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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A day in the life of karate pro Sabina Lääveri

In mid-September we wrote about Sabina Lääveri. You remember…the karate pro who eats almost exclusively vegetarian food. Perhaps you then also remember that we promised to ask Sabina for a detailed diet and exercise diary? And now it’s finally time for us to find out how a vegetarian’s day can look as an elite athlete like Sabina.

– Sabina, can you tell us how a normal November day looks for you?

Of course I can! As an athlete, I spend a lot of time out and about. The days are often very long and I appreciate the little things in everyday life. A cup of coffee at home on the couch early on a dark autumn morning may be taken for granted by some but these are moments that I deeply appreciate. The following is how a typical day can look for me:

05:30 – Alarm clock rings

Occasionally, periodic fasting has worked well for me despite frequent training and during such periods I move up the rest of the day’s meals a few hours. But during a period of very intense training, I eat breakfast. What is important is that I adjust and time what I eat in accordance to when and how I train.

My breakfast consists of:

– Oatmeal with 1 frozen green banana, cinnamon, 1 tablespoon organic peanut butter and frozen berries
– Coffee with oat milk
– Cold water with raw organic apple cider vinegar

A few days a week I plan on a morning workout at the gym before I go to work (that is, my “day job”). I think it’s nice to split up the strength training throughout the week, partly to get the body up and at em’ already in the morning, and partly to be able to prioritize mobility and rehab training – in my case injury prevention exercises mainly for muscles and joints like knees, feet and shoulders.

7:00 AM – Strength training

Warm up
Mobility Exercises
Power Clean 5×5 35 kg
Chin-ups 3x max
Dips 3x max
Clean with burpee 4×8 30 kg
Lunge with rotation and medication ball 6 kg
Box jump 4×8

08:15 – Recovery

– 2 Buckwheat crisps with chia seeds
– Peanut butter
– A banana

11:00 – Lunch

Mia and Lina’s mango stew (love it!). I add to that some beluga lentils, steamed butternut squash, spinach, quick-pickled red cabbage in apple cider vinegar, lime and sea salt. And a lot of cilantro!

Planning is everything for me and always having meals and snacks on hand makes things much easier. I  pack food for both lunch at work and dinner between the workouts. When I prepare the food, I always make large portions so it’s enough for the whole week. A good tip is to store all dry foods in one box, for example vegetables, lentils, potatoes etc., and stew or other like kind foods in another box. That way the food stays fresh longer.

14:00 – Snack 1

– A banana
No surprise.

16:00 – Karate training 1: technique

Warm up
Timing in footwork and striking

17:30 – Dinner

Quinoa with marinated tempeh. Another favorite!
(Are you curious about how Sabina makes this? Check out the blog tomorrow for the recipe!)

19:00 – Karate Pass 2: Situation Training

Warm up
Timing Exercises
Lead – laying under situation training
Sparring 10 rounds

20:30 – Evening meal

– 1 cup hummus with carrot sticks
–  Roasted salted almonds
– Green tea

– What a day Sabina, super busy!

Yeah, I really have to stick to my planning so that things flow. Elite training involves a lot of sacrifice in terms of social life with family and friends.  Leisure time needs to be planned in advance and there is seldom room for spontaneity. But I don’t pity myself though, on the contrary! I live for progress and personal development. To exercise purposefully and be able to control my body down to the smallest movements, to be quick and strong and to fight is pure euphoria. My goal is to make it to the Olympics.

– What inspires you when planning your meals?

Diet has always been an interest of mine and since I have decided to become the best in the world at karate, I also want to optimize my diet to perform as well as possible. The interest in a plant-based diet was associated with listening to Food Pharmacy as an audio book and since then you have inspired my everyday life and lifestyle. Today I am eating almost exclusively vegetarian diets and I have noticed that I recover better, I am more alert during the days and sleep better at nights. Worth gold to me!

But eating strictly vegetarian does require some knowledge. For myself, who wants to maintain muscle mass, I need to keep an eye on how much energy I expend during the day and how much protein I need to eat in order to not lose muscle.

Thank you Sabina! And for those of you curious about her dinner recipe, make sure to come back tomorrow, it won’t disappoint!




Food Pharmacy, Interview

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Wild Fish vs. Farmed

Fish expert Sofia B. Olsson is back today to answer a few more fishy questions. Sofia is head chef vRÅ (a fish restaurant in Gothenburg, Sweden) and incredibly knowledgeable when it comes to fish. Previously, she has helped us figure out which fish we can buy with a good conscience and explained the difference between KRAV-labeled, MSC-labeled and ASC-labeled fish. 

