What does the research say about dietary interventions on women with PCOS?

Image Credit: Eduardo García Cruz 

What does the research say about dietary interventions on women with PCOS?

Is there anything that can lower DHEA? Also, is there any information about the cause of PCOS? I keep hearing it is Insulin Resistance, but my Insulin/Glucose were only midly resistant, but my DHEA is three times too high. I don’t see Insulin as preceeding the high DHEA due to DHEA being so high and Insulin/Glucose not as bad. I have read about Spearmint Tea being able to lessen hirsutism in PCOS women, but by what mechanism? Does it lower a particular androgen or all of them? I also read both Spearmint and Peppermint tea are unsafe, is this true and what is the safe amount?

Also, what about Saw Palmetto? I read it can cause sterility/impotence/permanent loss of libido. Is this true and were any of these effects reported by women? Does it lower all or a particular androgen?

Can you please give me information about Maca Root and how it effects the body? Is it healthy? Is it safe? Is it actually good for hormones/fertility? What about PCOS, would it have a positive effect? I have PCOS, Insulin Resistance & High DHEA are my only known imbalances. I have read Maca will make me more masculine & I have also read it can cause heart palpitations & is a stimulant. I also read gelatinized is best, but concentrated. Please help.

Ava/ Originally posted in Enhancing Athletic Performance With Peppermint

Answer:

These are certainly good questions! First, it’s important to know exactly what polycystic ovarian syndrome (PCOS) is and how diet may have an impact. 

Polycystic ovary syndrome (PCOS) is the most common ovarian disease, associated with excess androgen in women. The cause is unknown affecting roughly 6-20% women (depending on diagnostic criteria). Common signs are hirsutism (excess hair growth), anovulation, and obesity, with signs of the disease likely generating in adolescence. Some women may not be obese  and present only with anovulation and high levels of angrogens. Affected women generally have multiple ovarian cysts and may be infertile. PCOS is tightly related to metabolic issues like insulin resistance/glucose intolerance, and obesity. Women are more likely to develop earlier than expected glucose intolerance states boosting the risk type 2 diabetes and cardiovascular disease. It is hypothesized that excess levels of circulating insulin may decrease the concentration of sex hormone–binding globulin (SHBG – a beneficial hormone that helps removes excess dangerous hormones from the body), thereby increasing the amount of unbound free testosterone. Modifying sex hormones may be a useful to improve symptoms and risk factors associated with PCOS. Inflammation also seems to play a role, as C-reactive protein (CRP) levels appear to be elevated in young women with PCOS. Adopting a healthful diet in adolescence may lower risk of developing metabolic complications associated with PCOS. One study found young women with PCOS tended to have lower fiber intake, poorer eating pattens (eating late at night) and over-consumed calories. This type of eating pattern can lead to weight gain, which unfortunately is one of the largest problems surrounding PCOS. The good news is if we know some of the factors helpful for weight loss PCOS can be better managed. 

Obesity tends to exacerbate almost all diseases and PCOS is no exception. Obese women with PCOS tend to have increased free testosterone (a common type of androgen hormone) and more insulin resistance.  The obesity and PCOS connection is so strong research  suggests prevention and treatment of obesity is important for the management of PCOS. This might be why we see so many studies conducted on weight loss. 

Dietary interventions for women with PCOS:

