Flax is an ancient plant, probably originating in the Fertile Crescent and being native to India through the Eastern Mediterranean. It’s cultivation by humans goes back to Ancient Egyptian and Ancient Ethiopian cultures. Evidence of flax use as weaving material has been found dating back over 30,000 years. As a food it is rich in protein (20% by weight), fibre (28% by weight), fatty acids (41% by weight) and natural chemicals called lignans & phytoeostrogens. Flaxseed is one of the highest sources of lignans, containing more than 3000 times that of red wine and over 10 times the amount found in sesame seeds. These lignans are extremely powerful antioxidants which are metabolized by bacteria in the colon into antimicrobial and even anti-cancer substances.
Many women with PCOS take ground flaxseed meal or flaxseed oil (also called linseed oil) as a health supplement and modern research is continuing to find conditions which benefit from flax.
Note: Flaxseed meal contains additional benefits that you will not get from taking just flaxseed oil. The lignans are contained in the seed, not the oil and these provide the strong antioxidant benefit and the hormone balancing effect. It is important to grind the flaxseed finely to ensure that the nutrients can be digested properly, as flaxseeds have a tough outer shell that protects the inside of the seed from digestion.
Omega-3 : Omega-6 fatty acid ratio
It is very important to maintain an appropriate ratio of omega-3 to omega-6 fatty acids in your diet. Omega-3 fatty acids reduce inflammation, whilst omega-6 fatty acids generally increase it. The seeds of the Flax plant yield an oil containing omega-3 and omega-6 fatty acids in a beneficial ratio of 3 parts omega-3 to 1 part omega-6. Whilst it is recommended that people eat at least 3 times as much Omega-3 fatty acids as they do Omega-6, due to the modern diet most people in fact consume as much as 25 times more omega-6 to omega-3 as omega-6 fatty acids are found in meats, nuts, cereals and most vegetable oils. It is hypothesized that it is this severe imbalance in fatty acids which is largely responsible for the epidemic of inflammatory diseases in civilised countries today.
Flaxseed oil contains the essential fatty acid alpha-linolenic acid (ALA), which the body can convert into eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), the omega-3 fatty acids found in fish oil. There is considerable debate amongst scientific researchers as to whether flaxseed oil will have the same anti-inflammatory effect as fish oil, because the human body isn’t very efficient at converting ALA into EPA and DHA and the benefits of ALA, EPA, and DHA are not necessarily the same. Some studies have indicated that people with diabetes or schizophrenia may have even more difficulty in converting ALA into EPA and DHA. Many studies have shown that the omega-3 fatty acids in fish oil have reduce inflammation and help prevent chronic diseases related to long-term systemic inflammatory processes such as heart disease and arthritis. For some people it may be preferable for them to obtain their omega-3 from these sources instead.
Reduction of Free Testosterone
Flaxseed meal contains lignans (a type of phytoestrogen) which have a very strong antioxidant effect and also increase the body’s production of Sex Hormone Binding Globulin (SHBG). Having reasonable SHBG levels is important for women with PCOS as it binds to testosterone, preventing it from wreaking havoc on our bodies.
Although many women are concerned about consuming excess phytoesotrogens in their diet as the majority of women with PCOS already have oestrogen dominance, it is important to note that phytoestrogens can be either oestrogenic (increase oestrogen) or anti-oestrogenic (inhibit oestrogen). As you can see with flaxseed oil, the effect on testosterone is very beneficial for those who suffer from the symptoms of it’s excess. Soy and alfalfa are other foods rich in phytoestrogens.
Note: Phytoestrogens refer to a family of compounds found in plants that have both oestrogenic and anti-oestrogenic properties. They do not necessarily raise oestrogen levels.
Blood Sugar Stabilisation & Satiety
Studies on the effect of various forms of fibre on blood sugar levels have found that flax lowers the glycaemic response of the body to carbohydrate containing foods. As with all fibers, it increases the feeling of fullness after a meal. These effects are extremely beneficial for women with PCOS and can have a beneficial effect on a whole host of symptoms which are ultimately caused by high levels of insulin in the blood in response to sugar.
Reduction of High Cholesterol
Some studies have shown that taking flaxseed oil or meal can lower cholesterol, however, they have been small and one other study found no effect.
