PCOS : what is it and what the heck to do about it.

Polycystic Ovarian Syndrome (PCOS) has become so UBER COMMON in our world. I would simply love to do a study on how many women actually ovulate each month in 2019 when compared to how many women ovulated each month in 1819…I think the results would be astonishing. PCOS truly is a ‘disease’ of the modern age. I use the term ‘disease’ with caution because really what PCOS is most of the time is an imbalance of hormone levels (most importantly insulin) which is most often triggered by the influence of modern day life: stress, poor sleep, diet, exercise and also epigenetic changes (more on that another time!) Here’s a quick rundown of what PCOS is all about and how you can fix it.

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Polycystic Ovarian Syndrome (PCOS) is a broad term for lack of / delayed ovulation, absent or irregular periods, excess androgens, blood sugar imbalance, and of course, polycystic ovaries (multiple follicles). 

Not all follicles produce eggs that will be ovulated. Follicles are, in essence, “baby eggs” that are immature and not large enough to become a dominant follicle, and only dominant follicles are ovulated in a normal menstrual cycle. In PCOS, a mature, dominant follicle rarely develops, if it develops at all.

And it’s not just the lack of dominant follicles that is problematic; it’s also those multiple “baby follicles:” they can produce estrogen, which can lead to estrogen overload, and this estrogen can get “aromatized” into testosterone, driving androgen excess.


Up to 70% of anovulatory cycles (aka you do not ovulate) are related to PCOS, which is generally diagnosed with blood testing for hyperinsulinemia, elevated blood sugar, androgen and sex hormone levels or with ultrasound to detect multiple follicles. Ultrasound alone is NOT a good way to diagnose PCOS, however, as many women without PCOS have multiple follicles. PCOS needs to be diagnosed with blood work and ultrasound.

While the typical PCOS sufferer is overweight, PCOS can happen to all types of women - 20-25% of cases are in lean women with BMI under 25.

PCOS is incredibly paradoxical: it may be over-diagnosed, under-diagnosed, or misdiagnosed depending on the woman and the practitioner. When it is properly diagnosed, there is a very poor clinical understanding of how it should be managed. Many functional medicine practitioners, including me, have found great success helping women with PCOS using a whole body-mind approach - much like the Core Four in my Baby Making and Beyond program

Signs You Might Have PCOS

  • Skin issues. Acne or hair growth on your chin or upper lip are signs of excess androgens, a marker for PCOS.

  • Hair thinning or hair loss. This is also a sign of excess androgen production.

  • Irregular periods without ovulation (no temp rise when you chart your BBT), a sign of overall hormone imbalance, often driven by androgens.

Blood Work & Ultrasound Testing

  • This is the most important step! Get a full blood sugar and hormone panel that includes progesterone, estrogen, testosterone, DHEA, LH, FSH, prolactin, AMH (anti-mullerian hormone), HbA1C, fasting insulin, cholesterol, and a full thyroid panel. If your practitioner is not willing to order these tests, find a new practitioner or order labs directly.

  • Blood work will likely show low progesterone; high testosterone, DHEA, LH, and AMH; high- to borderline-high HbA1C; and thyroid irregularities.

  • Ultrasounds are used to check for follicles are done in ADDITION to blood work. With PCOS, there are often 12 or more follicles within the ovary, with a diameter of 2-9 mm and/or ovarian volume 10 cm3 or greater. This many follicles do not mean you’ll release multiple eggs; follicles in PCOS are not mature and don’t develop into an egg that gets ovulated.

Common Causes

  • Elevated insulin, insulin resistance, and androgen excess. This is the primary cause of PCOS and should be the target for your treatment strategies. Insulin resistance (IR) occurs when your body’s cells become resistant to the effects of insulin, which is supposed to move glucose (sugar) into the cells when the body senses a rise in blood sugar. In IR, your cells don’t soak up all that glucose - so it stays in your bloodstream, resulting in chronically high blood sugar. The elevated insulin drives the overproduction of almost anything, including an ovarian enzyme called cytochrome P450c17α that increases androgen concentrations in the body. At the same time, if your body stays in this state for too long, the pancreas, which is responsible for making insulin, eventually gets worn out and stops making enough insulin. This is when Type 2 diabetes can develop.

  • Inflammation caused by blood sugar imbalance and high insulin. Inflammation is also a marker for PCOS.

  • A diet heavy in processed foods. This drives high blood sugar and insulin levels without providing adequate nutrients to the body.

  • Uncontrolled stress levels. Cortisol and other stress hormones increase blood sugar and make it harder for glucose to get out of your bloodstream and into your cells. It also makes you crave more sugar. This also applies to exercise stress, which can also lead to hypothalamic amenorrhea due to suppression of the HPA/HPG axes. Learn more about this good stuff in the Hormones and Fertility Modules of Baby Making and Beyond.

Risks Associated with PCOS

  • Infertility because you stop ovulating

  • Should pregnancy occur despite uncontrolled PCOS, there is an elevated risk for gestational diabetes, preeclampsia, and problems with breastfeeding.

  • Depression and mood imbalances

  • Possible increased risk for metabolic disease

  • Liver inflammation

Treatments for PCOS

While drugs are available to address some of the causative factors for PCOS, we also advocate a whole-body approach centered around blood sugar balance. Be sure to read our lifestyle and supplements section and find a practitioner who can help guide your treatment plan.

Drugs prescribed by your caregiver

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  • Metformin is a drug that works by lowering blood sugar and improving the cells’ sensitivity to insulin, which helps insulin levels decrease. This can increase fertility, making it a miracle drug for many women with resistant PCOS. Always take B12 with metformin, as it will decrease your B12 levels.

  • Oral contraceptives are often used to treat PCOS, but they do not address any of the underlying causes like insulin resistance or high stress. They can also deplete certain nutrients critical to a healthy pregnancy, like folate. If your provider offers this as the only solution, consider finding a new provider for a second opinion.

Supplements

In addition to our baseline supplement recommendations found in Baby Making and Beyond, the below supplements might be a worthy addition to your protocol. As always, talk to your provider before adding these into your plan.

  • Melatonin + myo-inositol. Several studies in women undergoing IVF have demonstrated the effectiveness of this combination. The sweet spot seems to be about 3 mg of melatonin (taken nightly as a chewable or drop) combined with 2-4g of myo-inositol.