A study in The American Journal of Clinical Nutrition looked at the difference between a high-protein diet (>40% of calories coming from protein; 30% fat; 30% carbohydrate) and a standard protein diet consisting of (<15% protein; 30% fat; 55% carbohydrate). There were 57 women with PCOS enrolled in the study, but only 27 women completed the study after the 6 month period. The women were not asked to limit calories, but were told to exercise 30 minutes a day. The high-protein diet resulted in greater weight loss, waist circumference and decreases in blood glucose than the standard protein diet. Women eating the standard protein group still lost weight (-7 lbs.) just not as much as the high protein group (-17 lbs.), but interestingly they had significantly lower testosterone levels than the high protein group (after adjusting for weight loss). When you look at the diets recommended and actual intake of nutrients there were no differences in saturated fat or fiber intake. In fact, as you’ll see from many of these studies researches are trying to keep total fat constant so they can measure the differences in biomarkers from different diets and see what works. Anyway, the high-protein groups were asked to avoid sugar and starchy carbohydrates and replace those foods with vegetables, fruit, nuts, and more protein from meat, eggs, fish, and dairy products. Beans and legumes were discouraged as protein sources because of their higher carbohydrate content. This is true, but beans still have a low-glycemic index so it was interesting the diet was designed as such. Just shows they really wanted to make sure folks were eating high protein and low carb. Both groups were advised to limit intakes of sweets, cakes and soft drinks and consume 6 servings of fruits and vegetables a day. Although this study found a higher protein diet was better for weight loss and glucose control versus the standard protein diet perhaps the lower levels of testosterone seen in women eating a standard protein diet are relevant.  When we look at a similar study with the same type of design comparing high protein diets (HP: 30% protein, 40% carbohydrate, and 30% fat) with high carbohydrate diets (HC: 15% protein, 55% carbohydrate, and 30% fat) researchers found similar results. This time women were asked to restrict their calories by 1,000 kcals. After one month weight loss occurred in both groups, but there were no differences between the groups (about -4.0 kg ) . There and there were no statistical differences between the groups in circulating androgens or glucose levels, but when both groups were studied together circulating androgens and insulin sensitivity measurements did improve. There was no increased benefit to a high-protein diet.

A dietary intervention on obese women with PCOS compared two different diets on weight loss. Women were randomized to either a low-glycemic vegan diet or a low-calorie weight loss diet for 6 months. The vegan group lost significantly more weight at 3 months, but not at 6 months. Interesting the vegan group consumed even less calories (almost 300 kcal’s less) than the low-calorie dieters after 6 months. 

Meta-analyses take into account several intervention studies at once, which can be very helpful.  This meta-analysis tracked diet and exercise interventions on different sex hormones. Both interventions were found to offer significant improvements in hirsutism, and improved levels of follicle-stimulating hormone (FSH) levels, sex hormone-binding globulin (SHBG), total testosterone, androstenedione, and free androgen index (FAI) – a useful measure of the testosterone/SHBG ratio. All of these hormones play a role in PCOS. It is unclear exactly what foods were eaten in the dietary interventions, but in general the groups reduced daily caloric intake by roughly 500  calories and shot for macronutrient percentages of 50% carbohydrate, 30% fat, 20% protein.  Exercise programs varied per study group as well , but in general 30 minutes of moderate exercise (walking, biking, aerobics) daily was recommended, but not always monitored. I think it is important to list the lifestyle methods performed as they do not seem drastic, however, the results were significant and note worthy. 

Lastly, different diets were compared in this review. The most impactful was a low-glycemic diet, improving menstrual regularity and reducing insulin resistance, fibrinogen (a clotting factor), and cholesterol, while also improving quality of life. A low-carb diet seemed to help for some of these factors as well, including weight loss. A high-carbohydrate diet appeared to increased the free androgen index (which is a different conclusion than we saw before). The review concludes that all diets were helpful for weight loss and therefore should be a focus for all overweight women through reducing calories but making sure adequate nutrient intake and healthy foods are being consumed regardless of diet composition. 

So what does this tell us? Well, it seems like diets for diabetes and heart disease prevention may also help women with PCOS. If controlling hormones and losing weight are some of the largest factors associated with PCOS, let’s look at some data comparing sex hormones and metabolic profiles between omnivores and vegetarians in pre- and post-menopausal women. Note that these women did not have PCOS, but this may help understand potential changes in sex hormones from certain dietary patterns. There were 62 women in the study. The vegetarians reported  higher levels of sex hormone-binding globulin (SHBG), bowel movements, and total fiber intake as well as lower levels of free estradiol, free testosterone, dehydroepiandrosterone sulfate (DHEA-s) and BMI. After controlling for BMI (to make sure weight was not a factor on other variables) these changes were still significant. Researches concluded the rise in SHBG could be explained by the higher fiber intake and may explain the lower risk of developing type 2 diabetes. 

