One of my close friends is pregnant (I am very excited)!  We were chatting about pregnancy health and the topic of preeclampsia came up.  Recently a study(1) was published which suggests that increasing the amount of fibre eaten during early pregnancy may help to reduce the risk of preeclampsia developing later.  I thought now was as good time as any to look into this complex topic further!

Preeclampsia is a serious condition also known as: pregnancy-induced hypertension (PIH); proteinuric gestational hypertension; and toxaemia of pregnancy.  It is a form of high blood pressure (hypertension) that develops in conjunction with water retention (oedema) and/or excess protein in the urine (proteinuria).  Around 3% of all pregnant women suffer from preeclampsia each year and this condition is the principal cause of maternal death in the UK.  Around 10 mothers and 1000 babies die each year as a result of the effects of preeclampsia and the condition is also the most common reason for elective (often early) delivery.  Usually preeclampsia occurs between the 20th week of Pregnancy and the end of the first week postpartum.  The earlier it presents in pregnancy the more threatening it can become.

As I began my research last week I thought this post would be relatively short.  Going back to my 2001 MSc lecture notes there was not a whole lot of dietary/nutrition related evidence to work with.  However, as I began to search through recent medical databases I was pleased and enthralled with the emergence of new information.  The definitive causes of preeclampsia are not known and there are many theories.  Nutritional factors, however, do seem to be at play. 

Keep body weight in check:
Maternal overweight and obesity places women at risk.  A BMI (body mass index) greater than 25 is seen as a risk.  To work out your BMI divide your weight in kg / by your height in metres² (height x height) or use an online BMI calculator e.g. the NHS calculator.  A recent study(2) also shows that gaining a lot of weight during pregnancy may be a risk factor.  This study looked at 34,143 women age 18-34 who were already overweight at the start of their pregnancies.  Gaining more than 15lb during pregnancy was a significant risk factor for the development of preeclampsia and gaining more than 25lb increased the risk further.  The lowest risk of adverse outcomes was for women who gained 6-14lb.

Dietary fibre:
The study(1) mentioned in my opening paragraph was carried out because evidence already exists for the beneficial effects of fibre in reducing hypertension (high blood pressure).  1538 pregnant women were involved in the study and their dietary intake was assessed 3 months before and during early pregnancy.  Women with the highest dietary fibre intake (more than 21g/day) had a significantly reduced risk of preeclampsia when compared to women with the lowest dietary fibre intake (less than 12g/day).  These are important findings, as I have mentioned in previous blog posts the average intake of fibre in the UK is low (around only 12g/day).  The recommended daily intake is currently set at 18g/day in the UK, however for optimal health many experts regard at least 25g/day as necessary. 

This most recent study adds weight to earlier evidence(3) which also found that fibre was associated with a significantly reduced risk of preeclampsia.  The researchers also found that potassium intake was a significant protective factor (I will be discussing potassium intake a blood pressure further on Thursday).  This evidence was interesting as it mentioned specific foodstuffs, with fruits and vegetables being associated with a reduced risk of preeclampsia development (unsurprisingly since vegetables and fruits are great sources of fibre and potassium).

Fruits, Vegetables and Antioxidant Vitamins:
You may be sick of my constant mentioning of vegetables and fruits?!  Well, they really are vitally important to health and I will be writing about them as often as possible!  As indicated above these super foods provide the body with fibre and are fantastic sources of potassium.  In addition to this they are packed full of vitamins, minerals and flavonoids (bioactive plant compounds).  Many of these plant nutrients act as antioxidants in the body.

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

Dietary antioxidants and supplemental vitamin C and E(4,5), lycopene(6), selenium(7,8) and  multivitamins(9) all appear to have some protective role to play against the development of preeclampsia, although the evidence for supplements is not yet conclusive and further large trials are needed.  The evidence to date certainly seems to suggest an important role for fruit and vegetable consumption during pregnancy, a variety of colourful vegetables and fruits will provide a whole array of vital nutrients to the body.  Selenium is not as widely available in the UK diet, although Brazil nuts are a terrific source. 

In addition to diet you may wish to discuss taking a pregnancy safe multi-vitamin and mineral supplement with your GP, midwife or health professional.

