On July 28 I wrote about coenzyme Q10 and the ability it has to potentially boost exercise performance.  Today I want to look into the antioxidant capabilities of this coenzyme and how these may relate to post exercise muscle pain.  A study published recently in the British Journal of Nutrition (1) found that CoQ10 supplementation reduced exercise-induced muscular injury in athletes.

When we exercise intensively we may actually cause damage to our muscle tissue.  This damage is believed to be causal in post-exercise muscle fatigue, pain and inflammation.  Intense exercise seems to be linked to the production of free radicals (unstable oxygen molecules).  These free radicals are quite destructive and can cause all kinds of problems within the body if they are not dealt with properly by natural bodily antioxidant systems.  These destructive free-radicals are believed to be behind some of the post-exercise issues in intense exercisers.

The body does produce its own antioxidants but also relies on vitamins, mineral and phytochemicals (bioactive plant chemical) from the diet, especially from colourful vegetables and fruits, for additional valuable supplies.

The production of free radicals within the muscles seems to increase in proportion to the intensity of exercise, as you push yurself harder during exercise more free radicals will be produced, and as mentioned above these free radicals may be responsible for some of the muscle damage, inflammation and pain experienced post-exercise(2).  Normally during the day, whilst we move around and at times of gentle and moderate exercise free radicals are generated at a low rate and are taken care of by our well developed antioxidant systems.  However, during intense exercise a greatly increased rate of free radical production may exceed the capacity of our natural antioxidant defence system.  Consequently, a substantial attack of free radicals on our cell membranes may lead to cell damage and could initiate inflammation and then pain or fatigue. 

 
Coenzyme Q10 is naturally produced by the body and was first isolated in 1957, it is essential for energy production in all bodily cells and also acts as an antioxidant in the body.  The study mentioned at the start of this post (1) found that individuals who were supplemented with CoQ10 had less evidence of free radical damage after intensive exercise than those who were not supplemented.

Exercisers who have a high intensity exercise regimen (exercise for over an hour 4 or more times a week) may want to look at the possibility of taking extra antioxidant supplements (to boost the natural antioxidant systems in the body), which could include a Co Q10 supplement.  It is also important to ensure the diet includes a minimum of 5 portions of vegetables and fruits.  These foods are naturally packed with antioxidant vitamins, minerals and flavonoids which are easily absorbed by the body and are also associated with reducing the risk of a number of diseases (including heart disease and cancer).

Coenzyme Q10 itself is found in many foods but is particularly concentrated in nuts and oils.  The body does produce this nutrient naturally and does not rely on external sources.  In order to produce CoQ10 we require various essential cofactors.  These include a variety of vitamins especially of the B group (Folic Acid, Vitamin B2, The Niacinamide form of Vitamin B3, Vitamin B5,Vitamin B6, Vitamin B12) and Vitamin C .  Hence a healthy diet rich in fruits, vegetables, wholegrain cereals and lean proteins will aid the natural production of this coenzyme and help to keep our circulating levels high.

(1)Michihiro K et al.  2008.  Reducing exercise-induced muscular injury in kendo athletes with supplementation of coenzyme Q10.  BJN.  100:903-909
(2) Sjodin B et al.  1990.  Biochemical mechanisms for oxygen free radical formation during exercise.  Sports Medicine.  10(4):236-254.

Written by Ani Kowal

As you are aware from my previous posts I champion vegetable and fruit consumption.  These treasures are abundant in taste, texture, vitamins, mineral and fibre.....but they are also full of bioflavonoids, or flavanoids (members of the polyphenol family).  Flavonoids are bioactive plant compounds which have gained increasing amount of publicity over the last few years.  Scientists have been looking into the health benefits of these plant compounds and quite a lot of interesting data has been coming to light.

A yet to be published review article(1) looked at polyphenols (mainly found in grapes) and their role in health and found that these compounds may help to reduce the risk of heart disease.  The authors of the study state that “Consumption of grape and grape extracts and/or grape products such as red wine may be beneficial in preventing the development of chronic degenerative diseases such as cardiovascular disease".  Grape seeds, grape skin and grape juice contain many different polyphenols including; resveratrol, anthocyanins and flavonoids – you may be familiar with these names as they are widely available as supplements.  In conclusion to this review the authors say "supplementation with grape seed, grape skin or red wine products may be a useful adjunct to consider for a dietary approach in the prevention of cardiovascular diseases, although additional research is required to support such a strategy"

Flavonoids act as antioxidants in the body, helping to prevent cell damage and protection against disease by mopping-up destructive unstable oxygen molecules known as 'free radicals' (I have mentioned antioxidants and their role in health previously a number of times).  Polypheonols also seem to have other protective effects on the heart and blood vessels.  They seem to prevent blood clotting, abnormal heart beat and blood vessel narrowing.  As yet scientists are not exactly sure of how these plant compounds act, however they do seem to positively change the way our genes function.

Another recently published study(2) looked at the association between a variety of flavonoids and the risk of cardiovascular disease and stroke.  The scientists studied 1950 Finish men aged between 42-60 who were free from prior heart disease or stroke.  Participants were followed for an average of 15 years and during this time over 100 strokes and 150 cardiovascular disease deaths occurred.  Data analysis revealed that men who consumed the highest amounts of flavonoids had a greatly reduced risk of stroke and there was also a reduced risk of death from cardiovascular disease.  The results are unsurprising as fruit and vegetables are the major sources of flavonoids and there is plenty of data to show that these foods protect us from all kinds of diseases including stroke and heart disease.  The interesting point comes from the fact that the analysis took into account various vitamin intakes suggesting that the flavonoids themselves make a real impact on health.

Yet another study published just this month (3) highlights the health benefits of flavonoids, this time their potential role in weight maintenance and prevention of weight gain.  The researchers of this study looked at the association between flavonoids and BMI (body mass index, a measure of overweight) over a 14 year period in 4280 men and women aged between 55-69 years.  The results showed that women with the highest intake of flavonoids experienced a significantly lower increase in BMI over the study period.  Again, this is not surprising.  Individuals who eat a lot of vegetables and fruits tend not to fluctuate in weight and stay leaner.   