People who follow a Mediterranean diet, high in fish, poultry, ‘healthy fats’ like olive oil and with an appropriate balance between omega-3 and omega-6 fatty acids, wholegrains, root vegetables, fruit and lots of green vegetables and walnuts & flax which both contain alpha-linolenic acid tend to have higher levels of HDL cholesterol which is the beneficial kind. Red meat and saturated fats, which are high in omega-6 fatty acids are only consumed very infrequently in this diet.
As women with PCOS often suffer from ‘dyslipidaemia’ which can include high LDL cholesterol and low HDL cholesterol, and flax will benefit other facets of PCOS it would seem that the addition of flax to your diet if you suffer from high cholesterol and testosterone would be beneficial.
Scientific studies indicate that people who eat a diet rich in alpha-linolenic acid (which is also likely to include a broad array of fruits, vegetables, nuts, legumes and wholegrains) are less likely to suffer a fatal heart attack than those who have a diet poor in ALA, probably due to it’s ability to reduce inflammation and platelet aggregation or their tendency to clump together in a sticky mass. If blood flows more easily through the blood vessels then there is less chance of heart-attack and stroke-causing clots. ALA might also reduce the risk of heart disease through promoting the health of blood vessels, reducing elevated blood pressure and reducing the risk of arrhythmia or irregular heart beats. Certainly eating a healthy diet filled with fresh, whole foods is a step in the right direction for ‘good health’ of any form and flax has many qualities with recommend it as part of a healthy diet. Women with PCOS have 7 times the risk of heart disease as the general population, therefore, including anything in your diet that is likely to reduce this risk would seem prudent.
Flaxseed and its various constituents are being studied with promising results in the prevention and treatment of cancer. A 2006 study by researchers in the Nutritional Sciences Department of the University of Toronto found that feeding mice a diet including flaxseed or various compounds found in flaxseed redused the rate of metastasis (tumours from the ‘parent’ breast cancer turning up in other locations in the body, such as liver, lungs etc) from excised breast cancer tumours. Flaxseed and its compounds are also being studied in relation to other cancers, such as prostate.
As flax contains such a high quantity of both soluble and insoluble fibre and oil it has a slight laxative effect due to the combination of fibre adding bulk, and the oil lubricating the digestive tract and facilitating motility. This enhances bowel regularity and improves the health of the colon.
How Much Flaxseed is Appropriate?
In 1994, researchers from two universities evaluated flaxseed powder consumption in women and reported that the lignans, which they considered to exert a protective effect against certain cancers, were normally metabolized by the microflora in the gut. They reported that 60 grams or approximately 6 tablespoons of raw ground flaxseed in healthy people was safe. Generally for someone consuming 2000 calories or less each day a couple of tablespoons of ground flaxseed per day, or 20 grams, will be sufficient. This will provide about 8 grams of flaxseed oil, just over half of which will be alpha-linolenic acid. Of course if you are consuming a lot of oily fish or other foods rich in omega-3 fatty acids, then the amount of flaxseed required would be less.
If you wish to take flaxseed oil in lieu of fish oil, you will need to take quite a bit more of it than you would fish oil. For instance, to replace 2 grams of fish oil, you would need about 14.4 grams of flaxseed oil or roughly 2 tablespoons (30 mls). This will contain about 14 grams of alpha-linolenic acid and about 260 calories.
Note: Do remember to grind up the flax seeds so that you will be able to digest them properly. They can be added to smoothies, cakes, breads, porridge, sauces or sprinkled on top of breakfast cereals.
Interactions with Other Drugs
As with any form of fibre, don’t take flax at the same time as you take any pharmaceutical medicines, herbs, vitamins or minerals as it may partially prevent the absorption of those medicines. Be sure to take flax at least two hours after any other medicines or supplements you are taking.
Flaxseed is likely to make any drug in the statin family, used for lowering cholesterol levels, more effective. This family of drugs includes atorvastatin (Lipitor), lovastatin (Mevacor) and simvastatin (Zocor).
NSAIDs or non-steroidal anti-inflammatory drugs carry a strong risk of stomach ulcers with their use, especially over the long-term. Studies in animals have found that giving omega-3 fatty acids can reduce the risk of ulcers from drugs like ibuprofen (Advil, Brufen) and naproxen (Alleve, Naprosyn). No studies have yet been done to see if the same effect occurs in humans.
