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This blog is about gut flora, good bacteria, scientific research, and anti-inflammatory food. It’s a prescription for anyone who wishes to eat their way to a healthier life. It’s impossible to overdose on this course of treatment.

Food Pharmacy, Interview

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PCOS, Insulin Resistance and Vitamin D (part 1)

A few episodes ago on our Swedish podcast we talked about PCOS with Jenny Koos, a sexual health advisor and Holistic Reproductive Health Practitioner. During the episode we promised that Jenny would appear here on the blog as our very own expert on PCOS and today it is finally time.

– Jenny, tell us. What is PCOS exactly?

Polycystic ovary syndrome, PCO-S, is part or a precursor to a metabolic syndrome including diabetes, obesity and cardiovascular problems. The name has been on the verge of changing for several years to “metabolic reproductive syndrome”, or “Anovulatory Androgen excess”, because “PCOS” is misleading. Explained here:

“[The name PCOS] is a distraction, an impediment to progress,”… “It causes confusion and is a barrier to effective education and communication. It focuses on… polycystic ovarian morphology, which is neither necessary nor sufficient to diagnose the condition. ”(NIH panel, 2012)

– What are the symptoms?

Women with PCOS have an excess of androgens (“male” sex hormones), which can express themselves as an irregular menstrual cycle, acne, increased hairiness according to a “male” pattern, thinning of the scalp, or obesity around the waist. In the long run, it is linked to a higher risk of diabetes and gestational diabetes, cardiovascular disease, high blood pressure and uterine cancer.

However, the syndrome is more complex than singular external symptoms, but conventional medical treatment focuses on suppressing the symptoms, e.g. by completely shutting down the ovulation and causing regular withdrawal bleeding. The problem with PCOS, however, is not that you do not bleed, but you do not ovulate.

– Yeah, we are aware of the issue with ovulation. We have many friends with PCOS who have had problems with irregular periods and difficulty getting pregnant. How common is it with PCOS?

It is estimated that up to 18 percent of women of childbearing age have PCOS, and of course that number isn’t’ including unknown cases. It is a metabolic syndrome, a endemic disease based on diet and lifestyle and is not about arduous ovaries. Read more here, here and here.

– Breakdown for us what it is that’s happening in the body?

In a normal menstrual cycle, the growing follicle (egg shell) actually produces androgens, that is, “male” hormones. However, this androgen in the follicle should then convert to estrogen, and a peak of high estrogen is necessary for the brain to drive the ovulation using the hormone LH. The problem with PCOS is that the follicles stay idling.

The hormone LH from the brain at PCOS is elevated for longer periods than normal – because the brain wants to ovulate, which for various reasons cannot be completed. This can make ovulation tests difficult to read.

When the levels of LH are elevated, the conversion to androgens such as testosterone and dihydrotestosterone increases, giving rise to acne and hirsutism (increased male-type body hair). Even stress is a major contributing factor, as androgens can also be overproduced from the adrenal glands.

– What’s the relationship between androgen excess and ovulation?

Essentially, androgen excess, accumulated from various sources, affects the regulation of the menstruation cycle from the brain, resulting in a vicious circle where the weakened ovulation ends up preventing itself.

In addition, from the “half-mature” follicles (growing eggs that have not come to the end spurt), the hormone AMH is released. Women with PCOS have therefore increased AMH. They also have low SHBG, a transport protein that normally binds free testosterone and makes it inaccessible.

– That’s a lot to keep track of, but so interesting. How is the diagnosis determined?

Well, there is a lot to think about. One or more ultrasounds that show on PCO do not equal that you have PCO-S. Diagnosis cannot be given just by ultrasound!

PCO stands for polycystic ovaries, and means many small semi-mature follicles in the ovaries without any particular one leading or appearing to be ovulating. This phenomenon is known as “the pearl band” when seen on ultrasound. However, the pearl band in itself says nothing about WHY your follicles go and go but don’t come to the party. It may have other things to do than PCOS: puberty, hypothyroidism (underactive thyroid), nutritional deficiency, stress, high prolactin, or some medications.

PCO alone can thus occur during an extended menstrual cycle, during stress, or after recently discontinued use of endocrine disrupting contraceptives, and is therefore, in certain circumstances, “normal”.