Now onto two pieces of research (4,5) which I am particularly fond of as they involve dark chocolate!  Readers of my blog will know my penchant for dark chocolate.  Dark chocolate containing 85%+ cocoa solids is something I truly adore and really savour the moment of one bitter square slowly melting over my tongue!  Drinking black cocoa is also something I enjoy.  The health benefits of cocoa have been publicised over the last few years and evidence that cocoa may help in the prevention of many conditions, such as cancer and heart disease, is mounting.  Cocoa is packed with great minerals such as magnesium and is also ‘choc’ full of flavonoids.

A very recent study(4) suggests that cocoa consumption may be good for the heart (great news since I would have trouble giving it up!).  The researchers investigated the short-term effects of eating either solid dark chocolate or drinking liquid cocoa on blood vessel function and blood pressure.  The small study included 45 adults who were overweight but healthy (and not obese) who were, on average, 53 years old.  In the first stage of the trial the participants consumed a bar of dark chocolate containing 22g of cocoa powder or a cocoa-free bar.  In the second stage the participants drank sugar-free cocoa containing 22g cocoa powder, cocoa containing sugar or a placebo containing no cocoa.

Eating dark chocolate and drinking sugar-free cocoa improved blood vessel function compared to placebo and blood pressure decreased in individuals who ate the dark chocolate bar or drank the sugar-free cocoa, compared to those who consumed the placebo.  The researchers conclude by saying “The acute [short term] ingestion of both solid dark chocolate and liquid cocoa improved endothelial [lining of the blood vessels] function and lowered blood pressure in overweight adults. Sugar content may attenuate [reduce] these effects, and sugar-free preparations may augment [improve] them”

The other small study(5) found that flavonoid rich cocoa was associated with a significant increase in blood flow to the brain, as measured via a special sort of ultrasound (Transcranial dopler ultrasound).  The authors suggest that their data could indicate a promising role for regular cocoa consumption in the treatment and prevention of stroke and dementia.

These studies were very small and preliminary but I found them interesting!!  I would like to add that this is not a plug to justify regular chocolate binges (although it does help me to feel better about my dark chocolate habit)!  The cocoa used in these studies, and other studies that link cocoa to health benefits such as lowered risk of heart disease, was high flavanol cocoa and only a very small amount was used daily.  Sugary, sweet milk chocolate won’t provide the health benefits discussed (sorry to be the bearer of sad news!). 

Flavonoids and polyphenols in general are found abundantly in fruits and vegetables, which are so important for our health.  Vegetables and fruit should form the core of a healthy diet and getting a good variety will give the body many of the nutrients that are needed for optimal health.  Flavonoid supplements are now available, though the evidence for their use is still in the early stages.  If you feel your diet is lacking in vegetables and fruits you may want to consider a supplement to top-up and cover the shortfall, but remember supplements are not a replacement for a healthy diet.

(1)http://www.elsevier.com/wps/find/authored_newsitem.cws_home/companynews05_01042 Mounting evidence shows health benefits of grape polyphenols.  Philadelphia October 28.  Due to be published in the November issue of Nutrition Research
(2)Mursu J et al.  2008.  Flavonoid intake and the risk of ischaemic stroke and CVD mortality in middle-aged Finnish men: the Kuopio Ischaemic Heart Disease Risk Factor Study.  BJN.  100:890-895
(3)Hughes L et al.  2008.  Higher dietary flavone, flavonol, and catechin intakes are associated with less of an increase in BMI over time in women: a longitudinal analysis from the Netherlands Cohort Study.  Am J Clin Nutr.  88:1341-1352
(4)Faridi Z et al.  2008.  Acute dark chocolate and cocoa ingestion and endothelial function:a randomised controlled crossover trial.  Am J Clin Nutr.  88:58-63
(5) Sorond FA et al.  2008. Cerebral blood flow response to flavanol-rich cocoa in healthy elderly humans. Neuropsychiatric Disease and Treatment. 4:433-440

Written by Ani Kowal

Unfortunately one of my very dear friends is seriously unwell, so I started writing this from the 9th floor of St Thomas’s hospital.  There are hand wash points all over the place in a bid to prevent the spread of infection.  Any hint of a sniffle and I would not be allowed to set foot onto the ward.  So, I am doing my very best to keep my immune system strong! 

In the past I have written about the prevention and treatment of colds and coughs and generally about the immune system and how to keep it strong.  It is the time of year when the cold and flu virus sis rife and people are very interested in how they can escape the infections that seem to be surrounding them.  Earlier this week I was made aware of the potential benefits of Black Elderberry extract (brand name Sambucol®) for the prevention and alleviation of the influenza virus.  I wanted to delve into the scientific research to discover if there is fact behind the hype.

Black Elderberry (sambucus nigra), a member of the honeysuckle family, is a tree-like shrub.  Traditionally various parts of the plant, including the leaves, bark, flowers and berries, have been used in medicine.  The health giving properties have been documented as far back as the 5th century.  Currently much of the interest and research has focussed on extract from the berries.  Research(1) suggests that elderberry has antiviral properties, especially against the influenza virus, and also seems to activate and boost the immune system as well as acting as an antioxidant.

The berries contain various bioactive plant compounds, known as flavonoids, as well as certain vitamins (C, A and various B vitamins), that appear to be responsible for the positive effects on the immune system and our health.

Sambucol® is a supplement that contains 38% standardised extract of black elderberry.  Research(2,3) suggests that elderberry extract appears to boost and activate the immune system in individuals who are healthy as well as those who are already suffering from a viral infection.

Two small well planned studies (randomised, placebo-controlled, double-blind studies 4,5) found that Sambucol® effectively inhibited the influenza A and B virus strains when given orally to patients in the first 48 hours of flu symptoms developing.  The earlier preliminary study (4) was very small, involving only 27 patients, but demonstrated the ability of elderberry (4 tablespoons of Sambucol® syrup per day) to reduce influenza symptoms in 20% of influenza patients within 24 hours and to reduce influenza symptoms in 75% of patients within 48 hours.  After three days of elderberry use, 90% of influenza patients experienced a total alleviation of symptoms. 