  • Myo-Inositol. Taken alone, this member of the B vitamin family supports healthy insulin regulation within the body. Women with PCOS seem to be deficient in the insulin signaling pathway (inositol- containing phosphoglycan mediators), which seems to be implicated in the development of insulin resistance. (Papaleo E et al 2009)  Inositol is also important for healthy ovulation and follicle formation, so this is particularly good for women with PCOS who would like to conceive.

  • Choline. Inositol works with choline to help with the proper utilization of insulin in the body.

  • Berberine. This compound is thought to improve insulin sensitivity by upregulating insulin receptors and stimulating glucose uptake in the cells. It might also improve acne, another common complaint in PCOS. Berberine can act as an anti-microbial, which might harm the balance of your gut bacteria if taken for extended periods of time (see below for why).

  • Proboitics: In women who are overweight with PCOS, studies have shown that the gut microbiome actually plays a pretty significant role in PCOS ( due to diminished microbiome diversity) . Take a solid probiotic and alternate strains every bottle.

  • Other nutrients. Ensure you have enough Vitamin D, magnesium (we like topical magnesium or the form magnesium glycinate) and zinc. A practitioner will help you decide what levels are right for you.

A note about maca and Vitex: I can almost always tell if someone has been taking Maca or Vitex when I look at a hormone profile. I’ll see someone with high DHEA who is depleted across the board in estrogen, progesterone, cortisol, and melatonin. Maca is most often the culprit. Maca seems to raise DHEA levels and androgen hormones more than dominant female hormones, like estrogen and progesterone. Meg has also seen Vitex exacerbate PCOS.

Diet & Lifestyle

Refer to the Core Four Nutrition section in Baby Making and Beyond for expanded recommendations, and focus on the following:

Lettuce wrapped grassfed burgers are a GREAT option. I ate these with a big green kale salad. Bonus points for eating your dinner while watching the sunset instead of wheel of fortune.

Lettuce wrapped grassfed burgers are a GREAT option. I ate these with a big green kale salad. Bonus points for eating your dinner while watching the sunset instead of wheel of fortune.

  • Higher protein and fiber, and lower sugar and carbs. Eat plenty of protein and lower-carb fiber-rich plants, and incorporate some starches that feed gut flora and improve insulin levels.  (Bindels et al. 2017)

  • Organic and grassfed when possible. Watch sourcing of your animal products. Organic and grassfed likely contain fewer exogenous hormone contaminants and fewer potentially inflammatory fats.

  • Focus on an anti-inflammatory foods. Watch your consumption of excess Omega 6 fats from modern processed foods. It may also be appropriate to reduce nut and seed consumption. Reduce or eliminate processed foods, simple sugars and ALL alcohol.

  • Not keto, I repeat, not Keto, but lower-ish carb. Full-on keto can raise cortisol levels, so we’d only recommend this approach with the guidance of a health professional. Eliminating processed carbs, grains, and the highly carb-rich plants, like sweet potato and higher-carbohydrate fruit, might help.

  • No calorie restriction or dieting. Consider consulting a nutritionist or health care provider who can help you figure out how much you should be eating.

  • Intermittent fasting. Fasting for short periods of time can improve insulin sensitivity in some women, but we recommend consulting with a practitioner first to ensure it will help you. If you feel absolutely miserable while fasting, it’s probably not the right solution for you. In this case, you can simply choose a 12-hour daily “eating window” (first bite or sip of anything that’s not water starts the clock; keep your meals and snacks within that 12 hour window), AND/OR try small and frequent (5-6) protein rich meals during the course of the day to help re-sensitize your cells to insulin and keep blood glucose regulated. Experiment and see which approach works for you.

  • Cinnamon. It’s delicious, and several studies suggest it helps improve blood sugar response.

  • Get your hormones and stress in check. Test for and correct thyroid and adrenal issues, ensure your exercise is appropriate and your stress is managed, and make sure you’re sleeping.

Sometimes the best thing you can do is just chill out and watch the sunset……..

Sometimes the best thing you can do is just chill out and watch the sunset……..

My Struggle with Hypothalamic Amenorrhea (HA). How I got my period back.

If you follow me on Instagram you may have noticed my post last week where I welcomed back my monthly visitor (this is what my grandmother would say) after a 10-year absence. I’ve kept pretty quiet about my struggle with HA. To be truthful, admitting my illness made me feel like an imposter and a fraud. How could someone whose job and life revolved around helping women find and nourish their own fertility be infertile and unhealthy herself?

I’ve helped countless women in my nutrition practice regain their cycles and balance their hormones. I’ve also supported hundreds more in my job as a midwife though their pregnancies and in the early months postpartum. Yet here I was, no period, no cycles, in fact, I had hormones in general (aside from cortisol). Sick, tired and at my wits end something had to give.

 

How did I lose my cycle?

 I lost my cycle 10 years ago directly following the sudden death of my fiancé. I was in a busy midwifery residency, which on it’s own was stressful, but when I lost my partner I had to find ways to cope that would allow me to feel like I had some sort of control over my life and simply keep going.

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I’ve always loved mountain activities like rock climbing, backcountry skiing and trail running. So, while in the final years of my residency, I took it upon myself to stay as “fit as possible” ,  to enable myself to enjoy the sports I loved and be fast and strong enough to keep up to all my mountain guide and professional athlete friends. The thing was, I wasn’t a professional athlete, I was staying awake for 30+ hr stretches regularly catching babies and instead of sleeping and resting to recover I would run 15- 30km. While this genuinely did feel GOOD, it resulted in over exercise, under fuelling and a general lack of relaxation in my life.

Some people call what happened to me a “female athlete triad”, but essentially what it means is you are sending your body the signal that all is not well. You force it to go into a state of self-preservation. With a lack of fuel and an abundance of stress hormones (like cortisol, which is produced during excessive exercise and a hard job where you often don’t sleep), your body prioritizes survival and shuts down reproduction because it fears that a pregnancy would not be able to be sustained.