According to the AE-PCOS Society, diagnosis can only be made if the person meets all three of these criteria:

  • Irregular cycles and/or PCO
  • Excess of androgens such as testosterone, androstenedione and DHEAS – or symptoms of the same in the form of acne, increased hairs (hirsutism) or obesity (especially around the waist)
  • Do not have any other reason to overproduce androgens, eg congenital adrenal hyperplasia

Thus, if you have been diagnosed with PCOS based solely on an ultrasound, without having taken blood samples, the doctor has not done his job. You could be able to ovulate a few weeks afterwards and thus not have the careless diagnosis anymore!

If you do not have a period for a couple of months it does not necessarily mean PCOS. You may instead have suffered from hypothalamus syndrome, which is not at the ovarian level but means that the brain closed down the menstrual cycle due to malnutrition or overtraining.

Knowing WHY your menstruation cycles are irregular, why it is difficult to ovulate, is absolutely crucial for which treatment will work for you!

– But if a woman finally gets the diagnosis, what does she need to know to alleviate the symptoms? For example, are there different types of PCOS?

Lara Briden refers to 4-5 different types of PCOS, which I think is a helpful approach to finding the drugs that actually work for the individual.

The first and foremost is the insulin-resistant variant. Of women with PCOS, 30% have been shown to have impaired glucose tolerance, another 7.5% have diabetes, and one need not be overweight to have blood sugar problems. Insulin resistance means that you cannot use insulin, which usually means increased production. Insulin resistance does not have to mean obesity or diabetes, but can definitely lead to it.

The insulin resistance factor is the reason why type 2 diabetes is a future risk for those who suffer from PCOS – at ground level it is essentially the same problem. And given that many of us are raised on frosted flakes, instant noodles and candy it’s maybe not so strange that PCOS is increasing.

Hyperinsulinemia affects the growing follicles locally and drives a testosterone production, instead of the estrogen that should actually dominate. High insulin also raises LH from the brain, further increasing the production of androgens in the ovaries. High insulin also lowers SHBG, which means more free testosterone.

A bit more progressive doctors use Metformin, a diabetes medicine, for PCOS. Often, however, the focus is often solely on lowering the androgens, which does not overcome the underlying problem.

– You mentioned PCOS stems from diet and lifestyle, and now you mention the link to insulin resistance and blood sugar levels. Does this mean that women with PCOS should think about what they eat?

Yes, you can definitely greatly reduce your sugar intake and make your insulin receptors more sensitive so the insulin doesn’t shout at them. Low Carb Diets is proven effective, but I would not recommend removing carbohydrate/starch completely, because you need them to be able to ovulate. Eat well and balanced during the day and avoid sugar-roller coasters, even if they consist of raw nutrition balls. Sleep helps, magnesium helps, inositol is an option.

– We’ve heard that vitamin D plays a roll here too, is this true?

Yes, vitamin D is a prerequisite for you to ovulate properly and there is plenty of research on how it is involved in PCOS. For example, it has been shown to induce ovulation in women with PCOS, as it optimizes follicle growth (the growing follicle has receptors for vitamin D), as well as lowers AMH and testosterone. Vitamin D deficiency is associated with insulin resistance, difficulty in ovulating, hyperandrogenism, overweight and so on. In this study, up to 85% of women with PCOS had low levels of vitamin D in their blood.

– Thanks, Jenny! We’ll continue with the rest of the PCOS issues on Thursday. Ciao!

Photo: Jenny Koos.

Jenny Koos is a Holistic Reproductive Health Practitioner, but also known as Vulverine, the pussy whisperer, or simply a holistic-minded sexual health advisor. You can find her on facebook and instagram.

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Recipes, Therese Elgquist

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Vegelicious Green Smoothie Bowl

During the spring and summer I tend to eat more smoothie bowls for breakfast (and lunch and dinner). The nice thing about smoothie bowls is that you can blend up virtually anything (well… almost), so don’t be afraid to go outside the frozen-banana-berry-and-acai powder box.

I like to mix as much vegetables as possible since it gives a fulfilling breakfast filled with nutrients. In this particular smoothie I just threw in a bunch of greens and vegetables that I had at home, including my new favorite – chlorella. It gives a really nice color and has mega benefits!