Anticoagulants (blood-thinning medications) are likely to be enhanced by the addition of omega-3 fatty acids so it is very important not to start taking omega-3 fatty acids without talking to your health care provider if you are already taking anticoagulants. The increased blood-thinning effect could have severe repercussions such as stroke, haemorrhage and bruising. Anticoagulants include drugs such as aspirin, clopidogrel (Plavix) & warfarin (Coumadin). Your health care provider will be able to advise you on how to combine the two safely. This will likely include regular monitoring of your INR (international normalised ratio) or the rate at which your blood clots and a gradual reduction in your medication.
Omega-3 fatty acid supplementation may reduce the toxic side effects such as kidney damage and high blood pressure of cyclosporine (Sandimmune), a drug given to transplant patients. It may also increase the effectiveness of psoriasis therapy with topical corticosteroids and etretinate (Tegison).
Storage & Quality of Flaxseed Oil and Meal
Any oil is capable of turning rancid under the right conditions, generally exposure to heat, light & oxygen. Flaxseed is no different. Although whole milled flaxseeds appear to store reasonably well for short periods of time (several months), once the oil is extracted, or the seed is ground, exposing more of it’s surface area to the corrupting influence of heat, light or oxygen, deterioration can be rapid. It is therefore necessary to store flax products in the refrigerator inside a darkly tinted, airtight container. High quality flaxseed oil or meal should be processed from freshly pressed seeds at low temperature in minimal light conditions and as little heat as possible. They should also be promptly packaged into dark, airtight containers and refrigerated. It is preferable to buy flax products from companies who certify that their products are free from heavy metals like mercury and lead, though contamination of flaxseed oil with these substances is less common than contamination of fish oils.
Freeman VL, Meydani M, Yong S, Pyle J, Flanigan RC, Waters WB, Wojcik EM. Prostatic levels of fatty acids and the histopathology of localized prostate cancer. J Urol. 2000;164(6):2168-2172.
M.G. Enig. Know Your Fats: The Complete Primer for Understanding the Nutrition of Fats, Oils and Cholesterol. Bethesda Press, 2000, p. 106.
J.W. Lampe, M.C. Martini, M.S. Kurzer, H. Adlercreutaz, J.L. Slavin. Urinary lignan and isoflavonoid excretion in premenopausal women consuming flaxseed powder. American Journal of Clinical Nutrition. 1994;60:122-128.
Balk EM, Lichtenstein AH, Chung M et al. Effects of omega-3 fatty acids on serum markers of cardiovascular disease risk: A systematic review. Atherosclerosis. 2006 Nov;189(1):19-30.
Angerer P, von Schacky C. n-3 polyunsaturated fatty acids and the cardiovascular system. Curr Opin Lipidol. 2000;11(1):57-63.
Fenton WS, Dicerson F, Boronow J, et al. A placebo controlled trial of omega-3 fatty acid (ethyl eicosapentaenoic acid) supplementation for residual symptoms and cognitive impairment in schizophrenia. Am J Psychiatry. 2001;158(12):2071-2074.
Yuen AW, Sander JW, Fluegel D et al. Omega-3 fatty acid supplementation in patients with chronic epilepsy: A randomized trial. Epilepsy Behav. 2005;7(2):253-8.
Pan A, Yu D, Demark-Wahnefried W, Franco OH, Lin X, “Meta-analysis of the effects of flaxseed interventions on blood lipids,” Am J Clin Nutr. 2009 Aug; 90(2): 288-97
L. J. Malcolmson, R. Przybylski1 and J. K. Daun Storage stability of milled flaxseed J Am Oil Chem Soc 2000 Mar; 77(3)235:238
Belluzzi A, Boschi S, Brignola C, Munarini A, Cariani C, Miglio F. Polyunsaturated fatty acids and inflammatory bowel disease. Am J Clin Nutr. 2000;71(suppl):339S-342S.
Boelsma E, Hendriks HF. Roza L. Nutritional skin care: health effects of micronutrients and fatty acids. Am J Clin Nutr. 2001;73(5):853-864.