Another study that looked at the ability of diet to reduce bioavailable sex hormones included 104 healthy postmenopausal women with high testosterone levels. Researchers tracked changes in testosterone, estradiol, and sex hormone-binding globulin (SHBG) over 4.5 months. Intense dietary counseling was performed. These women even had specially prepared group meals twice a week! The diet was designed to reduce insulin resistance: low in animal fat and refined carbohydrates and rich in low-glycemic-index foods, monounsaturated and omega-3 (polyunsaturated) fatty acids, and phytoestrogens. Women in the intervention group significantly boosted levels of SHBG while decreasing serum testosterone, compared to women who made no dietary changes. Furthermore, the intervention group significantly decreased body weight, waist:hip ratio, total cholesterol, fasting glucose level, and insulin resistance. The authors concluded that increased phytoestrogen intake decreases the bioavailability of serum sex hormones in hyperandrogenic postmenopausal women. 

About DHEA and PCOS:

It is not clear the role of dehydroepiandrosterone (DHEA) on PCOS risk, however, since 20-30% of women experience excess androgen production it seems super important to research! DHEA serves as a good biomarker for androgen production.  Therefore, DHEA may help researchers as they explore how certain foods or dietary patterns may help lower DHEA. One study found DHEA could be lowered by exercise and diet. Women with PCOS either followed a calorie restricted diet (35% protein, 45% carbohydrate and 20% fat), or an exercise program for 24 weeks. At the end of the study both interventions seems to help lower DHEA. 

Reminder about medication and PCOS:

Check with your doctor about medications like metformin, as it has been studied extensively for the treatment of PCOS with positive results. Since medications come with side-effects it is important to weight the risks vs. benefits with your healthcare team. Often with PCOS you’ll find both medication and lifestyle intervention(diet and exercise) can be most effective. Perhaps if lifestyle is going so well that you are seeing improvements than tapering off the medication can be achieved?  Interestingly, a few studies give hope that dietary changes may control PCOS as well as metformin. (Please keep in mind this may not always be the case and a few published studies does not justify avoiding potentially needed medications). Regardless, this study randomized 46 overweight women with PCOS to either a diet consisting of 1200-1400 kcal/day diet (25% proteins, 25% fat, and 50% carbohydrates plus 25-30 gm of fiber per week) or to take metformin for 6 months. Both groups had significant improvements in menstrual cycles, reductions in BMI, and luteinizing hormone levels and androgen (testosterone, androstenedione, dehydroepiandrosterone sulfate) concentrations. One method did not seem to be better than the other. Clinical outcomes such as menstrual cycle patterns, ovulation, and pregnancy rates were also similar in both groups. This suggests high insulin and androgen hormone levels may be improved by diet or metformin. A second study looked at women with PCOS either eating a similar low calorie diet vs taking metformin for 12 weeks. Weight loss was seen in both treatments, but the diet group in this case was more effective in improving insulin resistance in the overweight and obese women. This study also looked at CRP levels and found both groups significantly lowered levels. This may be proof that diet works like metformin, which gives hope there is options for PCOS treatment. Still we need longer term follow up studies to see how these women are doing years after the experiment. Have the stuck to their diets? Did they end up needing medication? And what exactly were the participants eating and how could their diets improve? Lastly, Dr. Greger has a video presenting a study where lifestyle intervention reduced diabetes incidence by 58 percent, compared to only 31 percent with the drug. The lifestyle intervention was significantly more effective than the drug, and had fewer side-effects.

What about exercise and PCOS?

Many of the studies recommended about 30 minutes of exercise a day so perhaps the combination of diet and exercise has better results. That said, some studies did isolate diet alone (or rather did not tell participants to change exercise patterns) and exercise alone has been shown to help women with PCOS. My advice would be do both! Why perform one without the other as it would seem together diet and exercise can be more powerful. Obviously if limited in either capacity do what you can. I believe when dealing with any disorder mindfulness is important as well as social support and stress reduction techniques. 

Dietary supplements and herbs for PCOS:

Marjoram is an herb that has been found to reduce DHEA and insulin levels in women with PCOS.

Dr. Greger mentions this study on spearmint in women with PCOS showing in just 5 days women were able to drop their free and total testosterone levels by about 30% drinking two cups of tea a day.  I am unsure about mint and safety, check with your doctor if on medications with specific food interactions. To my knowledge mint should be safe for women with PCOS.

Maca root may be used to improve sexual function.  In a petri dish there appears to be antioxidant activity. There seems to be limited data on concerns with psychological symptoms from taking maca. In other research, men taking maca had better health scores and significantly lowered an inflammatory marker, IL-6, known to increase cancer risk. It’s been traditionally consumed for nutritional and medicinal properties, but I am unsure how much is deemed unsafe. I did not see any research on maca and masculinity or heart palpitations. (If anyone find’s any or has more to add please add the research citation in the comments section). Again, I would speak with your doctor about their recommendations for usage. Visit our site on women’s health for more information that correlates with metabolic syndrome.