Omega 3 Essential Fatty Acids:
Recent evidence suggests that women with preeclampsia have reduced levels of essential omega 3 fatty acids in their blood(9,10).  Omega 3 fatty acids are vital for the efficient functioning of the immune system.  A lack, or imbalance, of these fatty acids is associated with inflammation in the body.  Inflammatory chemicals (cytokines) have been implicated in the development of and risk for preeclampsia.  Omega 3 fatty acids are essential for optimal foetal development (and are especially important in brain and immune development) and it is important to ensure a regular supply during pregnancy.  I have spoken about these fats extensively in previous posts.  Good dietary sources are oily fish (salmon, trout, mackerel, sardines) and flaxseeds or walnuts for vegetarians/vegans.  Many people in the UK do not eat these foods regularly.  Speaking to your GP or midwife about an omega 3 supplement, a fish oil (providing about 250mg EPA and 250mg DHA per day) or flaxseed oil may be prudent to ensure adequate levels throughout pregnancy and beyond.

At the moment the evidence is preliminary and needs backing up by large, well designed trials and further research.  Personally, I feel that the take home message is that being a normal weight (BMI 19-24), being physically active and having a healthy, nourishing diet rich in fruits, vegetables and essential fats may be protective.....great advice for good health for all of us then!

(1) Qiu et al.  2008.  Dietary fibre intake in early pregnancy and risk of subsequent preeclampsia.  American Journal of Hypertension.  21:903-909 [EPub doi:10.1038/ajh.2008.209 17 July]
(2) Langford A et al.  2008.  Does Gestational Weight Gain Affect the Risk of Adverse Maternal and Infant Outcomes in Overweight Women?  Matern Child Health J.  [Epub ahead of print]
(3) Frederick, I. O., et al.  Dietary fiber, potassium, magnesium and calcium in relation to the risk of preeclampsia.  J Reprod Med.  50(5):332-344, 2005.
(4)Chappell LC et al.  1999.  Effects of antioxidants on the occurrence of preeclampsia in women at increased risk: a randomised trial.  The Lancet.  354:810-816
(5)Chappell  LC et al.  2002.  Vitamin C and E supplementation in women at risk of preeclampsia is associated with changes in indicies of oxidative stress and placental function.  Am J Obstet Gynecol.  187:777-784
(6)Sharma JB et al.  2003.  Effect of lycopene on preeclampsia and intra-uterine growth retardation in primigravids.  Int J Gynaecol Obstet.  81:257-262
(7)Han L & Zhou SM.  1994.  Selenium supplement in the prevention of pregnancy induced hypertension.  Chin Med J.  107:870-871
(8)Rayman et al.  2003.  Low selenium status is associated with the occurrence of the pregnancy disease preeclampsia in women from the United Kingdom.  Am J Obstet Gynecol.  189:1343-1349
(9) Bodnar LM et al.  2006.  Periconceptional multivitamin use reduces the risk of preeclampsia.  Am J Epidemiol.  164:470-477
(10) C et al.  2006.  Erythrocyte omega-3 and omega-6 polyunsaturated fatty acids and preeclampsia risk in Peruvian women.  Arch Gynecol Obstet.  274:97-103
(11)Mehendale S et al.  2008.  Fatty acids, antioxidants, and oxidative stress in pre-eclampsia.  Int J Gynaecol Obstet.  100:134-238

Written by Ani Kowal

Almonds are my one of my favourite snacks, I love the way their crunch turns to creaminess after a bit of chewing!  I learned something new this weekend, Almonds (botanical name Prunus amygdalus dulcis) are actually fruits.  They are not botanically classified as Nuts but are considered so for commercial and culinary purposes. 

A recent study(1) has found that almonds may act as prebiotics, a food source that promotes the growth of ‘friendly’ gut bacteria in our digestive systems.  The research was carried out by the Institute of Food Research which found that ground almonds stimulated the growth of beneficial bacteria in a model gut system.  The fat portion of the almonds seemed to be the most important component for the growth of the good bacteria.  Studies in human volunteers will, no doubt, take place in the future.  Prebiotics may be important not only for the optimal health of the digestive system but also for the health of the immune system and hence our ability to ward off infections (I have mentioned this in previous posts).

Reading this research reminded me of all the other benefits of almond-eating!  Almonds have been shown to have cholesterol lowering effects and may also protect against type 2 diabetes and heart disease.  In addition to this they have antioxidant potential and are a good source of vitamin E, fibre, calcium, magnesium and monounsaturated fatty acids.

