Thursday, June 30, 2011

A Friend's Story - Infertility and PCOS

My Friend Before (33% body fat) & After (25% body fat)

Imagine yourself in this scenario...You are a newlywed woman in your mid 20's.  You have been diagnosed with Polycystic Ovary Syndrome (PCOS) which causes you to lose your period thereby threatening your hopes of ever conceiving a child naturally.  Imagine the sadness of having finally married your high school sweetheart but believing that you two may never be able to have children.  Imagine too that you are also at a high risk of developing cardiovascular problems at an early age as a consequence of PCOS.  Not only may you lose the chance of ever having children but you may be separated from your life's love at a tragically young age.

This is the situation my friend found herself in.  To hear her tell the story, she verbalized that she was resigned to the cards that she had been dealt regarding infertility.  But to see her, there was a blueness that belied the acceptance.  Shortly after her honeymoon, she decided to lose weight via conventional means.  It was an eight month struggle but she eventually lost 15 lbs.  After going on the TNT Diet, she lost a further 15 lbs in ONE MONTH!  Spontaneously, her period returned and has appeared regularly for the past handful of months since reaching her present weight.  Her MD tells her that her PCOS may be reversing itself as her hormones are regulating themselves.  Here is her story in her own words:

This low carb diet helped me lose weight but not only that, it
reversed my PCO syndrome. My hormone levels regulated itself after
losing 8% (33% to 25%) body fat! I am no longer in risk for high
cholesterol and triglyceride, praise God! The first week I lost 6 lbs
due to shedding water weight. In total I lost 15 lbs in 1 month (145
lbs to 130 lbs) and have kept it off since January! I just maintain
low carb dieting with 2 days per week of allowing healthy carbs such
as brown rice and whole wheat bread instead of white and sugar filled
items. It's all about making healthy choices but in order to do so we
have to learn all the hidden names for sugar and cut that out of our
diets. If you have a sweet tooth like me, don't worry! There are many
alternative recipes on the internet including in this low-carb blog!

PCOS is a condition where the ovaries form lots of fluid filled cysts instead of the one egg filled follicle shortly before a menstrual period.  The woman with PCOS has higher than normal levels of insulin (too much insulin causes the ovaries to produce more testosterone than normal) and testosterone (male hormones which prevent ovulation when elevated).  This abnormal hormonal milieu often results in the lack of egg production and therefore the inability to get pregnant.  Women with PCOS may also have high triglycerides, LDL (bad cholesterol), & blood pressure leading to an enhanced risk of heart attack.  There is also a greater chance of getting endometrial cancer because of an overgrowth of the uterine lining in response to decreased progesterone levels.  The following links discuss normal ovulation and PCOS in detail, respectively.  http://en.wikipedia.org/wiki/Ovulation   http://www.womenshealth.gov/faq/polycystic-ovary-syndrome.cfm

If you have PCOS, there is indeed hope for reversing your condition.  http://www.fertilitychicago.org/2569/how-does-a-low-carb-diet-help-to-reverse-pcos/  A 2005 pilot study from Duke University showed that a low carbohydrate ketogenic diet lowered free testosterone levels, leutenizing hormone to follicular stimulating hormone ratio (LH/FSH), and insulin levels while also reducing percent body fat in obese women with PCOS.  Two of the study participants who completed the 24 week course even conceived after previous infertility.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1334192/pdf/1743-7075-2-35.pdf 

A 2006 study from the University of Alabama demonstrated that women with PCOS can decrease their insulin concentrations, both fasting and post-eating, by following a reduced carbohydrate diet.  The hope is that the reduction in insulin will allow for improvements in the hormonal/fertility area as demonstrated in the study cited above.  http://www.ncbi.nlm.nih.gov/pubmed/16500338

In 2009, the Harvard School of Public Health found that even in normal women without PCOS, high carbohydrate intake and high glycemic load foods are associated with infertility which results from the lack of ovulations.  http://www.ncbi.nlm.nih.gov/pubmed/17882137