Lastly, there is some research that suggests supplements like magnesium, n-acetylcysteine, cinnamon, alpha-lipoic acid and/or omega-3 fatty acids may modulate factors associated with insulin sensitivity, thereby helping women with PCOS. One article in Today’s Dietitian mentions these supplements and other research on PCOS.  

Comments about PCOS and diet:

Dr. Forrester is an esteemed member and volunteer with NutritionFacts. He elaborates on his findings 2 years ago and gives suggestions about the best diet for PCOS.

In Summary:

Weight loss is an important factor for PCOS as we see in study after study. I think overweight women need to find the best route of weight loss that works for them. I do not think calorie restriction is needed to loss weight.  A high fiber diet low in the glycemic index seems to offer the best solutions. You would think with all this research an optimal diet could be recommended. I mean even this study titled “The optimal diet for women with PCOS?” fails to confirm the best approach. What is helpful about this study (and all the others referenced here) is that it provides awareness about dietary trends. Since women with PCOS are at greater risk of type 2 diabetes and heart disease any diet that promotes weight loss and glycemic control may be beneficial. One interesting note is that most studies are performed on calorie restriction rather than dietary composition. The authors conclude a diet low in saturated fats and high in fiber from low-gycemic index foods are recommended.

My dietary suggestions for women with PCOS:

– Boost fiber intake to help modulate hormones and lower circulating testosterone

– Promote weight loss in overweight women

– Improve glycemic control and avoid developing diabetes

– Help manage symptoms like acne and hirsutism

– Focus on foods that help reduce inflammation

Of course, discuss these parameters with your healthcare team as dietary treatments are individualized. I highly recommend utilizing a registered dietitian for personal dietary advice. 

For more information to help achieve these dietary suggestions: 

FIBER 

DIABETES AND INSULIN RESISTANCE 

WEIGHT LOSS 

DIABETES 

Image Credit: Eduardo García Cruz / flicker

Discuss


19 responses to “What does the research say about dietary interventions on women with PCOS?

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  1. This is wonderful. Thank you for your hard work in putting this together. It is one of the more comprehensive articles I have seen among those I can trust.

    For what it’s worth, I have had PCOS for 7 years. After switching to a plant based diet for the past 2 years, my “nonexistent” periods are now quite regular, which has left my gynecologist in shock.

    Maybe it’s because of my diet. Maybe it’s the other ways I take care of myself because I took the initial step in feeding my body well. Maybe it’s the way I feel when I am eating whole, plant based foods. It could be one of these, all of these, or none of these. But just wanted to put that out there.

    I would love to hear any updates in the research world about PCOS! Thank you so much.

  2. This is a great response, you should consider amending the porting about cinnamon and blood sugar in light of the newest data exibiting liver toxicity in cassia cinnamon. Also, what is the deal with lead in maca, here in California, we have a Prop 65 warning on all maca products stating they contain lead, and from what I’ve heard, no amount of lead is safe? I find maca an amazingly effective mental and sexual stimulator, but I don’t want brain damage, any info would be appreciated.

  3. I have elevated DHEA, but did not experience any symptoms nor discover the problem until about a year after I moved from TX to MA. The doctor also discovered that I now have a Vitamin D deficiency as well. Are there any studies that discuss a relation between Vitamin D and DHEA?

  4. I have PCOS since i was 14, my menstruation came about once or twice a year and sometimes i didn’t have one in a very long time. I’m became vegetarian and cut out allmost all dairy since the beginning of this year. And my menstruation is normal since then! I was shocked and didn’t even notice it untill a few months in it being regular. I started thinking it could have something to do with me cutting out meat and dairy out of my diet, but this article confirms it has definitly have something to do with it!
    I’m slowly transitioning into going vegan to see if it continues improving.