A study published in 2004(2) found that adding almonds to our usual daily diets can produce favourable nutrient changes without any additional dietary advice or modification.  The study evaluated the impact of long-term almond supplementation on the nutritional intake and diet quality in 43 healthy men and 38 women aged 25-70 years. The participants were followed for 1 year. During the first 6 months, individuals were simply asked to follow their usual diets; in the second 6 months, they were asked to add almonds to their diets (about 50g per day, an average of 42 almonds). Their nutrient intakes were assessed seven times during each 6 month diet period.

When the study participants changed from their usual diet to the almond-supplemented diet, their intakes of healthy, mono- and poly- unsaturated, fats significantly increased by 42% and 24% respectively, fibre by 12%, vegetable protein by 19%, vitamin E by 66% and Magnesium by 23%; their intakes of trans fatty acids (not very healthy for the body), salt, cholesterol and sugars significantly decreased by 14, 21, 17 and 13% respectively. These were spontaneous nutrient changes (not caused by nutritional/dietary advice or literature) that closely match the dietary recommendations given to prevent cardiovascular and other chronic diseases.  The study highlights that something as simple as adding a handful of almonds for a healthy daily snack to an individual’s routine diet can induce favourable nutrient modifications for chronic disease prevention.

Before you throw your hands up in horror and say “but Ani, I can’t possibly eat nuts on a daily basis because of the calorie content and the impact on my weight” I ask you to please read on!  Nuts have a stabilising effect on blood sugar levels and may therefore help prevent sugar cravings, hunger-pangs and mid-afternoon energy slumps.  The fibre content may also help to keep you feeling fuller for longer.  Almonds can replace other common snacks such as crisps or ‘cereal bars’ which are refined foods and certainly not as nutritious.  In addition to this, studies have shown that including nuts in your daily diet will not cause you to pile on the pounds.  A study published in 2003(3) found that almonds may also be useful in weight-reduction programmes:

The study scientists wanted to evaluate the effect of an almond-enriched, or complex carbohydrate-enriched, low-calorie diet in a weight reduction program.  The study ran for 24-weeks and included a total of 65 overweight and obese adults age 27-79.  The almond group ate 84g of almonds per day as part of their diet.  Overall their daily nutrient intake was 39% total fat (25% monounsaturated fatty acids), and 32% carbohydrate (as percent of dietary energy).  The other group ate a complex carbohydrate, low fat diet comprising 18% total fat (5% monounsaturated fatty acids), and 53% carbohydrate.  Both diets had the same calorie and protein content.

Those on the almond supplemented diet, in contrast to complex carbohydrates, had greater sustained, reductions in weight, waist circumference, body fat mass and blood pressure.  Both groups saw a reduction in symptoms characteristic of type 2 diabetes and metabolic syndrome (e.g. glucose levels, blood pressure, cholesterol, triglycerides, and insulin resistance), however among subjects with diagnosed type 2 diabetes, diabetes medication reductions were sustained or further reduced in a greater proportion of the almond group as compared to the carbohydrate group. 

As my final offering I would like to cite a study that took place in 2002(4).  In this study 81 individuals (male and female) ate around 50g almonds (about 320 calories) a day for six months following a period of six months of eating their normal daily diets.  The participants received no additional dietary advice.  During the year the body weight and normal exercise habits of the individuals was evaluated.  During the almond feeding period, average body weight was not statistically or biologically increased.  There was a positive increase in the unsaturated:saturated dietary fat ratio (a good ratio change!).  The authors estimate that there was a natural energy compensation ie the extra energy from almonds was naturally displaced by an unconscious reduction in consumption of other foods (perhaps snacking stopped or consumption of sugary or refined foods declined).

Go ahead, try snacking on something different and health-full today, eat a few almonds (be sure that they are unsalted, un-blanched and with their skins still on)!

(1) Mandalari, C. Nueno-Palop, G. Bisignano, M. S.J. Wickham, and A. Narbad.  2008.  Investigation of the potential prebiotic properties of almond (Amygdalus communis L.) seeds  Appl. Envir. Microbiol. 2008 : [E-pub ahead of print 00739-08v1] 
(2) Jaceldo-Siegl K, Sabaté J, Rajaram S, Fraser GE. 2004.  Long-term almond supplementation without advice on food replacement induces favourable nutrient modifications to the habitual diets of free-living individuals. Br J Nutr.  92(3):533-40.
(3) Wien MA, Sabaté JM, Iklé DN, Cole SE, Kandeel FR. 2003.  Almonds vs complex carbohydrates in a weight reduction program. Int J Obes Relat Metab Disord. 27(11):1365-72.
(4) Fraser GE.  2002.  Effect on body weight of a free 76 Kilojoule (320 calorie) daily supplement of almonds for six months.  J Am Coll Nutr.  21(3):275-83
(5) Institute of Food Research press release

Written by Ani Kowal

As I was tucking into my lunch yesterday I was taken by just how tasty the chickpeas were!  Munching on the little gems got me thinking about their nutritional value and their potential benefits to our health.

These ‘legumes’ go by many names: Chickpea, Ceci Bean, Indian Pea, Egyptian Pea, Garbanzo Bean and Gram and are mainly grown in the Mediterranean, Indian subcontinent and western Asia where they form a major part of the diet.  I was interested to learn that they are thought to be one of the earliest vegetables cultivated by humans.

Chickpeas are a useful source of fibre, zinc, folate and protein.  Being ever curious I hit the medical journals to see if there were any chickpea-specific studies.  I was in luck, one small study(1) has been published this month.  The authors wanted to assess the impact that incorporating chickpeas into the diet of 45 adults would have on their health.  The individuals taking part consumed about 728g of canned, drained chickpeas per week, (if you break this down to 100g per day it doesn’t sound like such a huge amount!), for 12 weeks.  After this time the participants went back to eating their normal diet for 4 weeks. 

In the ‘chickpea phase’ they ate around 7g more fibre a day (this is significant, as the UK population generally do not consume enough fibre) than they did during the ‘normal phase’.  They also had a lower saturated fat: polyunsaturated fat ratio.  Interestingly during the ‘chickpea phase the participants had significantly lowered total cholesterol and LDL cholesterol levels, low density lipoprotein cholesterol, thought to be the ‘bad guy’ cholesterol linked to heart disease, and also had better markers for blood sugar control (they showed lower fasting insulin levels and lower insulin resistance).  Analysis by the scientists revealed that it was the dietary fibre content of the chickpeas that was having the greatest effect on these health indicators.  The authors comment that their results warrant larger studies in groups who have problems with high cholesterol levels and/or poor blood sugar control (such as individuals with type II diabetes or insulin-resistance syndrome).

Another small study that was published in 2006(2) showed similar benefits of including chickpeas in the diet.  The study compared the effects of a chickpea-supplemented diet to those of a wheat-supplemented diet on cholesterol levels.  The 47 participants ate a chickpea-supplemented diet for at least 5 weeks and then a wheat-supplemented diet for at least 5 weeks.  The serum total cholesterol and LDL cholesterol levels were significantly lower after the chickpea-supplemented diet as compared with the wheat-supplemented diet.

A diet that is high in fibre has been linked to numerous health benefits in most areas of the body from the: heart, where it seems to have positive effects on blood pressure and risk of heart disease; digestive system where it seems to be useful to sufferers of irritable bowel syndrome (IBS), constipation and diverticulitis and the immune system where there seems to be a link with reduced risk of cancer.  A high fibre diet also appears to be very useful in blood sugar control and also appetite control as it gives us the feeling of fullness and helps to control satiety.  The recommended daily intake for fibre in the UK is currently set at 18g/d, however for optimal health many experts regard at least 25g per day as necessary.  In the UK our average intake is low at only 12g/d.

Chickpeas can be easily incorporated into salads, curries, dips (e.g. hummus), veggie-burgers, casseroles and stews....the list is endless.  If you are using canned chickpeas (which are very convenient and still nutritious) go for those in water with no added salt or sugar.

(1)Pittaway JK, Robertson IK, Ball MJ.  2008.  Chickpeas may influence Fatty Acid and fiber intake in an ad libitum diet, leading to small improvements in serum lipid profile and glycemic control.  J Am Diet Assoc. 108:1009-13.
(2) Pittaway JK, Ahuja KD, Cehun M, Chronopoulos A, Robertson IK, Nestel PJ, Ball MJ.  2006.  Dietary supplementation with chickpeas for at least 5 weeks results in small but significant reductions in serum total and low-density lipoprotein cholesterols in adult women and men.  Ann Nutr Metab.  50(6):512-8.

Written by Ani Kowal