Bradbury J, Myers SP, Oliver C et al. An adaptogenic role for omega-3 fatty acids in stress; a randomised placebo controlled double blind intervention study (pilot)ISRCTN22569553. Nutr J. 2004 Nov 28;3:20.
Dahl, WJ; Lockert EA Cammer AL Whiting SJ (December 2005). “Effects of Flax Fiber on Laxation and Glycemic Response in Healthy Volunteers”. Journal of Medicinal Food 8 (4): 508–511. doi:10.1089/jmf.2005.8.508
Itomura M, Hamazaki K, Sawazaki S et al. The effect of fish oil on physical aggression in schoolchildren – a randomized, double-blind, placebo-controlled trial. J Nutr Biochem. 2005;16:163-71.
Burgess J, Stevens L, Zhang W, Peck L. Long-chain polyunsaturated fatty acids in children with attention-deficit hyperactivity disorder. Am J Clin Nutr. 2000; 71(suppl):327S-330S.
Cho E, Hung S, Willet WC, Spiegelman D, Rimm EB, Seddon JM, et al. Prospective study of dietary fat and the risk of age-related macular degeneration. Am J Clin Nutr. 2001;73(2):209-218.
De Spirt S, Stahl W, Tronnier H, Sies H, Bejot M, Maurette JM, Heinrich U. Intervention with flaxseed and borage oil supplements modulates skin condition in women. Br J Nutr. 2009 Feb;101(3):440-5.
Dewailly E, Blanchet C, Lemieux S, et al. n-3 fatty acids and cardiovascular disease risk factors among the Inuit of Nunavik. Am J Clin Nutr. 2001;74(4):464-473.
Duda MK, O’Shea KM, Tintinu A, Xu W, Khairallah RJ, Barrows BR, et al. Fish oil, but not flaxseed oil, decreases inflammation and prevents pressure overload-induced cardiac dysfunction. Cardiovasc Res. 2009 Feb 1;81(2):319-27.
Fatty fish consumption and ischemic heart disease mortality in older adults: The cardiovascular heart study. Presented at the American Heart Association’s 41st annual conference on cardiovascular disease epidemiology and prevention. AHA. 2001.
Vaisman N, Kaysar N, Zaruk-Adasha Y, Pelled D, Brichon G, Zwingelstein G, Bodennec J. Correlation between changes in blood fatty acid composition and visual sustained attention performance in children with inattention: effect of dietary n-3 fatty acids containing phospholipids. Am J Clin Nutr. 2008 May;87(5):1170-80.
Frangou S, Lewis M, McCrone P et al. Efficacy of ethyl-eicosapentaenoic acid in bipolar depression: randomised double-blind placebo-controlled study. Br J Psychiatry. 2006;188:46-50
Goldberg RJ, Katz J. A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain. Pain. 2007 Feb 28; [Epub ahead of print].
Hall MN, Campos H, Li H, Sesso HD, Stampfer MJ, Willett WC, Ma J. Blood levels of long-chain polyunsaturated fatty acids, aspirin, and the risk of colorectal cancer. Cancer Epidemiol Biomarkers Prev. 2007;16(2):314-21.
Barceló-Coblijn G, Murphy EJ, Othman R, Moghadasian MH, Kashour T, Friel JK. Flaxseed oil and fish-oil capsule consumption alters human red blood cell n-3 fatty acid composition: a multiple-dosing trial comparing 2 sources of n-3 fatty acid. Am J Clin Nutr. 2008 Sep;88(3):801-9.
Milder IE, Arts IC, van de Putte B, Venema DP, Hollman PC (2005). “Lignan contents of Dutch plant foods: a database including lariciresinol, pinoresinol, secoisolariciresinol and matairesinol”. Br. J. Nutr. 93 (3): 393–402 http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=918612
Kris-Etherton P, Eckel RH, Howard BV, St. Jeor S, Bazzare TL. AHA Science Advisory: Lyon Diet Heart Study. Benefits of a Mediterranean-style, National Cholesterol Education Program/American Heart Association Step I Dietary Pattern on Cardiovascular Disease. Circulation. 2001;103:1823.
Newcomer LM, King IB, Wicklund KG, Stanford JL. The association of fatty acids with prostate cancer risk. Prostate. 2001;47(4):262-268.
