Nutrition and eating for the brain and mental health are topics I have written about regularly here.  Our mood can have powerful influences on many aspects of life and eating for a healthy body naturally impacts the brain.  A recently published study (1) highlights the importance of eating for mental health by demonstrating that there is an association between diet quality and the prevalence of mental disorders in women.  The study is preliminary and certainly warrants further investigative trials but the data is important to note.

The study authors wanted to examine the extent to which the high prevalence of mood disorders are related to diet/eating habits.  The research involved 1,046 women between the ages of 20 and 93 who were randomly selected.  A diet quality score was devised and the habitual eating patterns of the women were analysed.  The women also underwent a specialised questionnaire and clinical interview to assess their psychological health.  Current depressive and anxiety disorders were recorded.  The researchers found that a traditional western diet which includes processed/fried foods, refined grains, sugary products and beer was associated with anxiety and depression.  The results were not confounded by age, education or a variety of other behaviours, indicating that diet was having a very real impact on mood (1).

Eating a ‘traditional western diet’ was associated with more than a 50% increased likelihood for depressive disorders in the women involved in the study.  Depression and anxiety disorders were around 30% less likely among women who ate a healthier diet which consisted mainly of vegetables, fruits, fish and unrefined wholegrains (1) 

The authors suggest that further investigations are needed to determine whether unhealthy eating leads to declining mental health or whether declining mental health leads to unhealthier eating.  It is probable that these events are not mutually exclusive.  Feeling good often means that a better quality diet is eaten, self-esteem is high and we tend to look after our bodies and feed them healthfull foods.  Feeling ‘low’ may lead to lowered self-esteem and poorer quality food choices at a time when high quality foods would probably make a difference to mind and body.

As my previous posts relating to mood and mental health aim to highlight, a healthy diet and lifestyle which includes some regular exercise really can go far in impacting mental health.  Diets rich in vegetables, fruit, unrefined meats, fish, and wholegrains are a good basis health.  Omega 3 fats from oily fish and/or supplements seem particularly important for the brain and mood elevation.

(1) Jacka FN et al.  2010.  Association of Western and Traditional Diets With Depression and Anxiety in Women.  Am J Psychiatry (published online January 4, 2010; doi:10.1176/appi.ajp.2009.09060881)

Written by Ani Kowal

Heart disease is a topic I have written extensively about here in these blog posts.  In 2008 I wrote two posts entitled 'Do you know how to look after your heart' part 1 and part 2.  In part two I wrote extensively about refined carbohydrates and blood sugar levels and how these appear to be a greater risk for heart disease than dietary fat.  Eating a diet loaded with foods with a high glycaemic index or high glycaemic load has been increasingly linked with a raised risk for heart disease and other health problems.  High glycaemic index foods (foods that release sugar quickly into the body) include most refined carbohydrates like white bread, long-grain rice, sweets, biscuits, sugary foods and many other processed carbohydrates and processed foods. 

By contrast certain types of fat, especially the long chain omega 3 fatty acids (EPA and DHA) from marine sources have been linked to a reduced risk of heart disease.  Many studies have also found that there is not enough evidence to link heart disease to saturated fat or total fat intakes (e.g.1).  I feel quite strongly that the push to eat ultra low fat diets over the last 50 years has impacted negatively on our health (and mood) since it has often led to diets rich in carbohydrates, especially refined carbohydrates.  Look at a low fat yoghurt for instance, the natural fat is removed and, often, replaced with copious quantities of sugar.  Low fat products in general are often full of sugars.  Actually I think the low fat campaigns have been a BIG FAT LIE.

This month in the American Journal of Clinical Nutrition fat is mentioned in a number of studies (e.g. 2,3,4,5).  In a commentary (2) authors point out that “An independent association of saturated fat intake with CVD [cardiovascular disease] risk has not been consistently shown in prospective epidemiologic studies”, the authors also point out that if saturated fat is removed from the diet and then replaced with a higher carbohydrate intake, particularly a higher intake of refined carbohydrates, this is associated with an increased risk of heart disease – specifically a high carbohydrate diet is associated with increasing problems such as insulin resistance, increased triglycerides (blood fats associated with heart disease), increased levels of a particularly destructive type of cholesterol known as small dense LDL cholesterol.  The authors also note that high carbohydrate diets are also linked to a reduced level of HDL ‘good’ cholesterol (2).  They conclude that “there are few epidemiologic or clinical trial data to support a benefit of replacing saturated fat with carbohydrate” and “dietary efforts to improve the increasing burden of CVD risk associated with atherogenic dyslipidemia [blood fat disorder linked to health problems] should primarily emphasize the limitation of refined carbohydrate intakes and a reduction in excess adiposity [body fat]”.