I will let this other 2006 study from the University of Alabama speak for itself.  I quote from the Results section: "the PCOS group consumed significantly more white bread (7.9 +/- 4.4 vs. 5.5 +/- 2.9 servings over 4 days) and tended to consume more fried potatoes than did the control group (1.0 +/- 1.5 vs. 0.4 +/- 0.7 servings over 4 days). The PCOS group had a significantly greater fasting insulin concentration (22.5 +/- 14.9 vs. 15.1 +/- 8.3 muIU/mL) and a significantly lower glucose-to-insulin ratio (4.7 +/- 2.1 vs. 7.6 +/- 5.2) than the control group."  http://www.ncbi.nlm.nih.gov/pubmed/16762348

Tuesday, June 21, 2011

Acanthosis Nigricans (darkened skin folds)

Acanthosis nigricans (AN) may sound like the scientific name for an exotic South American bird, but it is a common sign of insulin resistance that people outside of the medical field may not recognize.  AN is a darkening of the skin commonly observed around the neck and in the armpits.  The following links are very educational but be warned that there are some graphic photographs of skin lesions.
http://dermatology.cdlib.org/DOJvol6num1/original/acanthosis/katz.html
http://emedicine.medscape.com/article/1102488-overview#showall

AN is significant not because of the rare malignant state but because it is a common sign of insulin resistance.  Why is that important?   In non-diabetics, insulin resistance/ hyperinsulinemia is an independent predictor of atherosclerotic buildup in the aorta, i.e. blockage that could lead to heart attack or stroke or peripheral vascular disease.  http://www.atherosclerosis-journal.com/article/S0021-9150(05)00580-0/abstract  The implication is that without being a diabetic, who are know to have an increased risk of heart disease, frequently eating refined carbohydrates may be clogging your arteries.  And we all know that is bad news.

The first time I became aware of this condition was during a discussion with a friend several years ago.  She was complaining about the darkening of the skin on the back of her neck and in her armpits, which led her to avoid sleeveless clothing and to wear her hair long to cover the embarassing marks.  This friend also revealed to me that it is a very frequent condition seen in pregnant women back in her Asian homeland.  She also remarked that she was surprised that I did not develop it when I was pregnant with my son because this darkening was strongly believed to indicate a pregnancy carrying a male child.  She in fact attributed her skin darkening to having bourne two sons, and she tried every conceivable skin lightening or exfoliating product to remedy it.  It makes me just shudder to think about all the women experiencing this skin darkening during pregnancy back in my friend's homeland, who may be suffering from gestational diabetes unbeknownst to them and its health implications for them and their children.  Another topic for another day!  http://care.diabetesjournals.org/content/31/5/e30.full.pdf+html

But it is not just ladies in a faraway land who suffer this condition.  AN is today used as a screening test for  children in the state of Texas to identify early those children who may have obesity related insulin resistance or Type 2 diabetes but who do not receive regular medical care.  http://www.infocusonline.org/acanthosis.pdf

AN can be misleading since it is not itchy or painful but merely unsightly.  My hope is that this discussion may prompt you to visit your doctor if you suffer from this condition so that you can start on the task of reversing this stealth killer - insulin resistance.

Tuesday, June 14, 2011

Recipe #3: Pasta Serendipity

Pasta Serendipity

This dish was the result of happy happenstance, hence the name, "Serendipity."  While preparing dinner, I was actually fighting some massive cheese curls cravings (the kids just got some for the lunch bags).  There were just some random bits of this & that in the fridge when suddenly I got a brainwave along the lines of fettuccini alfredo and spaghetti carbonara.  Using leftover Dreamfields spaghetti (see my previous posting on products that our family loves), I came up with this recipe.  Not so exact, kind of like a recipe you might find in your great grandmother's little recipe notebook.

Ingredients:
  • 1 package Dreamfields spaghetti prepared per label
  • 1 package bacon
  • 1-16 oz package of baby spinach
  • 3 cloves minced garlic (1 heaping teaspoon if using prepared garlic from a jar)
  • 1/4 cup shredded mozzarella or 1 slice provolone per serving
  • grated Parmesan or Romano cheese, 1 tbsp per serving
  • full fat cream, 2-3 tbsp per serving
Procedure:
  1. wash spinach & drain in a colander
  2. prepare bacon to desired crispness & reserve rendered bacon fat
  3. saute spinach & garlic in the bacon fat over medium-high heat until spinach is wilted
  4. place the following on a microwaveable plate in layers: single serving of spaghetti; 3/4 cup wilted spinach; mozzarella/provolone cheese; drizzled cream; sprinkled Parmesan/Romano cheese
  5. cover with a paper towel & microwave on high to melt cheese
  6. sprinkle with 1-2 slices of crumbled bacon
YUM-E!!!