The most recent study (5) involved 60 patients aged 18-54 years who had just began (48 hours or less) to suffer from flu-like symptoms.  Participants received 15 ml of elderberry or placebo syrup four times a day for 5 days, and recorded their symptoms using a special scale.  In the participants receiving the elderberry syrup the symptoms were relieved, on average, 4 days earlier and use of rescue medication was significantly less compared those receiving placebo.  The study was small but very encouraging, the findings need to be confirmed in a larger study.

The underlying mechanism (1) for elderberry’s effectiveness in the treatment of influenza virus was discovered by an Isreili virologist, Dr Mumcuoglu.  The berry seems to be able to prevent and inhibit the replication of the influenza virus.  The active compounds within the elderberry seem to ‘coat’ or neutralise the spike-like projections that are found on the surface of several viruses, including the influenza viruses.  When these spikes are deactivated the virus is prevented from piercing the human cells, so the virus does not enter our cells and is prevented from replicating.  Unlike bacteria, a virus cannot replicate on its own, it must attack living cells in order to survive.  If the virus is prevented from entering our cells it will be unable to survive and cause us to suffer health problems.

I mentioned earlier that elderberries also possess antioxidant properties.  Antioxidants protect our cells from the damaging effects of highly reactive molecules called free radicals, which cause oxidative stress in the body.  There is mounting evidence that these destructive molecules, together with lowered antioxidant defences, play a significant role in the development and aggravation of many diseases (including cardiovascular disease and cancer to name but a few).  The body does produce its own antioxidants but also relies on vitamins, mineral and phytochemicals (bioactive plant chemical) from the diet, especially from colourful vegetables and fruits, for additional valuable supplies.

The elderberry extract, Sambucol®, is widely available in the UK as a liquid or lozenge.  The products can be taken as a preventative or at the first signs of cold or flu-like symptoms.  A healthy diet (rich in fruit and vegetables) is obviously the most important way to keep the immune system strong, healthy and effective.  However, if you are surrounded by people with colds, or worried about the ‘flu-season’ taking an elderberry extract may well give your immune system an extra boost and help you to fight off invading infections. 

(1) Sambucus nigra - monograph.  2005.  Altern Med Rev.  10(1):51-54.
(2) Barak V et al.  2001.  The effect of Sambucol® , a black elderberry-based, natural product, on the production of human cytokines:I.  Inflammatory cytokines.  Eur Cytokine Netw.  12:290-296
(3) Barak V et al.  2002.  The effect of herbal remedies on the production of human inflammatory and anti-inflammatory cytokines.  Isr Med Assoc J.  4:S919-S922
(4) Zakay-Rones Z et al.  1995.  Inhibition of several strains of influenza virus in vitro and reduction of symptoms by an elderberry extract (Sambucus nigra) during an outbreak of influenza in Panama.  Journal of Alternative and Complementary Medicine.  1(4):361-369.
(5) Zakay-Rones, Z et al.  2004.  Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections.  J Int Med Res.  32(2):132-140.

Written Ani Kowal

As I mentioned on Monday, the 12th October marks World Arthritis Day 2008.  Today I am going to cover osteoarthritis which is the most common type of arthritis.  The disease occurs due to the gradual degeneration of the cartilage which lines the joints.  This causes pain, swelling and restricted movement.  The condition most commonly affects weight bearing joints such as the hips and knees but may also attack the joints in the hands and feet.  Women are twice as likely as men to be affected and the most common form of treatment are NSAIDs, non-steroidal anti-inflammatory drugs, to relieve pain and reduce swelling/inflammation. 

For more info on osteoarthritis please visit Arthritis Care, a UK based charity for those suffering with the condition.

My intention had been to start off by reviewing some of the evidence surrounding glucosamine sulphate and chondroitin sulphate in relieving symptoms of osteoarthritis.  However the press pounced on a story earlier this week and you may have read headlines saying that dietary supplements of glucosamine and/or chondroitin fare no better than placebo in slowing the progression of knee osteoarthritis. (Oh the media do love a negative story!).  The study(1) being referred to did indeed find that neither glucosamine sulphate nor chondroitin sulphate worked to slow the loss of knee cartilage in osteoarthritis.  However, the researchers have said that some of their findings were confusing and that more study was needed before any definite conclusions could be drawn.  In addition to this it was quite a small study which can affect the statistical analysis of results, and a small sub-set group of patients (with grade 2 osteoarthritis) did appear to show a trend toward benefit from the supplements (but the benefit was not statistically/mathmatically significant) compared to placebo.  The study did not measure the effects of supplementation on pain levels, or other symptoms, in the osteoarthritis sufferers.

I am going to continue along my planned lines of mentioning glucosamine and chondroitin sulphate supplementation for osteoarthritis as there are a number of studies that do indicate that these agents may well be beneficial to sufferers of the condition.

Glucosamine sulphate is an essential building block in the manufacture of cartilage and, taken as a supplement, may reduce the pain and inflammation associated with osteoarthritis.  Several studies exist which show glucosamine to be an effective treatment for osteoarthritis(2,3,4,5). Glucosamine sulphate has also been shown to control the symptoms of osteoarthritis as well as the NSAID ibuprofen (6,7). The normal recommended dose of glucosamine sulphate is 500 mg, three times daily. Once therapeutic benefit is achieved, it is usually possible to taper down to a once or twice a day dose.

Another agent which is often used in conjunction with glucosamine sulphate is chondroitin sulphate.  Chondroitin sulphate seems to work by attracting fluid into the joint cartilage tissue. This may improve the spongy, shock-absorbing qualities of the cartilage, and may also help bring essential nutrients to the area.  Many trials have shown that supplementation with chondroitin sulphate can reduce pain, increase joint mobility and/or cause healing within the joints of osteoarthritis sufferers (8,9,10,11). The normal recommended dose of chondroitin sulphate is 400 mg, three times a day.