A research paper (3) looking at data on saturated fat and cardiovascular disease (which includes coronary heart disease and stroke) evaluated 21 scientific studies which in total involved over 340,000 individuals followed for 5-23 years showed that “there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD [coronary heart disease] or CVD [cardiovascular disease]”.

Two other studies in the March issue of the American Journal of Clinical Nutrition (4,5) looked at the positive health benefits of the long chain omega 3 fatty acids, EPA and DHA, found in oily fish such as mackerel, trout, salmon and sardines.  In the first study (4) scientists show that supplementation with these fatty acids are beneficial in improving blood vessel function in individuals with type 2 diabetes.  In the second study (5) high intakes of EPA and DHA were associated with greatly reducing chronic disease risk. 
 

I am not advocating eating a diet that is packed with saturated fat, not in the slightest, personally I feel that the take home message from studies such as these is that a healthy diet, based around natural unprocessed and unrefined foods, is crucially important to prevent disease risk.  Any health-full diet will be rich in plant foods such as vegetables, fruits, beans and pulses, nuts and seeds and will include unprocessed meats and fish (especially oily fish), wholegrain unprocessed and unrefined carbohydrates.  Particularly I feel that omega 3 fats are important to health.  In a press release (6) the lead author of a study looking into heart disease and diet (7) said: "This isn't just hype; we now have tremendous and compelling evidence from very large studies, some dating back 20 and 30 years, that demonstrate the protective benefits of omega-3 fish oil in multiple aspects of preventive cardiology".  I also feel that refined carbohydrates are generally unnecessary and quite probably damaging to health when eaten regularly and consistently.

If you do not regularly, at least twice a week, eat oily fish then it would certainly be worth taking a fish oil supplement in order to provide your body with the essential omega 3 fatty acids.  For vegetarians and vegans a flaxseed oil supplement will provide the short chain omega 3 fatty acid, alpha linolenic acid.  Unfortunately the body is not very good at converting this into the long chain EPA and DHA forms that are crucial for health.  New vegetarian and vegan EPA and DHA supplements, made from algae, are becoming increasingly available and are worth looking in to.

(1)Mente A et al.  2009. A Systematic Review of the Evidence Supporting a Causal Link Between Dietary Factors and Coronary Heart Disease.  Arch Intern Med. 169(7):659-669.
(2) Patty W Siri-Tarino PW et al.  2010.  Saturated fat, carbohydrate, and cardiovascular disease.  American Journal of Clinical Nutrition.  91: 502-509
(3) Patty W Siri-Tarino PW et al.  2010.   Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease.   American Journal of Clinical Nutrition.  91: 535-546
(4)Stirban A et al.  2010.  Effects of n–3 fatty acids on macro- and microvascular function in subjects with type 2 diabetes mellitus.  American Journal of Clinical Nutrition.  91:808-813
(5)Makhoul Z et al.  2010.  Associations of very high intakes of eicosapentaenoic and docosahexaenoic acids with biomarkers of chronic disease risk among Yup'ik Eskimos.  American Journal of Clinical Nutrition.  91:777-785
(6) http://www.sciencedaily.com/releases/2009/08/090803173250.htm.  American College of Cardiology (2009, August 3). Mounting Evidence Of Fish Oil's Heart Health Benefits. ScienceDaily. Retrieved August 4, 2009, from http://www.sciencedaily.com¬ /releases/2009/08/090803173250.htm
(7)Lavie CJ et al.  2009.  Omega-3 Polyunsaturated Fatty Acids and Cardiovascular Diseases.  J Am Coll Cardiol, 2009; 54:585-594
Written by Ani Kowal

Tomorrow many of us will be celebrating the New Year and perhaps reflecting on the year past and the year to come.  Resolutions (I wrote about achievable resolutions last year) are often thought out and set at this time.  When it comes to health we often look for quick fixes that are, quite honestly, unachievable – we set ourselves up for a fall.