NOTE: the bacon fat is plenty salty, so you don't need to salt your spinach.  Also, if you choose to use turkey bacon, you should add 2-3 tbsp olive oil to the pan before wilting the spinach.

Tuesday, May 31, 2011

Artificial Sweeteners


homemade xylitol frosting on Pillsbury sugar free chocolate cupcake

A friend who's been reading my blog asked me a good question.  She knows that I like to eat organic if possible.  So what kind of sweetener do I use.

When my husband first started TNT, I was very uncomfortable with his use of artificial sweeteners.  Mostly he was getting them in the form of protein supplements and diet sodas.  When I was persuaded to go low carb myself, I began to do a lot more baking than previously because there aren't so many tasty and affordable low carb items in the marketplace.  Following my inclination toward natural & organic stuff, I tried to use stevia alone.  But I found the bitter aftertaste a little off putting.  Then I read somewhere that many companies that manufacture sugar free items combine two or more sweeteners to get a more natural sugar-like flavor.  Common combinations are Splenda + a sugar alcohol or acesulfame K + a sugar alcohol.  I tend to use Splenda + stevia to get a better overall flavor while reducing the total amount of artificial sweetener to achieve a certain sweetness.

I choose Splenda over the other common artificial sweeteners like Equal and Sweet N Low because it is the one artificial sweetener that is supposed to be the most stable when heated.  I also use small amounts of molasses, say in place of caramelized sugar when making a flan or in a tomato based sauce to cut the acid.  Molasses also has iron, which women & children could always use more of.  When I cheat & have pancakes or when I make low carb pancakes, I prefer the flavor of organic agave nectar over the artificial low carb maple syrups (not too keen on a strong maple flavor).  I chose agave nectar because it has a low glycemic index, i.e. it does not give you a big, quick blood sugar spike, and it is much sweeter than other syrups so I only need to use a tiny amount to get that big sweet flavor.  Pancakes with butter and gobs of Log Cabin syrup are one of my huge downfalls...just have to make efforts not to fall down too many times over the course of a month!  ;-)

There is evidently some debate about whether sugar alcohols are okay for those trying to reduce their carbs, whether you can subtract them from the total carbs when calculating net carbs.  (In case you are unfamiliar with calculating net carbs: total grams carbs - grams fiber = grams net carbs.  Some say this formula is okay: total grams carbs - grams fiber - grams sugar alcohol = grams net carbs.)  Our family has foods prepared with sugar alcohols as fun foods - treats like low carb ice cream on weekends or sugar free cake mix with homemade xylitol frosting for specials occasions or sugar free candies when that sweet tooth bites.  We don't use sugar alcohol as a tabletop sweetener.  Sugar alcohols vary in their sweetness and in their impact on blood sugar, so moderation in their use may be prudent especially for the insulin dependent diabetic.

Links:

Monday, May 30, 2011

My Mom's Story - Cancer & Sugar


Shortly before my dad died of cholangiocarcinoma (cancer of the bile duct) which metastasized (spread) to his liver, my mom entered into the chemo phase of the treatment for her own colon cancer.  She was still in recovery from the cancer resection (surgery to remove the tumor & surrounding lymph nodes to check for metastasis) and quite frail.  Her cancer was stage three, meaning that some of her lymph nodes were positive for cancer cells, i.e. the cancer was spreading.  Having seen how quickly my dad's cancer had progressed and the kind of horrible pain that it wrought, when the doctor gave her a choice of going forward with chemo then or delaying until she felt stronger, I encouraged her not to wait. 

The recommended chemo was evidently not as strong as say treatment for leukemia (cancer of the blood), but still the side effects were wearing and got progressively worse with successive rounds of chemo.  Having been a pediatric oncology nurse herself, my mom knew the importance of making efforts to eat although one's appetite takes a nosedive and side effects like a bad taste in the mouth made food choices limited.  My sister-in-law was an invaluable help to my mom as this time, preparing favorite ethnic dishes in an effort to tempt her to eat.