  5. Hello, I recently purchased your book and really enjoying it. Im 35 and recently been diagnosed with under active thyroid and POI/ POF/ early menopause. Its been one month. Im vegetarian but up until diagnosis was still eating salmon and cottage cheese. Ive since cut out any processed food, coffee, alcohol, wheat and sticking to plenty of fresh organic fruit & veg, almonds, rice & quinoa, swapped soy milk to oat milk and make my own almond milk plus taken up running. I didnt really consider myself un healthy before but knew i could always do better with my diet/ lifestyle. I have also started to take the following supplements daily; Ashwagandha root extract, vitamin D, vitamin A, Coq-10, red clover, agnus castus drops, dong quoi and add raw macca powder to my smoothie. Im prescribed L-thyroxine and sostilar. my blood test results were …
    TSH 5.8
    PROLACTINE 36
    FSH 137.8
    LH 88.3
    PROGESTERONE 0.4
    ESTRODIOL 30
    I was wondering if you could advise me further on what i can do personally- when i asked my gynaecologist she said to just stick to the prescription of L-thyroxine and sostilar. Im not expecting a miracle but maybe just some advise on how i can help myself further.
    kind regards
    Claire xx

  6. Thank you for the article!
    I’ve been recently diagnosed with PCOS by ultrasound. I already am vegan (full plant based diet, lots of fiber..gbc) and my bmi is just fine (19.5). I’ll try the mint tea… But is there anything more i can do? Heard about an herb called vitex that could help regulating the sex hormones. Have you seen any research on it?

    1. Shir fire: NutritionFacts has a couple videos on PCOS coming out very soon. If those videos do not answer your question, please post again. Sound good?

  7. Any thoughts on an HCG diet for someone with PCOS? I understand the potential risks HCG may have on insulin and ovarian cysts but my primary concern lies with potential increased fertility as I do not want to get pregnant- I just need to lose weight as I am very overweight and unhealthy (high blood pressure etc) and it has come to the point of considering weight loss surgery if I can’t lose weight in other ways. Weight loss has always been a struggle. And I am on metformin for insulin resistance. Thanks!

  8. Valerie: Have you seen the following article on HCG from the Mayo Clinic? It does not sound safe! http://www.mayoclinic.org/healthy-lifestyle/weight-loss/expert-answers/hcg-diet/faq-20058164

    I understand that you have a serious problem and need to address it some way. I recommend that you adopt the diet that helps with reversing insulin resistance and with losing weight. You can learn more about this diet, which is very consistent with the recommendations on this site, by reviewing Dr. Barnard’s book: “Dr. Neal Barnard’s Program for Reversing Diabetes: The Scientifically Proven System for Reversing Diabetes without Drugs” https://www.amazon.com/Neal-Barnards-Program-Reversing-Diabetes/dp/1594868107/ref=sr_1_1_twi_pap_1?s=books&ie=UTF8&qid=1489792110&sr=1-1&keywords=barnard+diabetes

    The back of the above book includes meal plans and recipes. It’s a great deal. However, if you would rather not get a book, I have some suggestions for you. I’d recommend watching these videos and putting the information into practice before doing weight loss surgery. If you like what you learn on these videos, but do not know how to implement it, I have some resources/suggestions.

    1) Doug Lisle, one of the experts in the Forks Over Knives documentary, gives a great ‘calorie density 101’ talk officially called: How To Lose Weight Without Losing Your Mind. I have watched the following talk from Doug Lisle several times and think very highly of it. And it’s free!!! And it’s entertaining! https://www.youtube.com/watch?v=xAdqLB6bTuQ
    .
    2) As good as Doug Lisle’s talk is, I also recommend a talk from Jeff Novick,Calorie Density: “How to Eat More, Weigh Less, and Live Longer,” http://www.jeffnovick.com/RD/Calorie_Density.html If talks aren’t your thing, the following article from Jeff covers a lot of the same information and has some great reference charts: http://www.jeffnovick.com/RD/Articles/Entries/2012/5/20_A_Common_Sense_Approach_To_Sound_Nutrition.html

    3) For a very moving story of someone who struggled with serious weight loss her whole life and what she did to fix it (all consistent with the above information), check out this talk from Chef AJ. I think it is motivational and helps explain that losing weight may be a “devil is in the details” sort of thing. If she can do it, you can do it too!!! Note that Chef AJ also has a program to help people lose weight. You may want to look into that. It’s not free, but it’s safer and cheaper than surgery… https://www.drmcdougall.com/health/education/videos/advanced-study-weekend-experts/chef-aj/

    Best of luck to you.

  9. I first had symptoms when i was 17 and was told that i had PCOS (thin people type PCOS) and was officially diagnosed at 22 ans now i am 35. I have always had regular periods and unless on birth control pills were they irregular at times and I had a hard time getting pregnant because of the absent periods. I was always told by doctors that I would have a hard time conceiving so I would only go on the pill periodically which i did for more than 4 years, not for protection against getting pregnant, but just to get a period (since I was told it’s not healthy to have less than 4 or so periods a year). Last time I went on a 3 month birth control pill and then stopped again because the medicine was not curing my pcos nor making me get pregnant. I went in search for a cure and ended up with so many drugs, medicine and even soaps that didn’t work. I actually thought at a point that i was cursed that there is no cure for it, i was prepared to live like that till i read a testimony of a patient who suffered from pcos whose case was even worse than mine and how she was cured completely, I was amazed and at thesame time anxious and curious so i had to contact the doctor with the contact details that she left on the note. The doctor gave me so much hope and confidence with her kind words of encouragement to believe in myself and i was lifted because no one has ever given me hope like that before. I ordered the medicine, took it for 8 weeks and to my complete surprise, all the facial hairs, weight gain and all disappeared I ended up getting pregnant within a few weeks of completing the treatment! I was in shock. I think the main reasons it happened was that I never gave up and was ready to try alternative treatment so my body was back to normal. Before now i never enjoyed sex because it was very painful but now i do and my husband is the best thing that ever happened to me..
    I hope this inspires some of you because I never in a million years would have thought that I would get pregnant and was getting frustrated and now our baby is due next month! You too can reach her on [aletedwin @ gmail. com] for more information, advise and also how to place an order for yours.

  10. I am interested in how effective marjoram is at lowering DHEA. I looked at the link to the article and don’t see a full text. Do you know the dose and frequency used in the study? What was the average decrease in DHEA? I see it is in umol/L, but what would that be in ug/dL?

  11. I found two articles that answered your questions:
    https://www.ncbi.nlm.nih.gov/pubmed/25662759/ and
    https://onlinelibrary.wiley.com/doi/abs/10.1111/jhn.12290/
    Both studies, however, just mentioned use of marjoram tea but did not specify exact dose. I was able to confirm usual method for making m. tea is as below:
    To make a cup of marjoram tea, take a cup of cold water and add a teaspoon full of marjoram herb. One cup of water can be up to 200 ml. Heat this mixture until it starts boiling. Now simmer the heat and let it boil for 15 minutes. Hope that helps!

  12. I am curious about maca, not as a so called supplement, but as a vegetable. I’m not sure how many are aware: it is a brassica, and as such, it should show benefits similar to other more known brassicas such as broccoli. The book Edible Medicinal and Non-Medicinal Plants, Volume 9 by T.K. Lim has 27 pages about the food, summarizing a fair amount of the research done at the time of writing. I haven’t looked over it much though it notes “total glucosinolates found in maca hypocotyls were 25.66 μMol/g,” which isn’t particullary high. Maybe there’s some other reason to consume or grow it (as fresh root and leaves) it but I’m unsure what that might be.

    I don’t know much about the growing conditions of maca in Peru. If it is true that it seems diversity is not great, being a brassica in itself might itself mean something if it’s the only brassica available to them, perhaps similarly to reports of those that consume it as a supplement that may not typically consume vegetables. The question remains is there anything unique about maca and how it does it compare, not to the commonly known and available cultivated varieties of brassica, but the many dozens available if one truly looks and seeks the best ones.

    1. Hello Soranus,
      I am a “Health Support Volunteer” for NutritionFacts, also a family doctor with a private practice in lifestyle medicine. I looked at the original Comment attached to your comment, by Joseph Gonzales from 4/12/2015 (https://nutritionfacts.org/questions/what-does-the-research-say-about-dietary-interventions-on-women-with-pcos/). Gonzales (nutritionist who used to work for NutritionFacts) cites two interesting studies about maca. Here are links to the full-text articles:
      1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2928177/ — this is a summary of 4 RCTs about use of maca to improve sexual function in men and women. In these studies, the maca was apparently taken as a supplement.
      2) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3856628/ — nice article showing higher overall health status of maca consumers in Peru, possibly due to its anti-inflammatory effects — they demonstrated lower serum levels of the pro-inflammatory interleukin-6 in maca consumers. In this study the maca was consumed as a food — most often in juice form.

      I have an anecdotal report from a 53 year old post-menopausal patient who found that maca definitely helped her hot flashes. (However, anecdotal reports should obviously be taken “with a grain of salt”).

      I’m sorry I don’t have any information about growing conditions of maca in Peru. But the 2nd article does contain lots of interesting information about maca.

      I hope this is helpful.
      Dr. Jon
      PhysicianAssistedWellness.com
      Health Support Volunteer for NutrtionFacts.org

      1. Hello Jon,

        Thank you for you effort. It is not helpful. :) As mentioned, I am curious about the relative ranking of maca as a brassica, compared to all other brassicas as well as compared to all other vegetables. If one is truly seeking the optimal diet, for every known plant, there are dozens, hundreds, or thousands of varieties. As it is known by Greger, antioxidants are significantly higher in other fruits. Not too often known, Vitamin C can reach 5,000 mg per 100 g; there are multiple examples that reach close to such levels. Calcium, as far as I know, has an upper limit in green leafys somewhere above 900 mg per 100 g.

        So in seeking plants, some examples. Spinach is part of the amaranthus family. Commonly available, that is those that grow throughout decently temperate North American climates, amaranthus that also are often traditionally used and rank decently in calcium, not the only measure, but why I go by at the moment, are amaranthus spinosus and chenopodium album. They make take effort to find, though various cultivated amaranths are available at farmers markets. Any I find that are typically more bitter than spinach or relatively decent compared to market greens, I’ll take. Of brassicas, I don’t bother with broccoli, brussel sprouts, kale, cabbage, etc. Higher in glucosinolates are moringa oleifera and mustard. Shepherd’s purse is another often traditionally used although I know of no comparison of glucosinolates but from the taste, it might be comparatively better as well as higher in calcium than all cultivated commonly known brassicas. Of radish, I prefer wild radish (raphanus raphanistrum) leaves due to its bitterness and mustard-like spiciness, also likely indicating higher levels of glucosinolates and calcium. Etc. Common beliefs such as sulforaphane being the most power liver detoxifier, I think it’s said, I generally ignore. How does it rank compared to other isothiocyanates? Are others not so well studied because of historical and cultural bias, such as broccoli being more studied because it’s more commonly consumed? As Greger mentions I believe only once, to paraphrase, it doesn’t make sense for nature to concentrate such effects in one family of vegetables rather than them being distributed through the plant kingdom. If total isothiocyanates are significantly higher than other brassicas, even without tests comparing them to sulforaphane, I’ll generally think that even without studies, I’ll have, let’s say “faith”, that it is likely better. With all plants, I look at the entire family, and seek out what are the best examples that grow wild in my area or can be grown.

        So concerning maca, the majority of studies I know of I find of little use. What I am interested in is if maca compares favorably to all other brassicas, as well as all other plants. So far the answer seems to be no, but who knows. I do highly recommend the 12 volume food science series Edible Medicinal and Non-Medicinal Plants by T.K. Lim. It perhaps totals over 10,000 pages covering over 1,000 plants, each summarizing a significant amount of available studies. If it’s a plant commonly used somewhere, it’s very possibly studied covered, or some relative is covered.

  13. This article ignored the fact that this person doesn’t have the insulin resistant, reversible PCOS phenotype. She has the “three times too high” DHEAS type, which I have, and which does not respond to diet or lifestyle interventions. Why are there a multitude of answers for the former, and continued research being done…and nothing for us? I spoke to one of the foremost androgen disorders researchers in the world, Ricardo Azziz, and he told me if I went to a psychiatrist and took psych drugs my symptoms would improve. As it turns out, and as my endo confirmed, he lied to me about the psychiatrist. They have limited research dollars to advocate to PCOS and since most are obese and overweight and can’t manage to change this, the medical community has to do whatever it can to help. Azziz himself is morbidly obese, so this probably plays into his compassion for that group. I am still not sure why he felt it necessary or ethical to tell me such an outlandish, disrespectful, insensitive, and thinly veiled lie, but I guess it is rather uncomfortable to admit that the research community has ignored huge swaths of the PCOS population, and that includes women of color. What a disgrace.

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