We regularly eat fish and have pondered for a while, what – if any – is the difference when it comes to nutritional content between wild and farmed fish. Is either way better than the other? So, of course we asked fish expert Sofia.

– Is there a difference in nutritional content between wild fish and farmed fish?

No, generally speaking you can not say that. While the nutritional content is obviously correlated to which kind of fish you are eating, it is also affected by what the fish themselves have been eating. If a wild fish ate a meager or poor diet, it in return will not contain great nutritional content. The same applies to farmed fish. However, if a fish farm is able to control the feed and give the fish highly nutritious food, the fish will then be higher in nutritional value. And again, vice versa there – a wild fish that has plenty of nutritious food where it lives, will also have more nutritional value. So I would say that, it is much more about what the fish eatsf than if it is farmed or wild.

-And this is probably hard to know as a consumer, right?

Yes unfortunately. The fish industry is far behind in terms of traceability. For example, in the meat industry, we talk about grass-fed meats and in many cases we can find out exactly where the animals have lived and been eating. In general it’s prefered to eat meat that has lived outside and eaten grass, for the sake of environment, taste and nutritional content. This concept and traceability is needed as well in the fish industry. What are the fish getting for feed? What does it contain? How does the manufacturing process look and so on. People can be very sceptical of this matter, but many good solutions to the problem exist.  I think being involved in the development process of these matters is very fun and inspiring. I hope it looks different in the near future.

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Food Pharmacy, Food Pharmacy, Interview

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Plant-Based Diet For Athletes?

Ever heard of a no meat athlete? A few weeks ago we met up with Sabina Lääveri. Sabina is a professional karate fighter and competes at the highest level in the world. Also, her diet is almost exclusively plant-based. And considering a) all the questions we receive about exercise and protein, and b) that we recently started a new series about plant-based protein here on the blog, we simply had to talk to Sabina about diet and exercise.

If all goes well, Sabina will make her World Cup debut in November, in Madrid. The long-term goal is the Olympic Games in Tokyo 2020 and Sabina is training hard with the other members of the Swedish Karate Federation. She talks so passionately about her training and the opportunity to go to the Olympics that you would never have guessed that, just two years ago, she was thinking about quitting.

– Really?

Yes, I was seriously thinking about quitting. I had just lost an important game and was completely worn out. I had no idea what to do. But then I got a call from the Swedish Olympics group and that’s when I decided: I’m going to do whatever it takes to get to the top. And after just two months, I won my first Premier League medal in Dubai. I just repeated my new mantra: this is fun, this is fun, this is fun. And the weekend after, I won the Nordic championships for the first time.

– Wow, what a story. What is your exercise routine?

I workout twice a day, usually at 3 pm and 6 pm. Really hard workouts, no goofing around.

– And what about food?

When I started training for the olympics, I also started thinking about food. I’m willing to do whatever it takes to get there, and I wanted to learn more about the impact of diet on fitness and wellbeing. I wanted to try something new, and then my old coach told me about the Food Pharmacy book. I was a sceptic at first, I did not have time to read. But then I listened to the audiobook, and loved it. The cookbook too! Nowadays, I eat almost exclusively vegetarian and vegan food. But I’m a good guest – I always eat what the host is serving.

– And what about the other athletes in the group, are you all interested in the plant-based lifestyle?

Well, many of them treat themselves with junk food after a hard workout. You know, because they’ve “earned it”. But now that I have learned so much about the connection between diet and health, eating pizza after workout would be more of a punishment than a prize. The response from friends and colleagues has been a bit mixed. Most of them still live in the “meat world”, they don’t really care what they eat.

– And now, the million dollar question: can athletes perform well on a vegan diet?

Yes, of course, you can definitely perform well on a 100% vegan diet. But, you need to educate yourself and track your protein intake.

– Does the plant-based diet affect your athletic performance?

Not while I’m working out, but I recover much faster afterwards. I’m not as tired and heavy as I was before. Actually, thinking about it now, I’m able to workout even harder.

– What do you eat on a regular day?

I do intermittent fasting and usually eat my first meal around lunch. I track my protein intake to make sure I am hitting my protein goals, and avoid sugar, white flour and meat.

– Has it been difficult?

Sometimes, but not really. Finding healthy snacks can be tricky. I eat a lot of roasted chickpeas and almonds, but once in a while I still crave potato chips. I make homemade cassava chips, but it’s not the same.

– Thank you Sabina! Wow. Fitness and veganism truly can go hand-in-hand. It’s quite obvious, but nice to hear it from someone who really knows. And what if it’s the secret to unlocking your full potential? Anyhow, good luck on your Olympic journey!




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