Okamoto M, Misunobu F, Ashida K, et al. Effects of dietary supplementation with n-3 fatty acids compared with n-6 fatty acids on bronchial asthma. Int Med. 2000;39(2):107-111.
Freund-Levi YF, Eriksdotter-Jonhagen M, Cederholm T, et al. Omega-3 fatty acid treatment in 174 patients with mild to moderate Alzheimer disease: OmegAD Study. Arch Neurol. 2006;63:1402-8.
Geerling BJ, Badart-Smook A, van Deursen C, et al. Nutritional supplementation with N-3 fatty acids and antioxidants in patients with Crohn’s disease in remission: effects on antioxidant status and fatty acid profile. Inflamm Bowel Dis. 2000;6(2):77-84.
Romano C, Cucchiara S, Barabino A et al. Usefulness of omega-3 fatty acid supplementation in addition to mesalazine in maintaining remission in pediatric Crohn’s disease: A double-blind, randomized, placebo-controlled study. World J Gastroenterol. 2006;11:7118-21.
Seddon JM, Rosner B, Sperduto RD, Yannuzzi L, Haller JA, Blair NP, Willett W. Dietary fat and risk for advanced age-related macular degeneration. Arch Opthalmol. 2001;119(8):1191-1199.
Bays HE. Safety considerations with omega-3 Fatty Acid therapy. Am J Cardiol. 2007;99(6A):S35-43.
Hooper L, Thompson R, Harrison R et al. Omega 3 fatty acids for prevention and treatment of cardiovascular disease. Cochrane Database Syst Rev. 2004;CD003177.
Dichi I, Frenhane P, Dichi JB, Correa CR, Angeleli AY, Bicudo MH, et al. Comparison of omega-3 fatty acids and sulfasalazine in ulcerative colitis. Nutrition. 2000;16:87-90.
Jeschke MG, Herndon DN, Ebener C, Barrow RE, Jauch KW. Nutritional intervention high in vitamins, protein, amino acids, and omega-3 fatty acids improves protein metabolism during the hypermetabolic state after thermal injury. Arch Surg. 2001;136:1301-1306.
Caron MF, White CM. Evaluation of the antihyperlipidemic properties of dietary supplements. Pharmacotherapy. 2001;21(4):481-487.
Kremer JM. N-3 fatty acid supplements in rheumatoid arthritis. Am J Clin Nutr. 2000;(suppl 1):349S-351S.
Olsen SF, Secher NJ. Low consumption of seafood in early pregnancy as a risk factor for preterm delivery: prospective cohort study. BMJ. 2002;324(7335): 447-451.
Pruthi S, Thompson SL, Novotny PJ, Barton DL, Kottschade LA, Tan AD, Sloan JA, Loprinzi CL. Pilot evaluation of flaxseed for the management of hot flashes. J Soc Integr Oncol. 2007 Summer;5(3):106-12.
Richardson AJ, Puri BK. The potential role of fatty acids in attention-deficit/hyperactivity disorder. Prostaglandins Leukot Essent Fatty Acids. 2000;63(1/2):79-87.
Stark KD, Park EJ, Maines VA, et al. Effect of fish-oil concentrate on serum lipids in postmenopausal women receiving and not receiving hormone replacement therapy in a placebo-controlled, double blind trial. Am J Clin Nutr. 2000;72:389-394.
Chen J, Wang L, Thompson LU (2006). “Flaxseed and its components reduce metastasis after surgical excision of solid human breast tumor in nude mice”. Cancer Lett. 234 (2): 168–75. http://www.ncbi.nlm.nih.gov/pubmed/15913884
Sundstrom B, Stalnacke K, Hagfors L et al. Supplementation of omega-3 fatty acids in patients with ankylosing spondylitis. Scand J Rheumatol. 2006;35:359-62.
Weinstock-Guttman B, Baier M, Park Y et al. Low fat dietary intervention with omega-3 fatty acid supplementation in multiple sclerosis patients. Prostaglandins Leukot Essent Fatty Acids. 2005;73:397-404.
Krauss RM, Eckel RH, Howard B, et al. AHA Scientific Statement: AHA Dietary guidelines Revision 2000: A statement for healthcare professionals from the nutrition committee of the American Heart Association. Circulation. 2000;102(18):2284-2299.