Sometimes tragedy can be a blessing in disguise 

Sometimes tragedy can be a blessing in disguise 

            In October 2016 I had another terrible climbing accident that left me in a cast for 8 weeks and kept me away from midwifery for almost 8 months. Although I tried to exercise during this time, being in a cast and in terrible pain forced REST on my body. I also experienced regular predictable sleep, for the first time in 12 years. I ate the same but overall, my calorie deficit was reduced and my body’s hormonal systems WOKE UP! I started to have all the symptoms of PMS (sore breasts, cramps, bloating). My body was starting to grow ovarian follicles, which produced precious ESTROGEN. This surge of estrogen stimulated my body to start holding onto body fat again.

Get psycked to buy new clothes...and belts:) For the record, I'm now ANOTHER jean size larger than I was here and I give zero fucks about it. 

Get psycked to buy new clothes...and belts:) For the record, I'm now ANOTHER jean size larger than I was here and I give zero fucks about it. 

Over the course of 8 months I gained about 15lbs and went from a body fat of 16% to 24%. My body did this despite any modifications in my diet and despite my resumption of a high level of activity. My body wanted to survive and heal. For most women to regain their cycles they need to overshoot their previous weights and body fat percentages by an average of 5 lbs and 3-5% hitting a new “set point “ of sorts. It’s worth noting that a fertile BMI ranges anywhere from 21-24 and fertile body fat % ranges from 22-26%. If you’re below this, I’m sorry to say, but 90% of you will have to gain weight to regain your cycle.

Recognizing that my body was taking charge of it’s own health and fertility, I finally decided to pay attention and support my body’s valiant efforts to recover a cycle, hormonal health and my own precious fertility.

How did I do it?

There are lots of ways to get your period back. Some things will work better for others but these are the things that worked for me.

Get properly diagnosed

Hypothalamic amenorrhea isn’t something you should “self diagnose”. It could me a symptom of a much bigger issue. Approach your primary care provider and find a good functional medicine specialist to work with you to diagnose the cause of your lack of period. Here are the tests you should be asking for:

1.     Blood Hormone Levels: Estradiol, progesterone, LH, FSH, testosterone, cortisol, prolactin and b-HcG. Most women who have HA have: Low estrogen, low to absent progesterone, low LH, low FSH, low testosterone, high cortisol.

2.     Thyroid hormones: TSH, T3/T4, TPO antibodies, Reverse T3

3.     Blood nutrient levels: B12, Vit D, Iron and ferritin

4.     DUTCH urinary hormone panel. This is a GREAT test that I did and I now offer to patients. It helps diagnose problems with hormone pathways and tests for not just hormones but also hormonal metabolites

5.     Ultrasound: To check for excess cysts (when combine with high testosterone this may indicate PCOS) and test for uterine thickness.

 

Diet:

1.     Move less and eat more: Reduce and aim to eliminate your caloric deficit. If you need help calculating your calorie and nutrient needs you can use an online calculator.

Never restrict when recovering. This organic vegan chocolate ice cream (with magic shell) was a key part of my recovery :) 

Never restrict when recovering. This organic vegan chocolate ice cream (with magic shell) was a key part of my recovery :) 

2.     Don’t restrict any macronutrient: You need carbs, fats and proteins to be healthy and produce hormones. Trust me I tried everything (low carb, high carb, keto, high protein)  but in the 3 months preceding my period returning I found that I was intuitively eating a balanced diet of about 33% fat 33% protein 33% carbs

3.     Eat clean, well-sourced, organic and nutrient dense foods: These are better absorbed and will cause less stress in your body. An anti-inflammatory diet is best. If you need help finding the best diet for you, send me a message. 

4.     Let go of foods and drinks that may cause stress to your body: While I’ve never been a big caffeinated coffee drinker thanks to a CYP1A2 enzyme gene) one of the biggest things I did was give up coffee (opting for organic Swiss water process). If you suspect food intolerances or if your digestion isn’t top notch, I’d encourage you to work with a practitioner to tease out what could be triggering your symptoms. All forms of stress should be eliminated in the body. I recently started working with a woman who lost her cycle and regained it by dietary modifications alone! It’s an important piece to the puzzle.

Exercise:

Move less: You’re going to have to mellow out a little bit or a lot. While some women have to give up exercise 100%, honestly, I didn’t completely. Much of the research I’ve come across suggests that giving up exercise completely (aside from short gentle walks and yoga) may help your period return faster but what really makes a difference is having a higher percentage of body fat sustained and maintained over multiple months. This sends signals to your hypothalamus that there are enough resources available to sustain a pregnancy.

How you choose to get there is up to you. But seriously, have a solid look at your workout routines and ask yourself if they support your body and goals or are causing more harm than good.

Sometimes the best activity is  rest  and spending time with the people you love

Sometimes the best activity is rest and spending time with the people you love

Supplements:

I’m a firm believer in “smart supplementation”. I don’t like to over supplement and I think that there is no real one size fits all approach to adaptogenic or hormone balancing herbs. If you’d like help finding what may work for you please send me a note. I was continually testing my hormone and nutrient levels using DUTCH testing and blood analysis to ensure smart supplementation. Here’s what I tried and here’s what you can try too.

1.     Vitamin C: Supports your body’s response to stress

2.      Magnesium: Supports progesterone levels and reduces stress

3.     Acetyl L-Carnitine: Supplementing with acetyl-l-carnitine (ALC) restarted menstrual cycles in 40% to 60% of women with HA in two studies. This compound has been shown to affect serotonin, dopamine, and beta-endorphins, reducing the impact of those molecules on the hypothalamus resulting in higher luteinizing hormone (the hormone you need to ovulate). This did seem to help me.

4.     Maca root: This seemed to boost my estrogen levels and accelerate fat gain. For me, I think it caused a state of estrogen dominance and increased my bad estrogen (yes there is good and bad kinds). I’d use this adaptogen with caution. See how it goes for 3 months and re-evaluate.

5.     DIM: I treated my estrogen dominance with DIM. This compound found in gassy veggies like broccoli and cauliflower helps promote healthy levels of good estrogen and clears unhealthy bad estrogen (as long as your liver is strong). This may only work if you’ve already increased your estrogen levels by increasing your body fat levels AND you have maintained a higher body fat for at least 3 months.  Please don’t try this unless you’ve put on a healthy amount of weight.

6.     Calcium diglutamate: This supports your livers processing and clearance of hormones. 500mg is best for most. 

7.     Vitex- If you lose your cycles it may be due to an increase in a hormone called Prolactin. If it’s high, Vitex may work for you. This wasn’t the case for me but I tried it anyway ;) 1000mg is best for most. 