A study due for publication next month(1), written by two psychologists from the United States, has found that individuals who make long-term plans and set-long term goals and focus on future rewards rather than instant gratification or immediate payoffs are more likely to make better, more positive decisions when it comes to their health.

The study (1) looked at many parameters for health from reducing alcohol intake to diet, regular exercise, breakfast eating and smoking.  The psychologists analysed over 450 people using three different validated questionnaires and health scales.  They were asked various questions related to their health behaviours as well as being asked to rate the extent to which they agreed or disagreed with specific statements like “I am willing to sacrifice my immediate happiness or well-being in order to achieve future outcomes”.  The results suggest that individuals who are more willing to pick later, larger rewards (i.e. future-minded individuals) are more likely to exercise more regularly, eat more healthily and drink less alcohol.

I think that the important message here is to make sure that when you set a health goal it is achievable and that you can clearly see that there will be a reward at the end.  If, for instance, you are struggling to lose weight or you have a lot of weight to shed (more than a stone for example) I think it is important not to let go of the fact that you are aiming for long-term, slow and sustainable weight loss.  Set a realistic 3 month, 6month, 9month and 12 month goal.  If it is weight loss that you are looking at then aim to lose around 2lb a week maximum and see that as a really positive step.  Focus on eating a healthy, balanced diet that is not too restrictive, allow yourself to eat what you enjoy on occasion.  If we over-restrict ourselves we are more likely to then have a total-blow out at some point which can leave us feeling dejected and like failures.

A good way to think about long term goals is to remember that making small, sustainable changes each day can add up – in a way it feels like you are doing very little but after 3 months or 6 months you get to see great results!

A few long term health ideas (for more ideas why not scan through a few of the posts on this blog):
*Exercise for 20minutes each day – that could be a power walk, an energetic dance whilst listening to your favourite radio station, a run, a fitness DVD, a swim or any other activity that gets you moving
*Eat at least 5 portions of vegetables and fruits daily – this isn’t a difficult one, with careful planning you can reach 5 and beyond a.g.  Grate an apple or chop a banana into your morning porridge, eat fruit or vegetable sticks for snacks, always have a mixed side salad with lunch and have at least 2 different types of vegetables with your evening meal
*Get enough omega 3 fatty acids.  Eat at least two portions of oily fish per week e.g. salmon, trout, mackerel or sardines.  For vegetarians it is important to get omega 3 fats into the diet, walnuts and flaxseeds are good sources.  Many people in the UK do not reach recommended levels of this vital type of fat, you may wish to consider a daily fish oil supplement to provide at least 250mg EPA and 250mg DHA a day or a flaxseed oil supplement to provide around 1000mg alpha-linolenic acid daily.  Vegan EPA/DHA supplements made from algae are becoming increasingly common too.
*Eat nuts and seeds – these are a great snack, rich in magnesium, zinc, calcium and other minerals as well as healthy fats and proteins.  Contrary to popular belief they are not fattening, 25-35g a day could help fill you up between means and keep hunger at bay.
*Include a source of protein with every meal – this helps to regulate blood sugar levels which can help reduce hunger, cravings and lethargy.  Good sources include eggs, beans/pulses/lentils, lean and unprocessed meats/fish
*Choose wholegrain, unprocessed varieties of grains, such as rice, millet, quinoa, pasta etc
*Minimise your consumption or processed and refined foods – these are often high in salt, sugar and unhealthy fats.

(1)Daugherty JR & Brase GL.  2010.  Taking time to be healthy: Predicting health behaviors with delay discounting and time perspective.  Personality and Individual Differences.  48:202-207
Written by Ani Kowal

Nutrition research studies that extol the virtues of healthy foods, healthy eating and healthy lifestyles are published daily, the number of blog posts listed here is testament to that.  What we eat can affect every aspect of our body and every organ system from the brain to the liver and beyond.  Eating healthily is an important way to prevent many health conditions from cancer to osteoporosis.  Fuelling our body well is truly vital for healthy living!

