How to Treat Polycystic Ovary Syndrome (PCOS) with Diet

Given the role that oxidant free radicals are thought to play in aging and disease, one reason fruits and vegetables may be so good for us is that they contain antioxidant compounds. As you can see at 0:20 in my video Benefits of Marjoram for Polycystic Ovary Syndrome (PCOS), different vegetables and herbs have different antioxidant content. When making a salad, for example, spinach, arugula, or red leaf lettuce may provide twice the antioxidants as butterhead lettuce, and choosing purple cabbage over green, or red onions over white can also boost the salad’s antioxidant power.

Fresh herbs are so powerful that even a small amount may double or even quadruple the antioxidant power of the entire meal. For instance, as you can see at 0:50 in my video, the total antioxidants in a simple salad of lettuce and tomato jump up by adding just a tablespoon of lemon balm leaves or half a tablespoon of oregano or mint. Adding marjoram, thyme, or sage not only adds great flavor to the salad, but effectively quadruples the antioxidant content at the same time, and adding a little fresh garlic or ginger to the dressing ups the antioxidant power even more.

Herbs are so antioxidant-rich that researchers decided to see if they might be able to reduce the DNA-damaging effects of radiation. Radioactive iodine is sometimes given to people with overactive thyroid glands or thyroid cancer to destroy part of the gland or take care of any remaining tumor cells after surgery. For days after the isotope injection, patients become so radioactive they are advised not to kiss or sleep close to anyone, including their pets, and if they breathe on a phone, they’re advised to wipe it “carefully” or cover it “with an easily removed plastic bag.” Other recommendations include “avoid[ing] splatter of radioactive urine,” not going near your kids, and basically just staying away from others as much as possible.

The treatment can be very effective, but all that radiation exposure appears to increase the risk of developing new cancers later on. In order to prevent the DNA damage associated with this treatment, researchers tested the ability of oregano to protect chromosomes of human blood cells in vitro from exposure to radioactive iodine. As you can see at 2:25 in my video, at baseline, about 1 in 100 of our blood cells show evidence of chromosomal damage. If radioactive iodine is added, though, it’s more like 1 in 8. What happens if, in addition to the radiation, increasing amounts of oregano extract are added? Chromosome damage is reduced by as much 70 percent. Researchers concluded that oregano extract “significantly protects” against DNA damage induced by the radioactive iodine in white blood cells. This was all done outside the body, though, which the researchers justified by saying it wouldn’t be particularly ethical to irradiate people for experimental research. True, but millions of people have been irradiated for treatment, and researchers could have studied them or, at the very least, they could have just had people eat the oregano and then irradiate their blood in vitro to model the amount of oregano compounds that actually make it into the bloodstream.

Other in vitro studies on oregano are similarly unsatisfying. In a comparison of the effects of various spice extracts, including bay leaves, fennel, lavender, oregano, paprika, parsley, rosemary, and thyme, oregano beat out all but bay leaves in its ability to suppress cervical cancer cell growth in vitro while leaving normal cells alone. But people tend to use oregano orally—that is, they typically eat it—so the relevance of these results are not clear.

Similarly, marjoram, an herb closely related to oregano, can suppress the growth of individual breast cancer cells in a petri dish, as you can see at 3:53 in my video, and even effectively whole human breast tumors grown in chicken eggs, which is something I’ve never seen before. Are there any clinical trials on oregano-family herbs on actual people? The only such clinical, randomized, control study I could find was a study on how marjoram tea affects the hormonal profile of women with polycystic ovary syndrome (PCOS). The most common cause of female fertility problems, PCOS affects up to one in eight young women and is characterized by excessive male hormones, resulting in excess body or facial hair, menstrual irregularities, and cysts in one’s ovaries that show up on ultrasounds.

Evidently, traditional medicine practitioners reported marjoram tea was beneficial for PCOS, but it had never been put to the test…until now. Drinking two daily cups of marjoram tea versus a placebo tea for one month did seem to beneficially affect the subjects’ hormonal profiles, which seems to offer credence to the claims of the traditional medicine practitioners. However, the study didn’t last long enough to confirm that actual symptoms improved as well, which is really what we care about.