8.     Probiotics: A healthy gut is a cornerstone of a healthy hormonal system. Alternate strains regularly for a robust microbiome.

9.     Sustained Release T3: After years of HA and a high stress job, my Reverse T3 levels were sky-high. Taking a sustained release T3 (prescribed to me by my naturopathic physician) helped me clear my high RT3 and was the final missing piece to getting my period back. Please ladies, have ALL your thyroid levels checked (TSH, TPO antibodies, T3/T4 and FT3). It can be a game changer.

Lifestyle:

1.     Learn to say no:  Over the past year, my blog hasn’t gotten as much attention. I’ve been taking more time to myself to really focus on getting well. Sometimes you just have to simplify. Have a good look at what you can say “no” to in your life and just say “no”.

2.     Sleep your ass off:  Your body is stressed and in a negative energy balance. Sleep is the MOST effective way to recover and rebuild. If you have struggled with insomnia and poor sleep while you’ve had HA, many women find that once you put on some body fat you’ll sleep like a baby again. I certainly did.

3.    Stress less: I’ve taken up a solid meditation practice. It only takes 10 min each day and has changed the way I think, feel and even breathe.

4.    Care for yourself. Get a massage, spend time in nature, Netflix and chill …..if it feels good do it and make sure you do it every damn day.

5.    Acupuncture:  Give it a try, there are several studies that support its use for both stress reduction, hormone balance and fertility. I found it uber helpful.

Coping with your changing body:

1.     Buy new clothes: seriously, tight clothes are such a huge trigger and for me totally ruined my day and made me feel so bad about myself. Sell your tiny sized clothes and use the money to buy some well fitting duds. Most women, myself included, go up 2 sizes when recovering.

2.     Change the way you think about your body.: This one is hard but essential. Your body is trying to survive. It’s trying to get back into balance and be healthy. Resist the urge to pinch your fat or have negative thoughts when you see your body change…..instead, just witness it. Your body is the vessel for your soul. It’s beautiful and dynamic. This is temporary and is the birth of a new normal. If you can’t think of anything positive to say, simply try to witness your body changes without judgment. Be like Switzerland and stay neutral.

3.     Say, “Fuck it” to what people think (including yourself): This needs no explanation. You’re getting healthy; I think you’d be surprised to find that most people, if they understood what you were doing would look at you with admiration not criticism. Often times we are our own worst critics. So perhaps we really need to say “fuck you” to our own self judgment.

4.     Join a support group.:There are countless online forums and FB groups for women coping with the same things as you. Reach out, you’ll be surprised to find that you’re not alone. Ask for help from your loved ones. Reach out. You're not alone! 

This is just my journey. I'm always happy to share. Everyone's journey is their own. If you need support or help, feel free to send me a message

 

The Real Deal on Vitamin A

2019 POST UPDATE** During my research for Baby Making and Beyond, there are some key changes to the vitamin A info I share below. One day soon, I’ll update this post but if you are TTC or are pregnant, check out Baby Making And Beyond’s core 4 nutrition guidelines for more details and recommendations!

Vitamin A is awesome (get it "A"wesome?) that vitamin A is the first one because in my mind, it is one of the most important micronutrients not only to help you boost your fertility and prepare for pregnancy, but also during pregnancy and breastfeeding. So, let's explore the wonders of this over achieving vitamin. 

The Scoop on Vitamin A 

Vitamin A is important for many key functions in the body. These include: 

  • Eyesight

  • Hormone Balance and Fertility

  • Thyroid function

  • Bone growth and skin health

  • Cell differentiation and multiplication

  • Immune Function (viruses and bacteria seem to retreat in the presence of high vit A)

  • For your growing baby specifically: Vitamin A is important for the development of the neural pathways between the brain and sensory organs and in the development of the nephrons in the kidney.

  • Vitamin A deficiency is also associated with pregnancy loss...needless to say, it's an important part of a healthy diet.

Two Types of Vitamin A

Liver is one of the very best sources of vitamin A

Liver is one of the very best sources of vitamin A

Retinoids (Reteinol Esters): Derived from animal sources. Retinoids are found in the liver of any animal and in smaller quantities in egg yolks,  butter and cream from grass fed cows. 

Carotenoids:  AKA Beta-carotene. Vitamin A derived from plant sources. Think carrots, winter squash, pumpkin, sweet potatoes, cantaloupe. Basically, if it has an orange hue, it's probably rich in carotenoids. Carotenoids must be converted by the body into retinol in order to be used by the body. This is kind of tricky for the body to do and is a pretty inefficient process. This process can be even trickier if you suffer from a hormone imbalance, thyroid condition, it can be effected by food preparation and cooking methods and also if don't have enough fat in your diet or if you have digestive problems. Babies also don't convert well (another reason to feed your infants over 6months liver).  

Vit A in a Nutshell

  • Fat soluble Vitamin. This means it must be consumed with a fat to be properly absorbed.

  • Both Retinol Esters from animals and Beta Carotene from plants must be converted by the body into Retinoids. Once converted they are stored in the liver as Retinol Esters. This is why liver is such a rad source of Vit A and also why high doses of vitamin A retinol, when taken in a concentrated form, can cause birth defects months after discontinuing them. High potency topical skin serums are known for this.

  • Traditional cultures around the world seem to instinctively know the the benefits of proper vitamin A consumption. In fact, liver is found in the diets of almost every tribal group around the world, from the Canadian Inuit to the Maori in New Zealand. Many cultures even make special efforts to ensure pregnant women consume liver regularly. They instinctively know that vitamin A is critical for the health and wellbeing of our growing babies and is an KEY part of there development. Weston A Price has a great article that goes into the details about why Vitamin A is so critical for fetal development. Take home message....CONSUME LIVER in reasonable amounts! 

Vitamin A Toxicity in Pregnancy

The fear about Vitamin A toxicity in pregnancy over the past 20 years is something that commonly worries women whenever I suggest regular  dietary liver consumption. Here's the deal.....In 1995, a small study based in Boston found that high does of vitamin A could cause neural tube defects. The issue with this study is that it only looked at higher does (25,000 IU+) Vitamin A consumption from SYNTHETIC sources (retinol & retinol esters).  Follow up studies from several sites in Europe concluded that doses up to 30-50,000 IU in pregnancy from REAL FOOD sources were very safe, in fact, potentially beneficial to pregnant women. Sadly however the FDA did not change it's message and the public was once again misinformed.