Glucosamine and chondroitin are very often combined together in nutritional supplements designed to enhance joint health, although it is yet uncertain whether a combination works more effectively than either agent alone.  A review(12) published this year concluded that “although the evidence is not entirely consistent, most research suggests that glucosamine sulphate can improve symptoms of pain related to osteoarthritis, as well as slow disease progression in patients with osteoarthritis of the knee. Chondroitin sulphate also appears to reduce osteoarthritis symptoms and is often combined with glucosamine, but there is no reliable evidence that the combination is more effective than either agent alone”

The evidence for other supplements aiding osteoarthritis is not strong(13) and further trials are needed however, there is indication that antioxidant vitamins such as vitamin C, E and Beta carotene, vitamins D and various B vitamins as well as omega 3 fatty acids may be involved with reducing symptoms.  To me this highlights the importance of a healthy diet rich in a variety of fruits and vegetables, to provide the body with vitamins and minerals, together with regular inclusion of oily fish to provide omega 3 fatty acids (which can act as anti-inflammatory agents in the body).

1.Sawitzke AD et al.  2008.  The Effect of Glucosamine and/or Chondroitin Sulfate on the Progression of Knee Osteoarthritis: A Report from the Glucosamine/Chondroitin Arthritis Intervention Trial. Arthritis & Rheumatism.  58:3183-3191.
2.Reginster JY et al.  2001.  Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial.  Lancet.  357:251-256.
3.Noack W et al.  1994. Glucosamine sulphate in osteoarthritis of the knee. Osteo and Cart.  2:51-59
4.Pujalte JM et al.  1980.  Double blind clinical evaluation of oral glucosamine sulphate in the basic treatment of osteoarthrosis. Curr Med Res Opin.  2:110-114
5.Dovanti A et al.  1980.  Therapeutic activity of oral glucosamine sulphate in osteoarthritis: a placebo-controlled double-blind investigation. Clinical Therapeutics.  3(4):266-272
6.Qiu GX et al.  1998.  Efficacy and safety of glucosamine sulfate versus ibuprofen in patients with knee osteoarthritis.  Arzneimittelforschung.  48:469-474
7.Muller-Fabbender H et al.  1994.  Glucosamine sulphate compared to ibuprofen in osteoarthritis of the knee.  Osteo and Cart.  2:61-69
8.Uebelhart D et al.  1998.  Effects of oral chondroitin sulfate on the progression of knee osteoarthritis: a pilot study.  Osteoarthritis Cartilage.  6(Suppl A):39-46
9.Verbruggen G et al.  1998.  Chondroitin sulfate: S/DMOAD (structure/disease modifying anti-osteoarthritis drug) in the treatment of finger joint OA.  Osteoarthritis Cartilage.  6(Supplement A):37-38
10.Bucsi L et al.  1998.  Efficacy and tolerability of oral chondroitin sulfate as a symptomatic slow-acting drug for osteoarthritis (SYSADOA) in the treatment of knee osteoarthritis.  Osteoarthritis Cartilage.  May 6, (Supplement A):31-36.
11.Leeb BF et al.  2000.  A metaanalysis of chondroitin sulfate in the treatment of osteoarthritis.  J Rheumatol.  27(1):205-11
12. Gregory PJ et al.  2008.   Dietary supplements for osteoarthritis. Am Fam Physician. 77(2):177-84.
13.  Wang Y et al.2004.  The effect of nutritional supplements on osteoarthritis.  Altern Med Rev. 9(3):275-96.

Written by Ani Kowal

Earlier this year a study was published(1) highlighting the fact that local removal of endometriosis, via key-hole surgery, was associated with good short-term outcomes but, on long-term follow-up, such procedures were often unsuccessful and there was a need for further surgeries later on.  The study authors concluded that better treatment is needed for those suffering from endometriosis.  Reading the paper led me to have a look and see if there were any natural remedies associated with an improvement in the condition.

Endometriosis is a painful disease that affects women during their reproductive years and is caused when the tissue lining the uterus starts to grow in other parts of the abdomen, outside of the uterus, such as the ovaries.  The precise mechanism for the development of endometriosis in the pelvis and abdominal cavity has not been elucidated. 

Evidence is accumulating to suggest a role for fish oils (long chain omega 3 fatty acids) in the management of endometriosis (2,3,4). Fish oils appear to reduce the inflammation associated with endometriosis.  Inflammation is mediated by a group of chemical substances in the body known as eicosanoids.  Synthesis of these inflammatory mediators can be influenced by the dietary ratio of omega-3 and omega-6 polyunsaturated fatty acids.  The eicosanoids derived from omega-3 fatty acids are far less potent inflammatory agents, hence it would seem sensible for women who suffer from endometriosis to increase their consumption of omega 3 fatty acids, found in oily fish e.g. mackerel, salmon, trout and sardines or consider taking a supplemet to provide around 250mg of EPA and 250mg DHA daily.  Studies do suggest that women afflicted with endometriosis generally have elevated levels of Leukotriene B4, a potent inflammatory chemical (5).

Very recent preliminary evidence(6) suggests that endometriosis is linked to excessive oxidative stress, and a lower level of vitamin E, an antioxidant.  This was just a small pilot study which needs follow up with larger trials.  However, another small study(7) published in March this year which found that supplementation with the antioxidant vitamins C and E was associated with a decrease in the concentration of oxidative stress markers in women with endometriosis.  The women involved were given 343mg vitamin C and 84mg vitamin E daily or a placebo.  After 4 months the supplemental group had lower levels of oxidative stress markers.

Antioxidants protect our cells from the damaging effects of highly reactive molecules called free radicals, which cause oxidative stress in the body.  There is mounting evidence that these destructive molecules, together with lowered antioxidant defences, play a significant role in the development and aggravation of many diseases.  The body does produce its own antioxidants but also relies on vitamins, mineral and phytochemicals (bioactive plant chemical) from the diet, especially from colourful vegetables and fruits, for additional valuable supplies.