Pause for a second of reflection on the topic of avocados. You have, as myself, likely become aware of the debates on, avocado water use and non-sustainable production as of recent. It is, among other things, regarding the fact that the hip crops are grown in such extreme quantities (as this gives the most yields) that the soils become overloaded.

Despite this, I have not completely stopped eating avocados. I do, however, make the occasions more rare and avoid buying if I do not find organic and grown “near” me or at least the continent I find myself on. Instead of making a point of eating an avocado every day, it is now a luxury that is saved for special occasions. Most recently, avocados ended up in this smoothie, and oh so delicious it was!

Vegelicious Green Smoothie Bowl
(1 bowl)

¼ – ½  fennel
1 handful fresh spinach, or about 4 cubes frozen
1 stalk of celery
½ inch (1cm) fresh ginger
1 tablespoon freshly squeezed lemon juice
½  avocado
1 large handful raspberries
2 fresh dates, pitted
1 – 1½  teaspoons of chlorella water to taste

Topping:
granola or roasted seeds and/or nuts
hemp seeds
coconut pieces
dried berries or fruits, such as inca berries and apricots
fresh mint

Throw everything down in a powerful blender and mix until it becomes completely smooth. Add a little water at a time until you get a consistency that you like. Are you going to drink it on the road? Pour in more water for a looser smoothie or less water for a smoothie that is best eaten with spoon. Top with optional nummies!

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Food Pharmacy, Recipes

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Nutrient Hunter’s Cake

At the end of last year, the world’s first Food Pharmacy baby was born. Two of our very own colleagues welcomed into the world a daughter. Though her taste adventure beyond mother’s milk has only just begun she’s likely bound to be a curious and happy little nutrient hunter.

Since her parents are well aware of the connection between a nutritious diet and good health, her diet consist of an array of superfoods for her gut flora.  It wasn’t exactly the same story when we became new parents. The concept of avoiding sweetened and overly processed food instead of steaming vegetables, making homemade porridges and mashing up avocados felt unnecessary. And we didn’t realize that the immune system is calibrated during the first year and that the intestinal flora is particularly sensitive at that time.

In our past life, we believed, along with so many others, that there was a contradiction between good and healthy. Clearly, we’ve shifted that belief and we love helping others on this quest.  Nutrient hunters don’t have to choose between delicious or nutritious. We can serve treats on friday family movie nights, and baked goods on father’s day, even scrumptiously fun cakes on children’s birthdays, all without having to compromise one thing over the other. We promise!

Speaking of scrumptious cakes. Should you have a festivity in your near future, we highly recommend this classic “princess cake”.  It’s a classic Swedish cake with a nutrient hunter twist, yet another great recipe to add to your arsenal of delicious and nutritious.

Nutrient hunter’s princess cake

Cake:
1 ¾ cup almond flour
¾ cup + 2 tbsp coconut flour
5 dates
⅛ tsp cardamom
1 ½  tbsp coconut oil
1 tbsp water

Directions: Combine all of the ingredients in a food processor into a dough. Split into three equal sized balls and roll out into the three layers of cake you will need.  

Custard:
¾ cup of natural cashew nuts
¾ cup water
1/2 teaspoon vanilla
6 dates

Mix in a food processor until it becomes a smooth sweet custard

Cream:
1 can of coconut cream
1/2 teaspoon vanilla

Whip the coconut cream and vanilla until fluffy, be careful not to over whip

Jam:
2 cups strawberries, frozen and thawed
2 tablespoons chia seeds

Combine and allow to rest until thickened, add a bit of honey of the strawberries were too tart

Marzipan:
1 ¼ cup almond flour
2 tbsp honey
2 tablespoons spinach

Pulse ingredients together until you have a smooth mass. Roll out into a thin layer to create the cover for the cake.

Assembly:

After mixing all of the cake components separately, begin assembly.  The trick for a dome shaped cake is to build it up in an upside down bowl, layer by layer. You can make one large cake or mini cake with this technique.