Retinol Sources and Levels

  • High-vitamin cod liver oil 230,000IU /100g

  • Regular cod liver oil 100,000IU /100g

  • Duck liver 40,000IU/100g

  • Beef liver 35,000IU/100g

  • Goose liver 31,000IU/100g

  • Liverwurst sausage (pork) 28,000IU/100g

  • Lamb liver 25,000IU/100g

  • Egg Yolk 1,442IU/100g

  • Pasture Raised Butter 2,500IU /100g (this level varies greatly depending on diet of cows)

The US  and Canada currently recommend 5,000 IU per day . From the work of Weston Price, we could guess that the amount of Vitamin A in primitive diets could have as high as 50,000 IU per day. Current  recommendations from a variety of sources hover around the  10,000 IU-15,000IU level when obtained from a modern diet rich in daily grass fed butter, eggs from pastured animals and beef, lamb or poultry liver several times once a week. If you're not eating liver adding a 1 tablespoon of fermented cod liver oil can help. You can also take liver capsules, which are also a great source of b-vitamins. Vital proteins makes a good product. What's a Pregnant Paleo Mama to do?

Lambs liver...one of the milder livers. It makes great meatballs and pate spreads.

  1. Always enjoy your vitamin A sources with a fat. Vitamin A is fat soluble and needs fat to be properly absorbed.

  2. Enjoy liberal amounts of butter from grass fed cows and egg yolks. 

  3. Enjoy liver from grass fed animals once or twice a week to ensure you have a good supply of retinoids. Unless you are consuming Polar Bear or walrus liver, a serving or two of liver per week is not likely to cause any trouble. If you find the flavour of liver to be strong, try chicken liver, duck liver or lambs liver. They are milder. I have a great lambs liver meatball recipe ! It's easy to hide a few ounces of liver in meatballs, burgers or meatloaf. If you're feeling adventurous you could also try one of  Liz's Liver Smoothie Shots I'm going to give this a go this week....keep your eyes out for me on Instagram giving this a shot...literally. Ha ha. 

  4. Consume beta-carotene rich foods to your hearts content. Yumm squash (I am a squash addict) 

    • Always consume vitamin A rich food with a FAT. This helps you absorb to absorb the nutrient. This gives you full permission to slather your yam or kabocha squash liberally with grass fed butter or coconut oil. 

  5. Make sure you are getting enough Vitamin E in your diet

    • Vitamin E is necessary for the absorption of Vitamin A. Vitamin E can be found in: spinach, turnip, chard, sunflower seeds, almonds, bell peppers, asparagus, collard greens, broccoli, kale and brussels sprouts.

  6. Pregnant or planning for pregnancy? I'd give your high dose Retinol skin creams a miss to reduce the chance of toxicity. Try a vitamin C skin serum instead to achieve a beautiful glow!  

 

Everything Pumpkin !

 

If you follow me on Instagram you may have noticed the rather 'unseasonable' weather we've been having here in the Canadian Rockies. It isn't unusual for it to snow in early September, but,  it typically disappears pretty quickly....not this time. We got a HEAP of snow (30cm to be precise) and it stayed below zero every day last week. These frigid temps sent me lunging for my slow cooker and craving all of my favourite PUMPKIN recipes.

Circa Thanksgiving 2013...pie...best enjoyed with Scrabble

Circa Thanksgiving 2013...pie...best enjoyed with Scrabble

What is it about pumpkin? I swear, it's the veggie equivalent of bacon! One mention of it sends people into a tizzy. Perhaps it's the slightly sweet, carby nature of this starchy veggie, or maybe it's the spices we often pair with it that conjure up good memories of family and warm cozy days spent fireside. Regardless , I wanted to share a few amazing pumpkin recipes with you and talk about the benefits of pumpkin as a part of your healthy fertility or pregnancy Paleo diet.

 

 

Pumpkin's Paleo Pregnancy Friendly Nutritional Benefits at a Glance

  • Pumpkin is one of the lower carb starchy winter squashes. A 100g serving typically contains 8g of carbs (3g of which are fibre). It's also rich in soluble fibre which can help feed your happy belly bacteria and optimize your gut microbiome. This can be a good choice even when you're following a reduced carbohydrate diet or if you have gestational diabetes.
  • Rich in vitamins such as folate, niacin, vitamin B-6 , thiamin and pantothenic acid, vit-c, vit-a (more on this next week! and vit-e.
  • A good source of potassium. This can help re-fuel you after a workout and can also help to keep your electrolytes in balance. If you suffer from pregnancy related leg cramps this can really help. 
  • Excellent source of many natural poly-phenolic flavonoid compounds such as α, beta- carotenes, cryptoxanthin, lutein and zea-xanthin. Zea-xanthin is a natural anti-oxidant which has UV (ultra-violet) rays filtering actions in the retina of the eyes. 
  • It tastes great is is often well tolerated in the first trimester when food aversion and nausea can dominate your life. In fact, the vitamin b-6 in pumpkin may actually HELP your morning sickness, especially if paired with ginger...think pumpkin pie! 

Slightly sloppy but seen here sporting a good dollop of coconut manna. 

Meg, The Modern Paleo Midwife's Pregnancy Pumpkin Gelatin Treat

This delightful single serving recipe utilizes the flavours of classic pumpkin pie while benefiting from healthy fats from coconut milk and the healing qualities of gelatin. There is also a sugar free option if you use stevia. 

Serves: 1

2/3 cup Coconut Milk (From a carton, light or full fat depending on how rich you'd like it)

1/3 cup Bpa free canned pumpkin or puree from homemade roast pumpkin

3/4 tbs Grassfed Gelatin

2 tsp Cinnamon 

2 tsp Vanilla Extract

1 tsp Ground Ginger

1/2 tsp Nutmeg and Sea Salt (brings out the sweet and spice)

Stevia to taste (for sugar free) or 1-2 tbs coconut palm sugar, honey or maple syrup

Combine 1/3 cup of the coconut milk and the pumpkin and heat in microwave (for 1 min) or pot on the stove until just starting to bubble but not boil. In the mean time, bloom gelatin in remaining 1/3 cup of coconut milk, stirring well to combine.  Add spices (adjusting to taste), salt, vanilla and sweetener to gelatin mix. Once pumpkin/milk is hot, add the gelatin/spice mix and stir until gelatin mix is totally dissolved. 