Antioxidants are important for many health reasons (which I have written about in previous posts) and eating plenty of colourful fruits and vegetables daily will provide the body with many antioxidant nutrients.  A healthy diet may well be particularly important to those suffering with endometriosis.  In 2004 a study (8) was carried out in order to investigate the relationship between diet and endometriosis.  The investigation involved 504 women with confirmed endometriosis and 504 women without endometriosis.  Dietary analysis suggested that a high intake of green vegetables and fresh fruit was associated with a significantly reduced risk of endometriosis whereas a high intake of red meat and ham (processed meat) was associated with a significantly increased risk.  Such associations do not show cause but studies like this do help to highlight the importance of a healthy diet, especially the real benefits of fruits and vegetables for disease prevention.  Taking a broad-spectrum antioxidant (or multi nutrient) supplement, in addition to a healthy diet, is also an option in order to ensure good intake levels are constantly achieved. 

For more information on endometriosis please contact Endometriosis UK, a charity dedicated to supporting women with the condition, or endometriosis.org a global forum for information about endometriosis.

(1) Shakiba K et al.  2008.  Surgical Treatment of Endometriosis: A 7-Year Follow-up on the Requirement for Further Surgery. Obstet. Gynecol.  111:1285 -1292.
(2)Covens AL et al.  1988.  The effect of dietary supplementation with fish oil fatty acids on surgically induced endometriosis in the rabbit.  Fertil Steril.  49(4):698-703.
(3)Gazvani MR et al.  2001.  High omega-3:omega-6 fatty acids in culture medium reduce endometrial gland and stromal cell cultures from women with and without endometriosis.  Fertil Steril.  76:717-722
(4)Yano, Y.  1992.  Effect of dietary supplementation with eicosapentaenoic acid on surgically induced endometriosis in the rabbit.  Nippon Sanka Fujinka Gakkai Zasshi.  44(3):282-288.
(5)Pungetti D et al.  1987.  Prostanoids in peritoneal fluid of infertile women with pelvic endometriosis and PID.  Acta Eur Fertil.  18(3):189-192.
(6)Campos Petean C et al.  2008.  Lipid peroxidation and vitamin E in serum and follicular fluid of infertile women with peritoneal endometriosis submitted to controlled ovarian hyperstimulation: a pilot study.  Fertil Steril. 2008 Feb 2. [Epub ahead of print]
(7) Mier-Cabrera J et al.  2008 Effect of vitamins C and E supplementation on peripheral oxidative stress markers and pregnancy rate in women with endometriosis. Int J Gynaecol Obstet. 100:252-256
(8) Parazzini F et al.  2004.  Selected food intake and risk of endometriosis. Hum Reprod.  19:1755-1759.

Written by Ani Kowal

Coronary heart disease (CHD) is the leading cause of death in the UK, looking after our hearts is very important!  However, at recent conference(1) it was disclosed that almost half of us (48%) do not know what CHD is, recognise the symptoms or know what increases the risk.  I hope to provide a little insight here.

CHD covers two main issues, heart attack and angina (severe chest pain).  “Coronary heart disease occurs when the coronary arteries (the arteries that supply blood and oxygen to the heart muscle) become narrowed by a gradual build-up of fatty material within their walls.  This condition is called atherosclerosis and the fatty material is called atheroma.  In time, the artery may become so narrow that it cannot deliver enough oxygen containing blood to the heart muscle, particularly at times when there is more demand -such as when you are exerting yourself. The pain or discomfort that happens as a result is called angina.  If the atheroma becomes unstable, a piece may break off and lead to a blood clot forming. If the blood clot blocks the coronary artery, the heart muscle is starved of blood and oxygen and may become permanently damaged. This is known as a heart attack.”(2)

The symptoms of CHD are varied and can include: shortness of breath, palpitations/irregular heartbeat, chest pain, jaw pain, arm pain, dizziness, fainting. 

Risk factors are also varied and include: smoking, unhealthy/unbalanced diet, overweight, obesity, lack of exercise, excessive alcohol consumption, emotional/psychological stress, social isolation, diabetes and high blood pressure.  The good news is that relatively simple dietary and lifestyle changes can protect the heart.

A fantastic resource that I highly recommend is The British Heart Foundation website.  There you can read, in detail, about risk factors, dietary advice and you can also download factsheets and information booklets.  There is a section dedicated to CHD prevention, which is key, it covers diet, weight, diabetes, cholesterol, smoking, diabetes, family history, stress and counselling.

Today I just wanted to cover a few points in relation to diet and heart health.

Fruit and Vegetables
The recommendation to consume vegetables and fruit for protection from heart disease is supported by an ever-growing body of evidence.  Much evidence is drawn from studies linking higher consumption of vegetables and fruit to a lower risk of CHD (e.g. 3,4,5).  I would like to highlight one of the most recent studies(6).  The researchers found that that the benefit of fruit or vegetable consumption in reducing the risk of CHD increased proportionally by the number of servings consumed. Those consuming the most fruit (more than five portions per day) had a 60% lower risk for coronary heart disease when compared to those eating one or fewer portions per day.  Consumption of vegetables more than three times daily was associated with a 70% lower risk of CHD compared to individuals who did not eat vegetables.  Consumption of fruits and vegetables really does seem to provide significant protection against coronary heart disease!  So Tuck in! 

Vegetables and fruit are probably acting to protect against CHD through a variety of relevant substances including numerous vitamins and carotenoids, minerals, phytonutrients (bioactive plant chemicals) and fibre.  Many plausible mechanisms can explain how these various nutrients or bioactive constituents in vegetables and fruit can prevent CHD.  Try and include a variety of different vegetables and fruits in your daily diet.  Each meal can contain a portion or two e.g. chop fresh fruit, or sprinkle a handful of unsweetened dried fruit into museli or yoghurt at breakfast time, include a side salad with lunch, snack on fruit or vegetable sticks rather than cereal bars, biscuits or other refined foods and aim to include at least two types of vegetable with your evening meal.
 