Shortly after my mom completed her last round of chemo & was declared cancer free, I discovered that cancer loves sugar.  The manner in which cancer cells use sugar is different than the way normal body cells do; basically, they ferment the sugar in order to get a quick jolt of energy.  http://en.wikipedia.org/wiki/Glycolysis  It's a wasteful process; instead of getting the full amount of potential energy that resides in the sugar, cancer cells carry out anaerobic respiration even in the presence of oxygen.  Normal body cells carry out aerobic respiration.  http://en.wikipedia.org/wiki/Aerobic_respiration  But then everything about the way cancer works is a waste.  Cancer cells have a special ability to hijack a body's resources and channel everything toward themselves in such a way that the cancer's host will eventually starve to death or be squashed by the overgrowth of the abnormal cells. 

So cancer loves sugar.  Most cancer cells need glucose to perform anaerobic respiration because their mitochondria (cellular power plants) are malfunctioning.  This is called the Warburg Effect.  http://en.wikipedia.org/wiki/Warburg_effect  It was discovered by the Nobel Prize winner Otto Heinrich Warburg who formulated the Warburg Hypothesis on the origins of cancer in 1924http://en.wikipedia.org/wiki/Warburg_hypothesis  There is in fact research going on today where cancer is being treated with a low carbohydrate-high fat ketogenic diet.   http://www.time.com/time/health/article/0,8599,1662484,00.html  Basically, one's body cells can survive on energy derived from fat.  And the byproducts of fat metabolism are  ketone bodies.  Previously, ketogenic diets have been used to treat some pediatric epilepsy.  For an in depth discussion of the topic, check out: http://cancerres.aacrjournals.org/content/66/18/8927.full.pdf

It also turns out that high blood sugar increases one's risk of developing 24 different forms of cancer: http://www.news-medical.net/news/20100521/Researchers-study-correlation-between-type-2-diabetes-and-increased-risk-of-cancer.aspx  Further, high blood sugar is a predictor of mortality for those with some cancers: http://aje.oxfordjournals.org/content/159/12/1160.abstract

If you are so inclined to read more scholarly articles, here are some links that attest to the negative relationship between high blood sugar, hyperinsulinemia (high blood levels of insulin either from over secretion due to insulin resistance or the chronic use of insulin to reduce high blood sugar), and cancer. 
So, out of concern and with the notion that it can't hurt to cover all one's bases, I began to nag my mom about reducing her refined carbohydrate intake in case there were any rouge cancer cells floating around trying to get another foothold within her body.  To my utter surprise, she listened and asked me how to go about reducing her carbs!  My mom is very independent and private, not one to be told what to do, and Asian, i.e. she eats white rice three times a day.  Hence, it was flabbergasting that she wanted to hear more. 

About a month & a half ago, I learned why she was so compliant.  My mom revealed to me that she too is diabetic.  I understood in that moment that this must have been crushing to my mom because I distinctly remember her telling me when I was about seven years old (30+ years ago) that she dreaded ever becoming diabetic after doing some private duty assisting a diabetic patient.  From what my mom told me, her doctor said that her case is not severe, that if she controlled her diet, she would not have to go on any medications.

So, we went grocery shopping together, and I showed her which products we frequently used and how to calculate net carbs from the nutritional information on prepared food containers.  After 70+ years of eating white rice daily, my mom does not partake anymore and does not even have cravings for it.  She snacks on nuts, cheeses, & sugar free sweets (such as Power Crunch protein bars and baked goods that I prepare & share with her), and she's substituted vegetables, low carb bread, & shiratake noodles for the rice she used to eat.  I don't know if you can tell from the pictures, but let me testify that my mom is aging in reverse; she is glowing again and stronger.  She is resuming daily exercise which includes walking & resistance training.  You would not know from looking at her that she had been so very ill less than a year ago.  I pray to God that the cancer is gone for good and that she can enjoy the remainder of her years with vigor and joy.  Amen!