Let set in fridge for 1-2 hrs until firm. Top with more cinnamon, melted coconut butter, whipped cream or my personal fav, vanilla coconut milk ice cream! 

Other Great Paleo Pumpkin Recipes (all Modern Midwife Approved!) 

Pale OMG's Round Up of her fab pumpkin recipes. 

Spunky Coconut's Pumpkin Chili 

Eat Drink Paleo's Pumpkin Garlic Cauliflower Mash and Meatballs

Classic Pumpkin Paleo Pancakes from Diane Sanfilippo's Practical Paleo

Elana's Pantry's Classic Paleo Pumpkin Pie

Paleo Mama's Pumpkin Pie Smoothie

 

 

 

Essential Fatty Acids: What's the Deal?

It's summer in the Canadian Rockies and the alpine wildflowers are in peak bloom. It's times like these I feel blessed to enjoy where I live and am thankful for the clean air, open spaces and wild country that I call home!

This was a cloudy day last week and a beautiful run through the wild arnica (good for tissue healing) around Buller Pass. This was 30mins from my house. That makes me happy! 

All these beautiful flowers, plus a post by Paleo For Women's Stefani Ruper inspired me to want to write own post about Evening Primrose Oil. I got going on that and then whamo! Up popped a post by Mark Sission that inspired me to write a more general post about Fatty Acid Supplementation.

This wee story may be the starting point for a longer novella about fatty acids in pregnancy but for now, here's my two cents on essential fatty acids. Before we jump right into why I encourage DHA supplementation during pregnancy, let's look at why, in the Paleo community, we talk about balancing our omega-3 and 6 ratios.

Why should I care about Omega3's vs Omega 6's? 

Good question! Why the heck should you care? I'm not a big fan of  'micromanaging' what you eat, but, I think it can be beneficial to take a big picture approach and look at your diet every once in a while. This is especially important if you are suffering from a chronic condition, are trying to optimize fertility or are expecting a little cavebaby! 

To explain it briefly and simply, omega-6 fatty acids (mostly Arachidonic acid ) promote systemic inflammation in the body by stimulating inflammatory prostaglandin's. Omega-3 fatty acids (mostly EPA/DHA)  aren't in themselves anti-inflammatory but rather stimulate a concurrent cascade of chemical activities that basically slows the entire inflammatory cycle down by competing with binding sites and decreasing tissue concentration of inflammatory prostaglandin's. 

Therefore, the amount of omega-3's you need in your diet should correspond to the amount of omega-6's in your diet. Too much omega-6 and you run the risk of developing diseases that are related to inflammation. These include cardiovascular disease, Chrohn's disease, hormone dis-regulation and insulin resistance. Being in a constant state of inflammation can also make conceiving more difficult. This is why we are all so fascinated and obsessed with omega 3:6 ratios. 

Back up here....Prosta-'what'-dins? 

Prostaglandins are autocrine or paracrine regulators rather than hormones. They are produced an act locally within cells and tissues. Prostaglandins have a wide variety of important functions in our body including: being responsible for the cascade of hormones to start labour, smooth muscle regulation, cell growth, hormone regulation, platelet aggregation (formation of blood clots) and localized inflammatory responses. 

This is a great visual that helps point out how much omega:6 is in our diet

 What is the optimal Omega 3:6 Ratio?

Well, good question. I don't think anyone really knows. A standard american diet (SAD)  typically includes ratios of 1:10 or upwards of 1:25. That's totally nuts! Many paleo authors have suggested a ratio of 1:1 -1:3 is a more reasonable ratio for optimal health. These ratios more closely resemble the ratio's that our traditional ancestral diet may have contained.

Should I Supplement?

Well, good question. If you eat a squeaky clean paleo, ancestral or primal diet, with no processed food, no inflammatory seed oils (think canola based margarine) it's easy to think you're doing a smashing job! That being said, even I occasionally cave and eat a bag of organic chips made with canola, and there are tons of Omega-6 fatty acids found in many paleo/primal friendly foods too. These include delicious delights such as avocados, nuts, nut flours (aka paleo treats), poultry and pork products (yup...bacon).  

Most of us aren't perfect in balancing these ratios and we tend to be exposed to many more omega-6 fatty acids in our diets than may be optimal. It's good to look at your intake of these foods and be honest about how much poultry, nuts and avocados you really consume.

To aid in ratio optimization, try to add in more grass-fed beef, game or organ meats, watch your consumption of nuts and seeds (walnuts and macadamias are a good choice), and try to include more cold water fish like herring, mackerel and sardines. You can also get DHA from flax, hemp and chia but it must be converted in the body from ALA to EPA/DHA. Unfortunately, this process isn't very efficient. According to Chris Kresser, less than 5% of ALA getting converted to EPA with less than 0.5% being converted to DHA. Best to stick with the fish and grassfed meats.

If you are trying to treat a specific health condition, trying to conceive or are pregnant or breastfeeding, supplementation may be a good choice and is supported by both mainstream medical doctors and most natural health practitioners alike.

DHA/EPA Supplementation

There are numerous studies touting the benefits of supplementation with DHA, most notably from fish oil. Supplementation of DHA from fish oil has been shown to be beneficial for fertility, pregnancy and breastfeeding.  

DHA supplements may help:

DHA helps babies brain, eye and overall neurological health

DHA helps babies brain, eye and overall neurological health

  • Enhance male fertility by aiding in sperm quality and motility
  • prevent pre-eclampsia in pregnancy
  • prevent mood changes and postpartum depression
  • Support fetal neurological development (brain/eyes)
  • Reduce of the risk of allergies in infants
  • Supplementation during breastfeeding dramatically increases DHA content of breastmilk...essentially making it "super-milk" 

DHA is one of the few fatty acids that crosses the placenta. Fatty acids are required by the developing fetus as a source of energy, to maintain the fluidity, permeability and conformation of membranes and as precursors of critical bioactive compounds such as prostacyclins, prostaglandins, thromboxanes and leukotrienes. DHA synthesis is limited in the fetus and supplementation or high dietary intake of DHA has been shown to increase overall fetal DHA levels and effect m-RNA expression. Translation: these are all good things! 