Is there anything that’s been shown to help? Well, reducing one’s intake of dietary glycotoxins may help prevent and treat the disease. Over the past 2 decades there has been increasing evidence supporting an important contribution from food-derived advanced glycation end products (AGEs)…[to] increased oxidative stress and inflammation, processes that play a major role in the causation of chronic diseases,” potentially including polycystic ovary syndrome (PCOS). Women with PCOS tend to have nearly twice the circulating AGE levels in their bloodstream, as you can see at 0:33 in my video Best Foods for Polycystic Ovary Syndrome (PCOS). 

PCOS may be the most common hormonal abnormality among young women in the United States and is a common cause of infertility, menstrual dysfunction, and excess facial and body hair. The prevalence of obesity is also higher in women with PCOS. Since the highest AGE levels are found in broiled, grilled, fried, and roasted foods of “mostly animal origin,” is it possible that this causal chain starts with a bad diet? For instance, maybe eating lots of fried chicken leads to obesity, which in turn leads to PCOS. In that case, perhaps what we eat is only indirectly related to PCOS through weight gain. No, because the same link between high AGE levels and PCOS was found in lean women as well.

“As chronic inflammation and increased oxidative stress have been incriminated in the pathophysiology [or disease process] of PCOS, the role of AGEs as inflammatory and oxidant mediators, may be linked with the metabolic and reproductive abnormalities of the syndrome.” Further, the buildup of AGE inside polycystic ovaries themselves suggests a potential role of AGEs contributing to the actual disease process, beyond just some of its consequences.

RAGE is highly expressed in ovarian tissues. The receptor in the body for these advanced glycation end products, the “R” in RAGE, is concentrated in the ovaries, which may be particularly sensitive to its effect. So, AGEs might indeed be contributing to the cause of PCOS and infertility.

Does this mean we should just cut down on AGE-rich foods, such as meat, cheese, and eggs? Or hey, why not come up with drugs that block AGE absorption? We know AGEs have been implicated in the development of many chronic diseases. Specifically, food-derived AGEs play an important role because diet is a major source of these pro-inflammatory AGEs. Indeed, cutting down on these dietary glycotoxins reduces the inflammatory response, but the “argument is often made that stewed chicken would be less tasty than fried chicken…” Why not have your KFC and eat it, too? Just take an AGE-absorption blocking drug every time you eat it to reduce the absorption of the toxins. What’s more, it actually lowers AGE blood levels. This oral absorbent drug, AST-120, is just a preparation of activated charcoal, like what’s used for drug overdoses and when people are poisoned. I’m sure if you took some ipecac with your KFC, your levels would go down, too.

There’s another way to reduce absorption of AGEs, and that’s by reducing your intake in the first place. It’s simple, safe, and feasible. The first step is to stop smoking. The glycotoxins in cigarette smoke may contribute to increased heart disease and cancer in smokers. Then, decrease your intake of high-AGE foods, increase your intake of foods that may help pull AGEs out of your system, like mushrooms, and eat foods high in antioxidants, like berries, herbs, and spices. “Dietary AGE intake can be easily decreased by simply changing the method of cooking from a high dry heat application to a low heat and high humidity…” In other words, move away from broiling, searing, and frying to more stewing, steaming, and boiling.

What we eat, however, may be more important than how we cook it. At 4:00 in my video, I include a table showing the amounts of AGEs in various foods. For instance, boiled chicken contains less than half the glycotoxins of roasted chicken, but even deep-fried potatoes have less than boiled meat. We can also eat foods raw, which doesn’t work as well as for blood pudding, but raw nuts and nut butters may contain about 30 times less glycotoxins than roasted, and we can avoid high-AGE processed foods, like puffed, shredded, and flaked breakfast cereals.

Why does it matter? Because study after study has shown that switching to a low-AGE diet can lower the inflammation within our bodies. Even just a single meal high in AGEs can profoundly impair our arterial function within just two hours of consumption. At 4:54 in my video, you can see the difference between a meal of fried or broiled chicken breast and veggies compared with steamed or boiled chicken breast and veggies. Same ingredients, just different cooking methods. Even a steamed or boiled chicken meal can still impair arterial function, but significantly less than fried or broiled.