Supplemental vitamins and minerals
Taking vitamin and mineral supplements should not be seen as a substitute for a healthy diet.  Supplements are void of many other substances found within fruit and vegetables which may be useful in CHD prevention such as phytochemicals (bioactive plant chemicals) and fibre.  However, there is a lot of evidence that has looked at specific nutrients in the prevention of CHD (too much evidence to list), vitamins such as the B vitamins, vitamin E and D, antioxidant vitamins such as vitamin C and many carotenoids and minerals such as magnesium and selenium may be useful protective agents.  If you feel that your diet is not rich in a variety of vegetables and fruits (at least 5 a day) you may wish to consider taking a broad-spectrum multivitamin and mineral supplement to ensure an adequate supply.  There are so many available supplements, it can be a mind-boggling experience trying to choose a product!  If you do decide to go down the supplement route I would recommend what are known as ‘food state’ multivitamin and mineral supplements.  These are easily absorbed by the body and are produced from food sources, rather than the usual chemical-isolate form of product.

Wholegrain cereals
Incorporating wholegrain foods into the diet may help to reduce the risk of CHD.  Whole grain foods (e.g. corn, barley, rye, oats & rice) in their most un-refined and natural form are rich sources of fibre, antioxidants, vitamins, minerals and phytonutrients, all of these probably act together to help protect the body against CHD.  Many studies demonstrate that the consumption of whole grain foods may help to reduce the risk of CHD (e.g. 7,8,9).  I would like to stress the importance of UN-REFINED foods.  There are many products that now advertise the fact that they are wholegrain but they may also be loaded with added sugar and have a high GI, high glycaemic index (i.e. they release sugar quickly into the bloodstream) and I certainly wouldn’t recommend their inclusion into the daily diet.  Be label savvy and look at the ingredients to see what you are buying.

Check back later this week for more heart healthy tips in Part II 

(1)British Pharmaceutical Conference 2008 http://www.bpc2008.org/
(2)British Heart Foundation http://www.bhf.org.uk/
(3) Rissanen TH et al.  2003.  Low intake of fruits, berries and vegetables is associated with excess mortality in men: the Kuopio Ischaemic Heart Disease Risk Factor (KIHD) Study.  J Nutr.  133(1):199-204.
(4) Liu S et al.  2000.  Fruit and vegetable intake and risk of cardiovascular disease: the Women's Health Study.  Am J Clin Nutr.  72(4):922-8
(5) Joshipura KJ et al.  2001.  The effect of fruit and vegetable intake on risk for coronary heart disease.  Ann Intern Med.  134(12):1106-14
(6)Nikolic M et al.  2008.  Fruit and vegetable intake and the risk for developing coronary heart disease. Cent Eur J Public Health. 16(1):17-20.
(7)Jacobs DR et al.  1999.  Is whole grain intake associated with reduced total and cause-specific death rates in older women?  The Iowa Women’s Health Study.  Am J Public Health.  89:1-8
(8)Rimm EB et al.  1996.  Vegetable, fruit and cereal fibre intake and risk of coronary heart disease among men.  JAMA.  275:447-451
(9)Liu S et al.  1999.  Whole-grain consumption and risk of coronary heart disease: results from the Nurses’ Health Study.  Am J Clin Nutr.  70:412-419

Written by Ani Kowal

Broccoli, of all things, drew me into writing about prostate problems!  It is being consistently branded as a ‘superfood’ and recently a study found that eating just a few portions of broccoli each week could really go far to protect men from prostate cancer(1).

The most common prostate problem in men over 50 years of age is benign (non harmful/cancerous) enlargement of the prostate gland, known as Benign Prostatic Hypertrophy (BPH).  This noncancerous condition tends to cause an impediment in the flow of urine and often an increased frequency of urination, especially at night.  Sometimes men also experience a difficulty in urinating or a weak flow stream. 

BPH is the most common cause of prostate enlargement, however, prostate cancer can cause similar symptoms and so it is ALWAYS important to visit a GP in the first instance before deciding to follow any natural guidance for BPH.  The good news is that BPH responds very well to nutritional approaches (any programme may take 6-8 weeks to produce results).

Today I am going to talk about BPH and prostate cancer prevention as both are linked to similar nutrients and dietary advice.  It is important to talk about prostate cancer as it is the most frequently diagnosed non-skin cancer within the male population of western countries.

Back to the broccoli!  Multiple studies have linked the eating of diets rich in fruit and vegetables to a reduced risk of prostate cancer, however the broccoli study(1) is the first human trial which investigated the mechanisms behind the positive results.  Amazingly the broccoli seemed to be switching on genes in the body which prevent cancer developing and switching off genes which usually help cancer to spread.  Broccoli is a cruciferous vegetable, as are brussel sprouts, cauliflower, cabbage, rocket, watercress and horseradish.  Cruciferous vegetables contain compounds called isothiocyanates, responsible for the bitter taste, these are likely to be providing the cancer-prevention benefit.  

Other studies have also suggested that consuming one or more portions of broccoli per week can reduce the risk of prostate cancer(2).  Different fruits and vegetables probably work through different mechanisms (for example through their anti-oxidant potential) and so providing a wide variety in the daily diet will confer the best protection to health!

One nutrient that is gaining attention for its cancer preventative prospects is Selenium.  Here in the UK many of us will not obtain much selenium from our diets because our soils are fairly deficient and so agricultural crops contain less selenium than from elsewhere in the world.  Since reducing our wheat imports from the USA our selenium intakes have dropped.  One sure fire way to provide ourselves with enough of this essential mineral is to eat Brazil nuts!  These nuggets are packed with selenium and just 5-6 a day would be beneficial!  A review paper has just been released(3) which assessed several observational and supplement studies that support a preventative effect of selenium against prostate cancer. 

