of like nature's lava lamps.

The clarity that resulted from the time off will definitely benefit all of you. I hope you have opportunities to do the same when your PCOS seems like it's taken a life of its own. Things will get better!