A recent study (1) has found that eating healthily can prevent kidney stone formation.  Kidney stones are quite common.  The NHS website (2) states that in the UK kidney stones affect around three in 20 men and 1 in 20 women.  Kidneys work by removing waste products from the blood.  The waste products are usually dissolved in the fluids that form urine but, occasionally, they can form crystals that collect around the inside of the kidney. The crystals may gather over time to form a hard stone-like lump. This is a kidney stone.  After a kidney stone has formed, it will often travel through the urinary system as it tries to be passed in urine. However, it is fairly common for a stone to block part of the urinary system, such as the ureter or the urethra (the tube that carries urine from the bladder to the outside of the body). If this happens, severe pain may be experienced in the abdomen or groin. A blockage in the urinary system can also lead to infection or more serious problems (2)

The study (1), mentioned above, looked at the link between a healthy diet, specifically a diet known as the DASH diet (The impact of the Dietary Approaches to Stop Hypertension) and incidence of kidney stones.  The researchers examined data from three very large cohort studies:

1.Health Professionals Follow-up Study – which involved 45,821 men who were followed for  18 years. 

2. Nurses’ Health Study I – which involved 94,108 older women again with an 18 year follow-up.

3. Nurses’ Health Study II – which involved 101,837 younger women with a 14 year follow-up.
 

The diets of the individuals were scored on eight components:
1. high intake of fruits
2. high intake of vegetables
3. high intake of nuts and legumes
4. high intake of low-fat dairy products
5. high intake of whole grains
6. low intake of sodium,
7. low intake of sweetened beverages
8. low intake of red and processed meats.

Over a combined 50 yr of follow-up, 5645 incidences of kidney stones were recorded.

Participants with higher DASH scores had higher intakes of calcium, potassium, magnesium, oxalate, and vitamin C and had lower intakes of sodium (salt) than those with low scores.  Those participants with the highest DASH scores were between 40-45% less likely to develop kidney stones than those participants with the lowest DASH scores – these results were independent of age, body size, fluid intake, and other factors.  The authors of the study conclude that “consumption of a DASH-style diet is associated with a marked decrease in kidney stone risk” (1).

Eating plenty of fruits, vegetables, nuts, low-fat dairy products, and whole grains, while limiting salt, red and processed meats, and sweetened beverages may well be an effective way to ward off kidney stones, but also represents great general advice!  Kidney stones are linked to higher rates of high blood pressure (hypertension), diabetes, overweight, and other risk factors for heart disease, so the findings could have considerable health implications.  Small conscious steps toward healthy living, like adding an extra portion of vegetables to your day, can soon add up. 

(1) Eric N. Taylor EN et al.  2009.   DASH-Style Diet Associates with Reduced Risk for Kidney Stones.  Journal of the American Society of Nephrology Published ahead of print on August 13, 2009.  doi: 10.1681/ASN.2009030276
(2)NHS: http://www.nhs.uk/Conditions/Kidney-stones/Pages/Introduction.aspx?url=Pages/Whatisit.aspx 

Written by Ani Kowal

Following a healthy eating regimen during pregnancy is highly important for the health of both mother and unborn child.  A recent study (1) has emphasised that it is important for pregnant women to include plenty of vegetables as part of their diet.  The study found that daily vegetable consumption by pregnant women was associated with a reduced risk of type I diabetes (insulin dependent diabetes) in their children.

The study (1) assessed and followed 5724 infants and looked at the diet their mothers consumed during pregnancy.  The children were given assessments at age 1, 2.5 and 5 years of age for diagnosis of type 1 diabetes (insulin dependent diabetes).  Low daily consumption of vegetables by the pregnant mother (vegetables were eaten 3-5times per week) was associated to an increased risk of type 1 diabetes in the child when compared to a higher vegetable consumption during pregnancy.

In essence the study found that pregnant women who eat vegetables (at least once) every day seem to have children who are less likely to develop type 1 diabetes.  This is only an association study and does not prove that vegetables protect against diabetes but it is informative and further supports the importance of eating well during pregnancy.  In a press release (2) one of the study researchers commented "This is the first study to show a link between vegetable intake during pregnancy and the risk of the child subsequently developing type 1 diabetes, but more studies of various kinds will be needed before we can say anything definitive,"  "We cannot say with certainty on the basis of this study that it's the vegetables themselves that have this protective effect, but other factors related to vegetable intake, such as the mother's standard of education, do not seem to explain the link," "Nor can this protection be explained by other measured dietary factors or other known risk factors."  It therefore seems plausible that the myriad of nutrients and flavonoids in vegetables are having some kind of action within the growing foetus.