Evidence suggests that selenium acts via multiple mechanisms and pathways, most-notably through its anti-oxidative and anti-inflammatory effects.  Selenium is an integral constituent of many hundreds of enzymes which work in most cells throughout the body and so it is not surprising that it shows anti-cancer potential.  Although larger-scale trials are needed it is, in my opinion, necessary that we make sure that our diets contain adequate amounts of this nutrient.  It is an essential mineral that the body cannot do without and so it seems prudent to at least provide the minimum amounts needed for health.  If you are not a regular consumer of Brazil nuts then you may wish to consider a supplement.  However, single nutrient supplements are not something that I recommend.  If you already take a multi-vitamin and mineral supplement check to see if it contains Selenium.  There is no current recommendation but many health professionals recommend at least a minimum of 35µg (micrograms) a day and no more than 200 µg a day (selenium in high doses can be toxic).  Many multivitamin-mineral supplements provide 75µg. 

Check back later in the week for part II

(1)Traka M, Gasper AV, Melchini A, Bacon JR, Needs PW, et al. Broccoli Consumption Interacts with GSTM1 to Perturb Oncogenic Signalling Pathways in the Prostate. PLoS One, 3(7): e2568 DOI: 10.1371/journal.pone.0002568
(2)Joseph MA et al.  2004.  Cruciferous vegetables, genetic polymorphisms in glutathione S-transferases M1 and T1, and prostate cancer risk.  Nutr Cancer 50:206-213
(3)Peters U & Takata Y.  2008.  Selenium and the prevention of prostate and colorectal cancer.  Mol Nutr Food Res.  Sep 2 [EPub ahead of print]

Written by Ani Kowal

Sticking to the theme of eye health I wanted to briefly write about cataracts today.  Cataracts are cloudy areas that develop in the lens of the eye, the cloudiness reduces the amount of light transmitted to the retina and this causes poor vision.  In the UK about 1 in 3 people over the age of 65 develop a cataract, which gradually forms over many years.  Initially vision may only be very mildly affected and this may not progress, however, in some individuals the vision will get worse over time. 

Treatment is an option when a cataract becomes bad enough to interfere with normal life e.g. if vision starts to interfere with reading, driving, watching TV etc or stops an individual from doing anything that they would normally do.  Before making a decision about treatment it is recommended to make sure your glasses are giving you maximum benefit.  Treatment involves the removal of the cloudy lens and replacement with an artificial plastic lens (an intraocular implant).

Cataracts seem to occur due to the breakdown and subsequent clumping of proteins in the lens.  Obviously, prevention is always better than cure!  Lifestyle factors that may increase the risk of cataract development include a poor diet low in antioxidant nutrients (found in fruits and vegetables), smoking and prolonged sunlight exposure.  Again, as with AMD, free radicals appear to play a causal role and hence dietary antioxidants may be protective.

I would like to highlight three (1,2,3) very recent research studies.  The first study(1) looked at the association between cataracts and dietary lutein and zeaxanthin, caroteinoids found in spinach, collard greens and kale.  The study involved 1802 women aged 50 to 79 years.  Women with high dietary levels of lutein and zeaxanthin had a 23% lower prevalence of cataract compared to those with low levels.  Women with the highest dietary intakes or highest blood serum levels of lutein and zeaxanthin as compared with those with the lowest were 32% less likely to have cataract.  For more information on these carotenoids and potential supplements please refer to Monday's post which looked at AMD.

The researchers involved in the second study(2) wanted to investigate the relationship between antioxidant nutrient intakes and incidence of age-related cataract over a 10 year period.  The study involved 2464 individuals (aged 49 or over at the start of the study) for 5-10 years.  Eye health was observed using lens photography and dietary intakes of various antioxidants, including zinc, beta carotene, vitamins A, C and E, was assessed.  Individuals with the highest total intake, from diet and supplements, of vitamin C had a 45% reduced risk of cataract.  An above average intake of combined antioxidants -vitamins C and E, beta-carotene, and zinc - was associated with a 49% reduced risk of cataract.  The authors of the study conclude that “Higher intakes of vitamin C or the combined intake of antioxidants had long-term protective associations against development of nuclear cataract in this older population”.

Both of these studies, as in the studies I highlighted in relation to eye health on Monday, re-iterate the importance of a diet rich in vegetables and fruits, which are fabulous sources of antioxidants.  As yet the role for supplementation in the prevention of cataract is unclear (and cannot, of course, substitute diet) but many individuals are taking multivitamin and mineral supplements to help keep their eyes, and bodies, healthy.  Future large supplementation trials are planned and I look forward to seeing the results.

The third study(3) involved around 2000 individuals aged 49 or over (at the start of a 5 year investigatory period).  The researchers found that higher dietary intakes of omega-3 polyunsaturated fatty acids were associated with a significantly reduced risk (42% compared to those with the lowest intakes) of developing cataract over 5 years.   For more information regarding omega 3 fatty acids and eye health please refer to the piece that I posted on Monday which looked at AMD.

(1)Moeller SM et al.  2008.  Associations between age-related nuclear cataract and lutein and zeaxanthin in the diet and serum in the carotenoids in the age related eye disease study, an ancillary study of the women’s health initiative.  Arch Opthalmol.  126:354-364
(2)Tan AG et al.  2008.  Antioxidant intake and the long-term incidence of age-related cataract: the blue mountains eye study.  Am J Clin Nutr.  87:1899-1905
(3)Townend BS et al.  2007.  Dietary macronutrient intake and five year incident cataract: the blue mountains eye study.  Am J Opthalmol.  143:932-939.

Written by Ani Kowal

My eyesight is something that I value very highly.  Without my spec's or contact lenses I have very limited vision.  Looking after my eyes, in order to prevent further long-sightedness in later life, is certainly high on my agenda.  Age Related Macular Degeneration (AMD) is the most common cause of blindness in people over the age of 50 in the UK and I feel that it deserves a little attention! 

The macular is the light sensitive area in the centre of the retina that controls visual field and the ability to see colours.  AMD is caused by the deterioration of the macular.  As this happens the peripheral, outer, vision remains intact as the centre field of vision becomes slowly blurry, grey or filled with a large black spot.  Two forms of AMD exists: the dry form which develops slowly, accounting for 90% of all cases; and the wet form which causes rapid deterioration of central vision.