“Interestingly, the amount of AGEs administered [to subjects] during the HAGE [high-AGE] intervention was similar to the average estimated daily intake by the general population,” who typically follow the standard American diet. This is why we can decrease inflammation in people by putting them on a low-AGE diet, yet an increase in inflammation is less apparent when subjects switch from their regular diet to one high in AGEs. Indeed, they were already eating a high-AGE diet with so many of these glycotoxins.

Do we have evidence that reducing AGE intake actually helps with PCOS? Yes. Within just two months, researchers found differences from subjects’ baseline diets switched to a high-AGE diet and then to a low-AGE diet, with parallel changes in insulin sensitivity, oxidative stress, and hormonal status, as seen at 5:54 in my video. The take-home learning? Those with PCOS may want to try a low-AGE diet, which, in the study, meant restricting meat to once a week and eating it only boiled, poached, stewed, or steamed, as well as cutting out fast-food-type fare and soda.

What if instead of eating steamed chicken, we ate no meat at all? Rather than measuring blood levels, which vary with each meal, we can measure the level of glycotoxins stuck in our body tissues over time with a high-tech device that measures the amount of light our skin gives off because AGEs are fluorescent. And, not surprisingly, this turns out to be a strong predictor of overall mortality. So, the lower our levels, the better. The “one factor that was consistently associated with reduced [skin fluorescence]: a vegetarian diet.” This “suggests that a vegetarian diet may reduce exposure to preformed dietary AGE…potentially reduc[ing] tissue AGE,” as well as chronic disease risk


What’s so great about antioxidants? See my videos:

Just how many antioxidants do we need? Check out:

For a few simple tips on how to quickly boost the antioxidant content of your food with herbs and spices, see my video Antioxidants in a Pinch.

I touched on the benefits of spearmint tea for PCOS in Enhancing Athletic Performance with Peppermint. Another sorely under-recognized gynecological issue is endometriosis, which I discuss in How to Treat Endometriosis with Seaweed.

Because of AGEs, I no longer toast nuts or buy roasted nut butters, which is disappointing because I really enjoy those flavors so much more than untoasted and unroasted nuts. But, as Dr. McDougall likes to say, nothing tastes as good as healthy feels. For more on why it’s important to minimize our exposure to these toxic compounds, see:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

 

 

Healthier Salt Substitutes

As I discuss in my video Shaking the Salt Habit, the two most prominent dietary risks for death and disability in the world are not eating enough fruit and eating too much salt. Eating too little fruit kills nearly five million people every year, and eating too much salt kills four million.

There are three things we can do to lower our salt intake. First, don’t add salt at the table. One third of us add salt to our food before even tasting it! Second, stop adding salt while you’re cooking. At first, the food may taste bland, but within two to four weeks, “as the sensitivity of the salt taste receptors in the mouth become more sensitive to the taste of salt in the usual concentrations”—believe it or not—you may actually prefer the taste of food with less salt. Some of the flavorings you can use in the meanwhile instead of salt include “pepper, onion, garlic, tomato, sweet pepper, basil, parsley, thyme, celery, lime, chilli, nettle, rosemary, smoke flavoring, curry, coriander and lemon.” Even if you did add salt while cooking, though, it’s probably better than eating out, where even at non-fast food restaurants, they tend to pile it on. And, finally, avoid processed foods that have salt added.

In most countries, only about half of sodium intake comes from processed foods, so there’s more personal responsibility. In the United States, however, even if we completely stopped adding salt in the kitchen and dining room, it would only bring down salt intake a small fraction. This has led public health commentators to note how challenging it is for everyone to reduce their salt intake, since so much of our sodium intake is out of our control. But is it? We don’t have to buy all those processed foods. We can choose not to turn over our family’s health to food corporations that may not have our best interests at heart.

If we do buy processed foods, there are two tricks we can use. First, try to only buy foods with fewer milligrams of sodium listed on the label than there are grams in the serving size. So, if it’s a 100-gram serving size, it should have less than 100 mg of sodium. Or, second, shoot for fewer milligrams of sodium than there are calories. For example, if the sodium is listed as 720 and calories are 260, since 720 is greater than 260, the product has too much sodium.

That’s a trick I learned from Jeff Novick, one of my favorite dieticians of all time. The reason it works is that most people get about 2,200 calories a day. So, if everything you ate had more calories than sodium, you’d at least get under 2,300 milligrams of sodium, which is the upper limit for healthy people under age 50. Of course, the healthiest foods have no labels at all. We should try to buy as much fresh food as possible because it is almost impossible to come up with a diet consisting of unprocessed natural foodstuffs that exceeds the strict American Heart Association guidelines for sodium reduction.