My interest in nutrition prior to, and during, pregnancy started when I was studying for my first degree.  We learned about the work of David Barker who was a researcher at Southampton University.  His hypothesis, which was known as ‘Barker’s hypothesis’ at the time, suggests that maternal diet affects foetal growth and is associated with chronic conditions in the child later in life.  It is suggested that what a pregnant mother consumes during pregnancy might affect the risk of her child developing conditions such as heart disease, stroke and diabetes (3).  This idea is now more widely known as the ‘Developmental Origins of Adult Health and Disease’ hypothesis.  Both over- and under- nutrition and eating during pregnancy can affect the growth and later health, and perhaps weight, of the child (4).  It is important to remember that what you eat during pregnancy not only affects you, the mother, it may also affect the health of the next generation and may directly contribute to cycles of obesity as well as other conditions (4)

As I have mentioned in previous posts relating to pregnancy, if you are pregnant you may wish to consider taking a multi-nutrient supplement specifically designed for pregnant women together with a fish oil (or flaxseed oil) supplement to provide omega 3 fatty acids.  Taking these sorts of supplements may help to make-up for any shortfalls in the diet but cannot be viewed as an alternative to a healthy diet.  Always check with your doctor of health professional before taking any supplements during pregnancy.

(1)Brekke et al.  2009.  Daily vegetable intake during pregnancy negatively associated to islet autoimmunity in the offspring-The ABIS study. Pediatric Diabetes, 2009; DOI: 10.1111/j.1399-5448.2009.00563.x Published Online: 16 Sep 2009
(2) University of Gothenburg (2009, October 27). Vegetables Can Protect Unborn Child Against Diabetes. ScienceDaily. Retrieved October 28, 2009, from http://www.sciencedaily.com/releases/2009/10/091027132422.htm
(3) Barker, D.J.P. (1997). "Maternal Nutrition, Fetal Nutrition, and Disease in Later Life". Nutrition, '13', pg. 807
(4)McMillen C et al.  2009.  Developmental Origins of Adult Health and Disease: The Role of Periconceptional and Foetal Nutrition.  Basic & Clinical Pharmacology & Toxicology.
102 (2): 82 – 89
Written by Ani Kowal

On Monday I wrote about omega 3 fats and how they are important for brain function and in protecting against and treating depression.  Today I wanted to look at a UK study which has just been published in the British Journal of Psychiatry (1).

The study authors (1) wanted to examine the association between overall dietary patterns and depression.  Data from over 3000 participants aged around 55 years was analysed.  Two main dietary patterns were found in the participants.  A ‘whole food’ pattern which was high in vegetables, fruit and fish and a ‘processed food’ pattern which was high in sweetened desserts, friend foods, processed meats, refined grains and high-fat dairy products.  Self reported depression was assessed in the study participants 5 years after the initial dietary analysis.  A special reputable scale, called the Center for Epidemiologic Studies – Depression (CES–D) scale, was used to make the assessment.  The study showed that participants who adhered most strongly to the ‘whole food’ pattern of eating had a significantly lower risk of depression.  Those individuals with the highest consumption of processed foods had the highest risk of depression.  The authors conclude “In middle-aged participants, a processed food dietary pattern is a risk factor for CES–D depression 5 years later, whereas a whole food pattern is protective”.(1)

The study is interesting as it looks at diet as a whole rather than individual nutrients or components.  The study shows that eating healthily and including a high proportion of vegetables, fruits and fish is associated with protection against depression in middle-age.  Processed and refined foods can not only damage our health they also seem to impact our mood.   Specifically, the researchers in the study found that (1) participants whose diet was high in processed foods had a 58% higher risk of receiving a CES-D depression rating five years later.  The study does not prove that a processed food diet causes depression, it simply shows an association or a link, it could be, for example, that people who become depressed become inclined to eat more processed foods or that there is a yet undiscovered factor behind the association.

However, the results of this study show a strong association and are interesting, when added to results from several other studies there is certainly a suggestion that a healthy diet does protect against mental illness.  Eating a high quality, healthy and nutritious diet is important for overall health an wellbeing.  Vegetables, fruits, beans/pulses, unprocessed meats and oily fish are important components to consider.  If you are concerned that your diet consistently falls short then you may wish to consider taking an omega 3 fatty acid supplement together with a good quality food-state multivitamin and mineral supplement.  It is important to be clear that supplements can never be viewed as a replacement for a healthy diet.

(1)Akbaraly TN et al.  2009.  Dietary pattern and depressive symptoms in middle age.  The British Journal of Psychiatry.  195:408-413
Written by Ani Kowal