The exact causes of AMD are unknown although free radical damage, where unstable oxygen molecules damage the eye cells, is strongly implicated.  Tobacco smoke and sun exposure can increase the level of free radicals in the body and both are a risk for AMD.  High blood pressure and diabetes are also risk factors as these conditions can limit blood flow to the eyes.

Evidence for diet and nutrition in the prevention, and to a certain extent treatment, of the condition is growing yearly.  The latest study was published in the August volume of the American Journal of Clinical Nutrition(1) and adds to the growing body of research(2,3,4,5,6,7,8) suggesting that oily fish and the long chain omega 3 fatty acids they provide, EPA and DHA (eicosapentaenoic acid and docosahexaenoic acid), may be preventative. 

This recent study(1) assessed the dietary intake data and photographic eye evidence of 105 individuals with AMD and compared it to 2170 control individuals (without any features of AMD).  All participants were aged 65 or over.  The researchers found that eating oily fish at least once per week compared with less than that was associated with a 50% reduced likelihood of having AMD.  There was no benefit from eating non-oily, white fish.  There was also a strong significant association between intake levels of DHA and EPA and AMD.  Individuals eating around 300mg or more of these fatty acids per day were 70% less likely to have AMD.  Two (75g) servings of oily fish, such as salmon, mackerel, sardines or trout, provides around 500mg of DHA and EPA 

The scientists are not yet recommending omega 3 supplements as the study did not investigate whether supplements would have the same benefit as dietary sources.  However, evidence for the potential benefits of fish oil (long chain omega 3 fatty acid) supplements is beginning to emerge, with one very recent study(5) finding that 800mg of DHA per day over 2-4 months was associated with beneficial changes in the macular. 

Omega 3 fatty acids are incredibly important for many aspects of health (and I have mentioned them throughout my blog postings).  Including at least two portions of oily fish per week is certainly recommended, however, many individuals in the UK do not achieve these intakes for various reasons.  A daily fish oil supplement providing around 250mg of EPA and 250mg DHA may be something worth considering (for general health).  For vegetarians and vegans a flaxseed oil supplement providing around 500-800mg of alpha-linolenic acid (a short chain omega 3 fatty acid which the body can convert to the longer chain forms) daily is a good way of ensuring a daily supply of these essential fats.

The other important nutrients worth discussing in relation to AMD prevention are the antioxidant carotenoids lutein and zeaxanthin, naturally found in foods such as spinach, collard greens and kale.  Research data(9,10,11,12) suggests that individuals with high dietary intakes of lutein and zeaxanthin, and high body levels of the carotenoids, have a reduced risk of developing AMD.  Supplements of these nutrients are now widely sold and targeted at eye health.  The supportive evidence for supplementation is not yet solid.  A small study(13) has shown benefit and paves the way for larger studies.  A very recent review(14) of the currently available evidence, published last month, concluded that “A definite association between lutein and zeaxanthin supplementation and clinical benefit has yet to be hown; however, it may still be an appropriate cautionary measure for patients at high risk for developing AMD”

Available ‘eye health’ supplements often contain vitamins C, E, beta carotene and the mineral zinc in addition to lutein and zeaxanthin.  The rationale behind this comes from dietary association studies and some research evidence.  If you are considering supplements remember that they are not a substitute (more of a bonus) for nutritious daily meals!  A healthy diet, rich in a variety of vegetables and fruits, will provide an array of antioxidant nutrients to keep the whole body healthy, including the eyes.

(1)Augood C et al.  2008.  Oily fish consumption, dietary docosahexaenoic acid and eicosapentaenoid acid intakes, and associations with neovascular age related macular degeneration.  American Journal of Clinical Nutrition.  88:398-406
(2)Chong EW et al.  2008.  Dietary omega-3 fatty acid and fish intake in the primary prevention of age-related macular degeneration: a systematic review and meta-analysis.  Arch Ophthalmol.  126:826-833.
(3)SanGiovanni JP et al.  2007.  The relationship of dietary lipid intake and age-related macular degeneration in a case-control study: AREDS Report No. 20.  Arch Opthalmol.  125:671-679
(4)Seddon JM et al.  2006.  Cigarette smoking, fish consumption, omega-3 fatty acid intake, and associations with age-related macular degeneration: the US Twin Study of Age-Related Macular Degeneration.  Arch Opthalmol.  124:995-1001
(5)Johnson EJ et al.  2008.  The influence of supplemental lutein and docosahexaenoic acid on serum, lipoproteins, and macular pigmentation.  Am J Clin Nutr.  87:1521-1529
(6)Cho E et al.  2001.  Prospective study of dietary fat and the risk of age-related macular degeneration.  Am J Clin Nutr.  73:209-218
(7)Seddon JM et al.  2001.  Dietary fat and risk for advanced age related macular degeneration.  Arch Opthalmol.  119:1191-1199
(8)Smith W et al.  2000.  Dietary fat and fish intake and age related maculopathy.  Arch Opthalmol.  112:222-227
(9)Seddon JM et al.  1994.  Dietary carotenoids, vitamin A, C and E and advanced age-related macular degeneration.  JAMA.  272:1413-1420
(10)Bone RA et al.  2000.  Lutein and zeaxanthin in the eyesm serum and diet of human subjects.  Experimental Eye Research.  71:239-245
(11)Bone RA et al.  2001.  Macular pigment in donor eyes with and without AMD:A case-control study.  Invest Opthalmol Vis Sci.  42:234-240
(12)Gale CR et al.  2003.  Lutein and zeaxanthin status and risk of age-related macular degeneration.  Invest Opthalmol Vis Sci.  44:2661-2465
(13)Richer S et al.  2004.  Double-masked, placebo-controlled, randomised trial of lutein and antioxidant supplementation in the intervention of atropic age related macular degeneration: the Veterans LAST study (Lutein Antioxidant Supplementation Trial).  Optometry.  75:216-230)
(14)Zhao L & Sweet BV.  2008.  Lutein and Zeaxanthin for macular degeneration.  Am J Health Syst Pharm.  65:1232-1238

Written by Ani Kowal