Not eating enough fruit as a leading killer? For more, see my video Inhibiting Platelet Aggregation with Berries.

In my latest sodium series, I lay out the evidence and dive into the manufactured controversy to expose salt industry shenanigans. See:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

How to Maximize Nutrient Absorption

Unhealthy lifestyle behaviors associated with an increased risk of premature death include smoking, excessive alcohol drinking, and not eating enough greens. The best way to get your greens is in whichever way you’ll eat the most of them, and one way to sneak extra greens into your daily diet is with whole-food smoothies, “a potent blend of good nutrition” in a quick, portable, delicious form.  

The Mayo Clinic offers a basic green smoothie recipe, combining the healthiest of fruits and the healthiest of vegetables, berries and dark green leafies, respectively. It calls for 2 ounces of baby spinach, which is about a cup and a half. Consider adding in some curly parsley, another mild beginner green to start with. Surprisingly, the sweetness of the fruit masks any bitterness from the greens such that the pickiest of children love these smoothies, as do adults who otherwise would not consume dark green leafy vegetables—or even fruit—for breakfast. Indeed, the average teen may only get about 1/20th of a serving of fruit otherwise—and Froot Loops don’t count. 

Offering smoothies can have a dramatic effect on fruit consumption for “students who do not want to take time peeling or chewing fruits.” (Who doesn’t have time to chew a fruit?!) The milkshake-y texture of smoothies may not only boost the quantity of fruit and vegetable consumption, but also the quality. 

Carotenoid phytonutrients, like beta-carotene and lycopene, can exist as microscopic crystals trapped inside the cell walls of fruits and vegetables. They’re only released when the cells are disrupted, which is why we have to chew really well. We either have to chew better or choose plants that are easier to chew. For example, while tomatoes have more beta-carotene than watermelon does, watermelon’s beta-carotene is more bioaccessible because its cell walls are wimpy compared with the smaller and tougher cell walls of other fruits and vegetables. To maximize nutrient release, food particle size would ideally be reduced to smaller than the width of the individual plant cells, but you can’t do that with chewing. Most vegetable particles end up greater than two millimeters when you chew them, whereas if we broke open all the cells, we could release much more nutrition, as you can see in my video, Are Green Smoothies Good for You?. The particle size distribution from chewing is about what you’d get blending in a food processor for about five seconds or one of those high-speed blenders for maybe half a second. Just 40 seconds in a blender can break down spinach to a subcellular level. 

Why does that matter? Let’s look at folate, the B vitamin in greens that is especially important for women of child-bearing age. Feed people a cup of spinach a day for three weeks and their folate goes up compared to control. What happens if you eat finely chopped spinach instead of whole leaves? You end up with more than twice as much in your bloodstream and the same absorption-boosting effect with lutein, the green nutrient so important for our eyesight.

It’s not what you eat—it’s what you absorb.  

The boost for lutein was only 14%, so a few extra bites of the whole leafy greens would have given you just as much. Some other nutrients, such as vitamin C, aren’t affected by pre-chopping at all. This is also less of an issue with cooked vegetables. If you boil carrots for three minutes, regular chewing can release about ten times more beta-carotene bioaccessibility than eating them raw, but not as much as blended. Intense cooking, like boiling for 25 minutes, so damages the cell walls so even gulping down large particles can result in significant absorption. But, blending may double carotenoid availability, explaining why we may be able to absorb three times the alpha- and beta-carotene from pureed cooked carrots compared to mashed cooked carrots. So, blending vegetables—raw or cooked—into soups, sauces, or smoothies can maximize nutrient absorption. Whether you went to the store and bought it, or toiled in your garden to grow it, you might as well take full advantage of it.  


Check out my other videos that touch on smoothies:

For other tips on getting children of all ages to eat healthier, see Tricks to Get Kids to Eat Healthier at Home and Tricks to Get Adults to Eat Healthier.

Finally, learn more about the effect of cooking on nutrient loss and absorption from these videos: Best Cooking Method, Raw Food Nutrient Absorption, and Sometimes the Enzyme Myth Is True.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations: