Wednesday, May 21, 2008

It's the marijuana, stupid

Much of my work is with polycystic ovary syndrome, PCOS, an inflammatory syndrome that is the leading cause of infertility in the United States. Women who have this syndrome are plagued with intense carbohydrate cravings that can make it nearly impossible to follow any kind of healthy diet.

A dietitian with the syndrome, who had a master's degree in nutrition, once told me, "If it's carbohydrate, and it's not nailed down...I eat it."

It happens more often than not, when I work with clients who have PCOS, that they cannot conceive of being in a physiological state where the majority of their thoughts revolve around sugar and where to find more. They might politely listen to what I have to say about how to eat to quell these cravings, but the inevitable question at the end of my pitch for my nutrition plan is, "OK, but what am I going to do when I crave sugar?" They have absolutely no knowledge of a time when cravings did not rule their food choices, and their experience causes them to assume that my program is going to fail their expectations just as every other diet has done.

That's why I work so hard for those clients who are willing to trust me and try my program. It's incredibly rewarding to talk to them a couple of weeks later and hear the surprised delight over not spending hours of time and energy trying to suppress the urge to binge on a chocolate cake.

It seems that one of the reasons women with PCOS have so much trouble with their carbohydrate cravings, is that their endocannabinoid systems are out of balance.

You may know of cannabinoids as the substance in marijuana that causes the munchies. These compounds have been found to be important appetite regulators.

Of course, in Western medicine, when receptor trouble is identified, that means dozens of scientists in drug companies around the world race to find the right chemical to fix the troubled receptor.

Currently, a drug has been developed designed to "improve" the function of cannabinoid receptors. For a lot of obesity scientists, this drug, rimonabant, (Acomplia), was supposed to be the obesity miracle drug. However, Acomplia was tripped up during the FDA approval process, because there were concerns about an increased risk of severe depression being a major side effect. That is what has been tested and observed with Acomplia use.

What is also apparently a concern is that since this drug is somewhat like "anti-marijuana," it has potential for antagonizing many of the neuroprotective properties that marijuana may actually have. In other words, users of Acomplia may find themselves at increased risk of neurodegenerative diseases such as Multiple sclerosis, Alzheimer's disease, Amyotrophic lateral sclerosis (ALS), Parkinson's disease, and Huntington's disease.

So what are women with PCOS--and men whose obesity is also fueled by carbohydrate cravings supposed to do?

If you're a regular reader of this blog, you should know by now that the first answer to any question should always be fish oil. :) Yup, fish oil can help to silence the marijuana munchies.

I included a reference for your perusal, but I have to say, it was a client who taught me about this. We'd spent a couple of hours in our initial assessment, and I gave her my standard omega-3 and diet protocol. She had been embarrassed to tell me in that initial meeting, that every Sunday evening she baked a chocolate cake, which she used to satisfy her voracious carbohydrate appetite. Two weeks into using fish oil, she had thrown out two chocolate cakes, because her appetite for sweets had so radically diminished, she didn't even think about bingeing.

The relationship between carbohydrates and omega-3 balance is so strong, that I know I've titrated the right dose of fish oil with the right amount of other fats when the cravings are gone.

If you've taken fish oil and you have not experienced a drop in carb cravings, chances are you either aren't taking enough of the stuff...or you haven't eliminated enough of the other fats that get in the way of fish oil doing its amazing job.

So don't despair because the FDA kept rimonabant out of the drug supply and out of YOU. Give thanks, and look to the ocean for an even better way of getting the same results.

Pasquali R, Gambineri A, Pagotto U. The impact of obesity on reproduction in women with polycystic ovary syndrome. BJOG. 2006 Oct;113(10):1148-59. Epub 2006 Jul 7.

Kim AH, Kerchner GA, and Choi DW. Blocking Excitotoxicity. Chapter 1 in CNS Neuroprotection. Marcoux FW and Choi DW, editors. Springer, New York. 2002. Pages 3-36.

Engeli S, Heusser K, Janke J, Gorzelniak K, Bátkai S, Pacher P, Harvey-White J, Luft FC, Jordan J. Peripheral endocannabinoid system activity in patients treated with sibutramine. Obesity (Silver Spring). 2008 May;16(5):1135-7.

Watanabe S, Doshi M, Hamazaki T. n-3 Polyunsaturated fatty acid (PUFA) deficiency elevates and n-3 PUFA enrichment reduces brain 2-arachidonoylglycerol level in mice. Prostaglandins Leukot Essent Fatty Acids. 2003 Jul;69(1):51-9.

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