Line the bowl with a parchment paper and dress the inside of the bowl with the marzipan cover. Continue by adding in the coconut cream, cake, vanilla custard, cake again, jam and finally a third layer of cake. Set the bowl in the freezer and let the cake set a bit. Carefully flip the princess cake out onto a serving plate just before serving and decorate how ever your heart desires.

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Henrik Ennart, Recipes

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Grilling Season, AGE and Roasted Carrots

BBQ Season. Hmm. I find myself often pondering between good and healthy, rarely does it become as abundantly clear to me as when grilling season is upon us again.

Almost everything we eat contains some component that can be interpreted as dangerous, but in that exact same bite may also be things that are undoubtedly good for our health.

Even when I think that I manage to make a sensible decision for health purposes, that sand castle can quickly deteriorate when climate, environment, fair trade and animal welfare are also accounted for.

Sigh.
And to add to that stack, it would be nice if the food taste good too.

Barbecue season is officially here and along with it pops up the issue of: AGE. It is an abbreviation of advanced glycation end products. This topic has already been breached here on Food Pharmacy by Stig Bengmark , he has highlighted the dangers of AGE for quite some time and that’s good.

Simplified, it’s about amino acids (the building blocks of proteins) reacting when they come into contact with sugars. AGE is considered to be one of several factors behind the aging process and is considered to contribute to Alzheimer’s. The effect has been similar to when an old rubber band dries up and cracks, with the slight difference of that it is happening within your own tissue in the skin, blood vessels and heart valves.

High blood sugar is a risk factor, but you can also absorb AGE directly through food. The largest direct source of AGE via the diet is by far from consuming meat that is fried or roasted at high temperatures. Other sources are processed food and pasteurized products, including hard cheese made from pasteurized milk.

One way to circumvent this is of course to avoid the dominant sources, but AGE can be formed to some extent in quite a few foods when heated up. One tactic is then to only eat foods that have not been heated above 70-80 degrees, but I think this is a rather sad solution because many flavors and fragrances are released just by heating through the so-called Maillard reaction and also by the process of caramelization. Cooking and heating can also have other advantages such as increasing the uptake of some substances which, on the contrary, are protective.

For the risk averse, there may be a golden middle road. In 2009, a study showed that test persons who ate a low-AGE diet could lower their AGE values ​​by as much as 60 percent in four months. Because AGE is sometimes used as a measure of biological aging, they were, at least according to this single parameter, younger. How did their low-AGE diet look? In addition to eating a lot of vegetables with antioxidants, they prepared their meat by poaching, steaming or using it in stews. Since water never gets warmer than 100 degrees, no large amounts of AGE are formed.

AGE is also counteracted by vitamin E, which is found among other things in nuts and seeds. I myself draw two conclusions, but you’re welcome to oppose. The first is that, it is not just about removing the dangerous sources, but also about adding vegetables to the plate that at least partially neutralize the harmful effects.

The second is that I will once again be taking out the grill this year. No one can live a completely risk-free life. Some want to take their chances parachuting or climbing mountains. I myself choose to not to heavily weigh the dangers of occasionally roasting something like these:

Roasted carrot with arugula, goat cheese, pumpkin seeds and orange

2 bunches of carrots
3 tablespoons olive oil
6-8 thyme sprigs
salt
3 tablespoons pumpkin seeds
1 orange
100 g of goat cheese (chevre)
1 handful arugula

Peel and split the carrots lengthwise. Heat the oven to 200°C/400°F. Put the carrots on a baking sheet with 1 tablespoon of olive oil, thyme twigs and a pinch of salt. Roast in the oven until the carrots begin to get some color, about 25 minutes.

Roast the pumpkin seeds in a dry frying pan on medium heat. Grate the peel of the orange and squeeze out the juice. Combine with olive oil and a pinch of salt to create a dressing. Garnish the carrots with goat cheese, orange dressing, arugula and roasted pumpkin seeds.

So simple, so appetizing and so good.

But aren’t there harmful substances formed when the carrot is heated to such high temperature? My Answer: Raw materials stuffed with antioxidants provide protection, but don’t let it burn. The best is just when it starts to take on some color.

Photo: David Loftus

Henrik Ennart, together with Niklas Ekstedt, is the author of the recently published book Happy Food 2.0 (currently only available in Swedish, however your can find their first book Happy Food in English here.).

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