DHA absorption by the fetus is shown by studies to really get ramped up in the final 10 weeks of pregnancy. So, if you are nauseated or just can't tolerate fish oil caps in the first half of pregnancy, no biggie. You can make up for it later when you are feeling better. 

What supplements should I buy?

This is a wee little Krill...he's a good choice if you're going to supplement with DHA. 

This is a wee little Krill...he's a good choice if you're going to supplement with DHA. 

Good question! I coach clients to look for DHA from krill or other small marine animals. Krill oil has been show to be more easily absorbed and increase blood DHA levels faster and more efficiently than traditional fish oil capsules. Plus, krill are small little animals and the lower you eat on the food chain, the less risk you have for being exposed to contaminants and toxins. Make sure your supplement has at least 200-300mg of DHA per cap and take between 1g-2g daily.  Chris Kresser wrote a long post all about how to choose a fish oil that is worth a read. 

For the Fish/seafood allergic there are options! 

For the Fish/seafood allergic there are options! 

Don't do fish?  If you're like me and are allergic to fish/seafood/shellfish there is one other option for getting your DHA. Marine algae. Studies have shown that taking a supplement of marine algae based DHA can be just as effective as fish oil. It's more expensive but if you have no other options, it can be a good solution. 

 

 

 

 

Evening Primrose Oil

Evening Primrose...not just a pretty flower

Evening Primrose...not just a pretty flower

What is Evening Primrose Oil (EPO)? 

Evening primrose oil is a pressed flower oil that contains omega-6 fatty acids, much like safflower or canola oil. I know what you're thinking,

"HOLD THE PHONE, aren't additional omega-6 fatty acids a bad?" Well, , yes, I'd agree, but, EPO is an exception. 

EPO is unique in that it is mostly comprised of (75%) Gamma-Linoeic Acid or GLA. GLA is one of the  few "anti-inflammatory" omega-6's fatty acids. It does this by it mitigating the inflammatory prostaglandin response caused by Arachidonic Acid (aka canola, safflower, sunflower oil) via similar pathways as DHA and EPA.

Evening Primrose Oil's Role in Women's health, Fertility and Pregnancy

There is very little research on the benefits of EPO but here is what we do know...or think we know :)

Manage PMS

  • Inflammatory prostaglandin excess can be responsible for a myriad of PMS symptoms including cramps, breast tenderness, joint pain and bloating. Taking a supplement of EPO may help to reduce these effects and make PMS a bit more manageable. Many PMS sufferers are found to have unusually low levels of GLA in their systems, which is why supplements might help so much. EPO can also help promote the absorption of iodine, a mineral that can be present in abnormally low levels in women with PMS and hypothyroid conditions. 

 Balance your Mood

  • What woman doesn't want help with the delicate balance of mood regulation during their menstrual cycle or pregnancy?  Studies have shown that supplementing with EPO can help reduce some of the mood changes associated with PMS, pregnancy and in the postpartum period. Many studies focused on the use of DHA, not GLA for pregnancy mood related changes so for clients who have struggled with mood in the past, I usually recommend a high dose fish oil or placental encapsulation (that's another post!) for this particular complaint.

Aid in Fertility

  • There are some claims that claim that taking evening primrose oil can help a woman conceive by making her cervical mucus more stretchable and slippery, enabling the sperm to move more quickly through the uterus and into the fallopian tube. Can't hurt!  

Supplementing with EPO during the third trimester of Pregnancy

  • Many midwives recommend supplementation of EPO during the third trimester of pregnancy to help soften and ripen the cervix in preparation for labour. I used to recommend this too until I did some further research. Honestly, it doesn't really seem to work. There have been many midwifery led studies in North America and Europe that show no change in cervical ripeness with EPO supplementation. Bummer. Does it hurt? Nope. Will it help? Probably not, but again, it doesn't hurt! 

 

 

How to Balance Your Hormones- Paleo Styles

My friend Erin Urton from Tuja Wellness, finding her balance in Zion a few years ago. 

Balance.  We all desire it and yet so many of us struggle to find it! It can be complicated, like a good relationship, as well as mystical, like the snuffleupagus. When it comes to optimal female health, fertility and wellbeing finding a healthy hormone balance is critical.

How do you know your hormones may be out of balance? Well if you suffer from sleep disturbance, fatigue, unexplained weight gain or loss, acne, irregular menstruation, infertility, PMS or have been told you have PCOS, then you suffer from a hormone imbalance. 

Meg the Paleo Midwife's suggestions for helping to improve your hormone balance

1. Limit Caffeine: Remember my Bulletproof post last week? Caffeine can be great for a healthy individual, however, if your body is under stress it can wreak havoc on your delicate adrenal system. The adrenal glands produce the stress hormone cortisol in addition to sending messages to your pituitary gland. It's your pituitary gland where the hormones LH (leutinizing) and FSH (folliclie stimulating hormone) are made. These two hormones are critical for egg maturation and ovulation, which are key parts of getting pregnant. If adrenals are depleated, hormonal imbalance can occur. Choose herbal tea or decaf or half-caf coffee instead.

You cand find these awesome chips here! They do online ordering too. How did I figure out how to include chips in a post about hormones? Can you see the irony? Ha ha

2. Avoid high Omega-6 Polyunsaturated fats: These are mostly found in vegtable oils like canola, safflower, sunflower or soybean oil. Avoiding these fats is a key part of the Paleo diet as they cause inflammation and easily oxidize in the body. Inflammation contribues to endocrine/hormone balance and can cause disruptions in the bodies natural cycles. The easiest way to avoid them is to read labels and ask what kind of oil is used in restaurants!  They linger in chips (even sweet potato chips) and packaged foods. Choose fats from animals like butter, ghee or lard in addition to non-animal fats found in olive and coconut oils. Need to satisfy your chip craving? These will do it and keep you healthy! 

3. SLEEP: Sleep really does fix everything. If your body isn't getting the rest it needs then it isn't getting a chance to repair and produce its own natural hormones. Not getting sleep affects your hormones viat two main pathways. The first is via the pituitary axis. Not only does the pituitary glad produce LH and FSH (see above) it also produces GH or growth hormone. This hormone is responsible for repair and rejuvination in the body. The second main way sleep contributes to hormone balance is with the simulation of your parasympathetic nervous system. This is the system that tells your body to chill out! Most endocrine (aka hormone) organs in your body need good parasympathetic 'tone'. There are several well documented examples of sleep deprivation effecting pancreatic insulin secreation and the release of leptin from fat cells. Leptin is an appetite-suppressing hormone. Sleep deprivation also effects your thyroid gland and it's overall function. All key things to help you look and feel your best.  If you have trouble sleeping developing a few rituals around bedtime can help. Here's a link to a great article about sleep hygiene. 

4. Exercise intellegently:  Running marathons and doing 5 hard WODs a week does not improve hormone function! Exercise just hard enough to challenge your body but not so hard that it can't recover. When you work too hard you stimulate an overwhelming release of cortisol, which tells your pituitary that you're stressed! Most bodies can do this for a little while but in the long term your body gets the signal that maybe this isn't a great time to be fertile and bring new little cavebabies into the world!

Gentle cardiovascular activity done early in the day and feel enjoyable are key (late day workouts can harm sleep) . Many people enjoy hiking, walking, swimming or biking. A bonus, exercise done outside also helps improve your mood, vitamin D levels and overall sense of wellbeing!  Lifting heavy weights 2-3 times a week can also help trigger a cascade of benifical hormone responses that can be ideal for hormone balance. 

This list changes anually so be sure to keep up to date. 

5. End your relationship with toxins: Choose your organic produce wisely. Using a guide like the dirty dozen and clean 15 can help you make budget friendly choices. Try to buy local, organic or pasture raised meats and eggs when possible.

It's not just what we eat that can effect our hormones. It's also what's in our homes, cars and offices. Limit exposure to things like plastics (BPA), non-stick/teflon cookwear and read labels on your skin care products and cleaning supplies. You'd be surprised where toxins can linger. Choose natural skin care products that don't contain hormone disruptors like parabens. Consider using homemade cleaners like baking soda, vinager and soap. You'd be surprised how effective these can be! .

Bulletproof Coffee and Pregnancy

Ever notice how things always seem to happen in three's? This week I've gotten three questions from readers about the safety of Bulletproof coffee in pregnancy. Huh, well, I guess I have my topic for the week! 

What is Bulletproof Coffee?

Bulletproof coffee is a trend that has taken the Primal/Paleo world by storm in recent years. Bulletproof coffee is a brand developed by Dave Asprey. Bulletproof coffee is made by blending high quality coffee, MCT oils and grassfed butter into a delicious and highly potent drink. Dave markets and sells "Upgraded" products including high quality coffee, Brain Octane (MCTs) and other products on his website but many folks simply use their own local grassfed butters, coconut oil and organic dark coffee beans.

 Bulletproof coffee is bascially a tweak of a classic Tibetan drink called yak butter tea. Now, if you've ever had yak butter tea, which I have, it isn't exactly the most palatable stuff but it is exactly what your body needs at higher elevations and serves as both a nourishing beverage and important social custom for many of the people of the high Himalayan. 

Benefits of Bulletproof Coffee

Dave claims that drinking this beverage regularly can help you lose weight, optimize brain function, enhance fertility and overall make your life more rad. Sound like a gimmick? Jury's still out on that one. Try it for yourself and see how you feel. I'm dairy allergic (can't even have ghee) so the only version I've had is coffee with copious coconut oil/butter. It was delicious but true story, I love breakfast and if I drink it I can't eat breakfast too (too rich) so it's a hard choice for me! 

 Is Bulletproof coffee safe for pregnancy?

Well, let's break down each ingredient and decide for ourselves:

Grassfed butter: Safe and Recommended

- High in Vitamin A, D and K2, all essential nutrients for pregnancy.

-  High in Oleic acid and Myristic acid (cancer fighting fats)

- Contains CLA (metabolism boosting fats)

- Source of dietary cholesterol (essential for brain development and nervous system function)

- High in glycospingolipids which protect the lining of the gut from pathogens

- Rich in Omega-3's which help babies brain and eye development as well as aid in optimal maternal cardiovascular function. 

MCT (Medium Chain Triglyceride): Safe and Recommended 

- High in lauric acid which our bodies convert into monolaurin, which has anti-viral, anti-bacterial, and anti-protozoa properties. 

- Stimulates metabolic activity (utilized as energy rather than being stored) and aids in healthy thyroid function.

- Shown to improve gut microbiome diversity (in a good way) which is really important during pregnancy.

- Anti- inflammatory properties and healing on the digestive system

Coffee: Approach with caution and moderation

- Aids in cardiovascular health and is protective against dementia and Alzheimer's 

- Rich in antioxidants and some studies have shown that it may reduce the risk of skin cancer 

- May block a substance called human islet amyloid polypeptide that may play a role in the development of diabetes.

- Aids in mental sharpness and athletic performance and recovery

- Coffee and pregnancy: Coffee naturally contains high levels of caffeine. For a full run down of the risks and benefits of caffeine in pregnancy, see this previous post of mine all about the use of coffee and caffeinated beverages in pregnancy. The take away message is that we don't know how much caffeine is safe during pregnancy. When pregnant,  the ability to metabolize caffeine decreases (via CYP1A2 enzyme pathways) therefore their circulating levels of caffeine in the bloodstream and thus to the growing fetus are increased. I take this delayed metabolism as a sign that it isn't something the body should have much of when growing a new little human.  You may notice that a little caffeine goes a long way when your pregnant. Maybe it's natures way of telling you to cool it. 

So....does this mean bulletproof coffee is 'out' during pregnancy?  Nope.

- Swap out regular coffee for Organic Swiss Water Decaf. Many studies show that decaf coffee still has many of the protective antioxidant benefits of regular coffee. Please be sure to source your beans well, choosing organic and fair trade when possible and make sure that the coffee isn't chemically processed. Dave even sells a clean decaf version of his Bulletproof coffee on his site but you can also just source your own beans from a local roaster. 

- MCT and grassfed butter are pregnancy superfoods! Consume in 'liberal moderation'! 

Do you drink bulletproof coffee? Have you noticed any benefits? Any downsides? 

Want to learn more about just what to eat and WHY it’s ok or not ok when you’re expecting or planing to conceive? Check out the Core 4 and the modules that are the right fits for you in Baby Making and Beyond .