Wednesday, May 25, 2011

Recipe #2: Cheesy Crackers

The internet has been so helpful in terms of finding low carb recipes that may be used straight up or customized for our tastes.  This recipe is perfect and so simple that small kids who can operate a microwave can make it.  And my 2 1/2 year old loves to eat this.  So much so that when I make it, there is hardly any left over for us parents!  On our microwave, a full minute works.  But as the recipe states, yours may be slightly different.  So experiment until you get the crispness & color that pleases you.

Ingredients:
American cheese slices
parchment paper

Instructions:
  1. cut a sheet of parchment paper to fit the microwave's glass plate
  2. break cheese slice into 16 pieces by repeatedly folding in half
  3. evenly space the cheese pieces on the parchment paper lined glass plate
  4. microwave on full power for ~1 minute (microwaves vary, so cooking time may be more or less than 1 minute)
  5. cool on the parchment paper for a minute, then enjoy!
Original recipe from the web:
http://www.ehow.com/how_4682690_low-carb-crackers.html#ixzz10yPmkq7r

Weight Loss & Recommended Books




BEFORE
 
AFTER

This week, I bought four new size 4 blouses.  It blows my mind to think of that number - four - because only two years ago, I was size 12 and expanding!  My dearest wish was to get down to a single digit dress size.  And 8 would have pleased me forever after that - I wasn't greedy!  Similarly, my husband went from a waist circumference of 34+" to almost 30".  Today, he finally bought size small t-shirts because he's swimming in all his other casual clothes.

Both of us have had ups and downs in our weights since we met and eventually married.  We both ballooned out after the wedding - a supposed sign of marital happiness according to teasing family friends.  And now we're both slimmer than on our wedding day ten years ago!  Many people will claim that they just want to get healthy.  That's why they spend so much time and money in the pursuit of weight loss.  But the deep dark truth is that we don't want to feel ugly anymore.  I know it was true in my case!

Both my husband & I had struggled with our weights, trying to find the time to exercise enough to burn away all those stored calories while trying to control the (natural) urge to eat and choosing masses of oatmeal & brown rice in the effort to "eat clean."  All to no great avail.  In my case, I slowly deflated 10 pounds over the course of a year & a half (33% body fat to start) but it started to creep back into place before I had even reached my goal weight. 

In the meantime, my husband had discovered TNT Diet: Targeted Nutrition Tactics by Campbell & Volek a year ago.  It was a great watershed event!  His weight seemed to just slip away like water off a duck's back.  We began to resemble the number ten - he the '1' and I the '0'.  It was not to be borne!  My hand was forced and I must join him in his racist way of eating (no white anything - no sugar, no flour, no potatoes, no bread).  Simply put: if you imagine loading up your plate as usual (meat + veg + starch), just remove the starch and substitute in another serving of veggies (meat + veg + veg).  The diet is not a high protein plan; increased protein is only added proportional to one's increased needs before & after weight training. To my absolute surprise, it worked for me also!  I dumped a further ten+ pounds in 3 months and lowered my body fat to 24%.  And I know it would work for you too if you would just keep an open mind and try it out.


Why does it work?  There is some discussion of the scientific rationale in TNT Diet but two books by another author truly dissect the history & science of fat gain & loss: Why We Get Fat: And What To Do About It and Good Calories, Bad Calories: Fats, Carbs, and the Controversial Science of Diet and Health by Gary Taubes.  In a nutshell as I understand it: when simple carbs (sugars & starches) are eaten, insulin is secreted by the pancreas; insulin stimulates fat cells to remove sugar out of the bloodstream & store it (i.e. we get fatter); it stimulates the liver to convert blood sugar into triglycerides & fatty acids (i.e. we develop bad blood lipid profiles); and it stimulates the kidneys to dump potassium by hanging onto sodium (i.e. we bloat & our blood pressure goes up).  Minimizing one's carbohydrate load, and thereby one's insulin secretion, allows your body to liberate the fat you've already stored as well as the fat in your food to be used for energy.  When sugar or starches are present, they are always preferred by the body, so fat is not used and is in fact stored on top of that which is already present.

If you have any interest in slimming down, whether for health or for vanity, please, look up these books and consider giving carbohydrate/insulin control a try!

Links to Recommended Books: